HomeMy WebLinkAboutSWG2024-00348 - SWG Application / Design - 8/16/2024 HELTON,WA
MASON COUNTY 4/SNBSHELTON: , 0427-97 ,EXT 4
SHELTON:36n-427-9870,EXT 400
eELFAIR:360-275-4467,EX7 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2024-00348
APPLICANT RANDLE ET AL MATTHEW Phone:
Address: 808 KAMAS WAY FOX ISLAND,WA 98333
OWNER RANDLE ET AL MATTHEW Phone:
Address: 808 KAMAS WAY FOX ISLAND,WA 98333
SEPTIC DESIGNER ROD LEFT' Phone: 360-698-8488
Address: PO BOX 2954 SILVERDALE,WA 98383
Site Address: 381 E RICHARDSON RD
Primary Parcel Number: 122187600030
Permit Description: New 3bd gravity trench with Class B waiver
Permit Submitted Date: 08/16/2024
Permit Issued Date: 09/25/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (additional fees may be raduyad upon installation of sntem).
Permit Expiration Date: 09105/2027 (Casedondatedmspentiom)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drainffeld installation not to exceed designed upslope and downslope depth specked on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic DesignerlEngineer installation approval prior to
backtill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masonwuntywa.govlhealthlenvironmentagonsiteloss-inspection-request.php or call:
360.427-9670,extension 400.
OFFICIAL USE ONLY
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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Matthew Randle Z
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808 Kamus Way Fox Island WA 98333 a
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381 E. Richardson Belfair WA 98528
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Rod Left 360-698-8488
HARE OF INST R RMNE p I N
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®NEW GONSTRUCTIDNIUPGRPDES EDREFAIR I REPLACEMEM OTHEROEMIS(a WhOy OTABLE I%RERVR I -I
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®DESIGNFORM(REWIRED) ®SEPTIC DESIGN IREOUIRED) REORC�Ii TOT. r I0)
MWANER(S)OFAPPLICAS E) 3 238,273 sq ft 0 I o
gREGTIONS iO SITEA1q 911E Lgp11O16:(u YCW plf
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OFFICIAL USE ONLY BELOW THIS LINE
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THIS FORM MAY BE SC NEDANOAVAILABLE FOR PUBLICVIEWIXITHE IMEONCOUMYWEBBRE REVI95oIN¢MS
DESIGN FORM—PAGE ONE Assessor's Parcel Number. l 2 2 1 6 — 7 6 — 0 0 0 3 0
A design will be reviewed when 3 copies of each of the following are submitted:
•Completed design farm that has been signed and dated 4 Scaled layout sketch,including all applicable items on checklist
°Sea]ed plot plan,including all applicable items On checklist °Crass-sectien sketch,including all applicable items on checklist.
This form may be scanned and available for public view on the Mason county Web site.M imum parer size: 11"X 1T'
Pernut Number SWG �co Designer's Name: Rod Left
Applicant's Name:
Matthew Randle Designer's Phone Number. 360-66843488
Mailing Address: Designer's
BOB Kamus Way Address: PO Boa 2964
Fox Island WA Mass Siiveniale WA 98383
Ci State Zi I city State Zi
Treatment Device
❑Glendon Biohlter Cl Sand Filter ❑Monts ❑Sand Lured Dreinfield ❑Rir tfletmg Filter,Type:
❑Aerobic Unit Make/Meald ❑Dicafe.Son Unit Meke/Model Other:
Drainfield Type
EdGravity ❑Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank(Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity .110 gpd Length 70 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Took Capacity 1250 gal Nurnbm 3
Receiving Soil Type(1-6) 4 Separation 5 R
Receiving Soil Appl.Rate .6 Spd/fta Orifices
Required Primary Area 600 ft' Total Number of Orifices NA
Designed Primary Area 600 Rr Diameter NA in
Designed Reserve Area 600 Ra Spacing NA in
TrenchBed Width 3 R Manifold
TmnchBed Length 200 ft Schedule/Class NA
Elevation Measurements Length NA ft
Original Dramfield Area Slope 5-8 % Diameter NA in
New Slope,If Altered 5-8 % Preferred manifold configuration used? O Yea ONO
DepthofExcavation Uppaotc in Transport Pipe
from Original Orade Non-aurae Ary in Schedule/Class 3034
Designed Vertical Separation ID in Length 30 R
Gravelless Chambers Required? ❑Yes O No Optional Diameter 4 in
pump Required? Cl Yes IdNo Dosing and Pump Chamber
Pump/Siphon Specifications Number Of doses/day NA
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity NA gal
Orifice xa R Chamber Capacity NA gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity B Total Pressure Head gpm OTimer OElapse Meter ❑Event Cmmter
Calculated Total Pressure Head ft If Time Pump on .Pump off
Comments APPROVED
04
MASON COUNTY ENVIRONMENTAL HEALTH
RET
DESIGN FORM—PAGE TWO Assessor's Parcel Number:l 2 2 1 8 — 7 6 — 0 0 0 3 0
Permit Number SWO
x tir f DESIGN CH
ECHIdST9.'
Scaled Plot Plan Scaled Layout Sketch Crass Section Sketch
1J Test hole locations [9 Drainfield orientation and layout Reference depth from original grade:
21 Soil logs Rf Trenchlbed dimensions and Ef Septic tank
m Property lines critical distances within layout 10 Drainfield cover
19 Existing and proposed wells Ed D-Box/Valve box locations Reference depth from original grade
within 100 fi of property [6 Septic tank/pump chamber and restrictive strata:
m Measurements to cuts,banks,and locations ;9 Laterals,trench bed,top and
i surface water and critical areas R1 Observation port location bottom
❑ Location and orientation of 19 Cleanout location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
R1 Location and dimension of Ef Lateral placement with distance Rf Observation ports/cleanouts
primary system and reserve area to edge of bed Other Information
19 Bmldmgs ❑ AudibleNisual alarm referenced Yea No
1J Direction of slope indicator �6 Scale of drawing shown on scale ❑ 56 Design staked out
1b Waterlines bar ❑ 11 Recorded Notices attached
Ed Roads,easements,driveways, lid ❑Waiver(s)attached
parking ❑ lif Pump curve attached
North arrow and scale drawing ❑ 69 Evaluation of failure
shown on scale bar Non-residential justification
❑ Rf Waste strength
❑ fi'j Flow
DESIGN APPROVAL
The undersigned designer most be notified by insta er a[time ation A Yes ❑ No
Signs of Designer Date
The undersigned bas reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site regulations:
Enviroureental Health Spt;ecialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CO ITION:
✓ The design is stamped"Approved"by Mason County Public Health. CqS 7
The Cristo,Sewage Permit has not expired,the Permit Expiration Date is: t
✓ Dnuafield site conditions have not been altered to adversely affect conditions of design approval.
Please Note: The system must be installed by a certified installer,
unless prior authorization is obtained from Mason County Public Health.
An Installation Fee is required.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
Mason County WA GIS Web Map
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