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HomeMy WebLinkAboutADU2024-00011 DDR - BLD Permit / Conditions - 7/31/2024 For Mason County Permit Center use: MASON COUNTY • COMMUNITY SERVICES AM _ 06 Building,Planning,Environmental Health,Community Health Recv'd by: Planner: 615 W Alder St.,Bldg 8,Shelton, WA 98584 Date Stamp Recv'd: Shelton Phone: (360)427-9670 ext 352 ❖ Fax (360)427-7798 ACCESSORY DWELLING UNIT PERMIT RECEIVED (Special Use Permit with AD criteria) JUL 31 2024 615 W. Alder Street Per it and Fee: Special Use Permit (DDR) —application fee: $ � *IfADU is within 200'of a shoreline you must apply for a Shoreline Substantial Development Permit(SHR)—fee.-$880.00 -Environmental Health fee: $ �!6* A "Special Use" is one that possesses unique characteristics due to size, nature, intensity of use, technological processes involved, demands upon public services, relationship to surrounding lands, or other factors. The purpose of this application is to provide for adequate oversight and review of such development proposals, in order to assure that such uses are developed in harmony with surrounding land uses, and in a manner consistent with the intent of the Development Regulations for Mason County; Ordinance No. 82-96. Acceptance of this application by Mason County does not guarantee approval of request. Applicant(s) Name: Mailing Address: 41 e An, 1gr R1 00FOr floc/0 5-,ea AT- Phone:— ��7 7 E-mail: �?'/�/y f/Al 5 P���i 100. Property Owners Name: (if different than applicant) Site Address: 5-17'" -<- Brief Legal Description: 5m 4ceerrra n 61 A- Tax Parcel #: ! -A 9P u Zoning: Project Description: Rev.January 2018 ADUPermit Page I of 4 ❑ SITE PLAN CHECK-LIST Please provide a site plan that includes the following: © Indicate Scale and North Arrow. ❑ Property line dimensions, easements, and right-of-ways. Q'The location of all existing and proposed structures. Include square footage of existing and proposed structures. ❑ Setback distance, in feet from all property lines and structures. ❑ Existing and proposed road access to and from the site. ❑ Parking spaces. ❑ Location of OnSite Sewage System (OSS)components (including tanks, drainfields, reserve areas, etc.) ❑ Location of existing and proposed wells,within 100ft. of property, shown with 100ft. radius. ❑ Location of existing and proposed waterlines. ❑ Steep bluffs, wetlands, streams, and bodies of water. ❑ Surface and storm water run-off routes. Mason County Code Title 17.03.029 requires the following criteria to be met for consideration of an Accessory Dwelling Unit (ADU) Permit: ACCESSORY DWELLING UNIT(ADU) REQUIREMENTS YES NO INFORMATION 1. Is the ADU in a shoreline jurisdiction? Please inquire with Mason County 1 a Are you in the Flood Plain? ❑ Community Services staff, if unsure. 2. Will the owner of the lot reside in either the principal residence or the ADU? 3. Will till the ADU be located on the lot of the principal El El or be a conversion of an existing detatched structure (i.e. garage); 4.The ADU shall not exceed 80%of the habitable area of the primary residence or 1,200sq feet,whichever is smaller.An existing residence can ❑ be converted to an ADU with the development of a new primary residence, the ADU shall be no more than 80%of the area of the primary residence and up to 1,500sq ft.Will your proposed ADU meet this criteria? Please inquire with Mason County 5.Will the ADU meet all setback requirements? I Community Services staff, if unsure. Please see last page of this packet 6.Will all applicable health district standards for water and titled"ADU Environmental Health sewer be met by the ADU? Requirements' Rev.January 2018 ADUPermit Page 2 of 4 7. Recreational vehicles are not allowed as ADUs. Please I�`I confirm (with YES)that you are not submitting a �J Recreational vehicle for review. 8. Your property will only have one 1 ADU? 9.You have provided an additional off-street parking space for the ADU? (Ord.108-05 Attach B.(part),2005) ❑ On a separate piece of paper(#of pages: ), state your reasons for requesting an Accessory Dwelling Permit and be sure to address the following six criteria. Your request will be evaluated based on these criteria and the Accessory Dwelling Unit Requirements from the previous section. 1. Will the proposed use be detrimental to public health, safety, and welfare? ,.I1/a 2. Will the proposed use be consistent and compatible with the intent of the Comprehensive Plan? �e-5- 3. Will the proposed use introduce hazardous conditions, at the site,that cannot be mitigated through appropriate measures to protect adjacent properties and the community at large? /vre o 4. Is the proposed use served by adequate public facilities,which are in place, planned as a condition of approval or as an identified item in the County's Capital Facilities Plan? 111e5 5. Will the proposed use have a significant impact upon existing uses on adjacent lands? lv� 6. If located outside of an Urban Growth Area, will the proposal result in the need to extend urban services? Applicants Signature � Date Rev.January 2018 ADUPermit Page 3 of 4 MASON COUNTY CPMUNITY SERVICESOMning.Emi I a Health,Con,m,.n;ty Heefth ADU ENVIRONMENTAL HEALTH REQUIREMENTS YES NO INFORMATION ��yy,�j 1.Will the ADU be served by an EXISTING Onsite Sewage System(OSS)? (R 0 f�Z 01 `W 193 3-���^""" OSS's are sized off bedrooms. y2bdSFk Refer to the onsite sewage records L�71 1(a). Total bedroom count from existing and proposed connected structures on file with Mason County to find match the approved OSS records on file? 0 your OSS approved size. If bedroom count exceeds system size, contact a licensed septic designer for upgrade options. OSS application and design permit 2. Will the ADU be served by a NEW Onsite Sewage System(OSS)? must be submitted and approved 0 (RY prior to EH approval of ADU ermits -Foundation to Drainfield(s):I Oft -Foundation to Reserve Area(s): loft 3. Will the ADU meet all setbacks to new or existing OSS components? Q -Foundation to Septic Tank(s): 5ft Down gradient Foundation/perimeter drains must aintain 30ft to Drainfields. Attach a signed Sewer Adequacy 4. Will the ADU be served by a NEW or EXISTING sewer connection? Form from Sewer System Manager to this application. 5. Will the ADU be served by a NEW or t�l public water system Attach a signed Water Adequacy Form from Water System Manager (over 3 connections)? to this application 6. Will the ADU be served by an EXISTING private well? Well must be permitted and 7. Will the ADU be served by a NEW well that is not constructed yet? constructed prior to EH approval of ADU permits. Mason County Code Title 17.03.029 requires EH approval prior t6 approval o ADU permit. Environmental Health Review Pre-approval: Comments: @VO4 40V t� ti APPROVED 6 4m k� �� a AUG 2 0 2024 r vNm q 5VH , MASON COUNTY ENVIRONMENTAL HEALTH DJA O0/i (EH approval stamp with Initials of EHS) t Min Cr�?rCivn�s)., 3 �edrPo� Sryo�� S jets' 1 baloom #1Od - Z pair,0,0t7 �F2. ADUPermit Page 4 of 4 - RECEIVED �A�U�a02�,yaoCb �� r JUL 31 2024 615 W. Alder Street WAT - A S O N COUNTY 415, Street Shelton,WA 98584 Shelton:360-427-9670,Ext.400 Public Health & Human Services Belfair:360-275-4467,Ext.400 Application for Determination of Water Adequacy Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water connection utilized. 3. Submit completed application with any required attachments for review. 4. An approved building site plan must accompany this application. Part 1: Applicant/ Parcel Identification Name on Applicant: /7/c/t,J6L A*4R.k&1'jr- Date: Mailing Address: if/r Al" P I;6 L, Phone: 33N" Parcel Number: 14 ZZO/! T 90(W4*1 Type of Water System Reason for Application ;9r Public/Community Water System (2 or more ®' Building permit connections) ❑ Division of land: ❑ Individual water source (one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ Other(explain) ❑ Replacement or Remodel (please indicate name If you have more than one residence connected of water system below if applicable—no to this well, check the Public/Community Water signature required) System box. Part 2: Water Connection Information e#(h.A4JT /eAr Ld m� Complete the section appropriate for the type of water connection being evaluated: Public Water System Name of Water System: Water Facility Inventory (WFI) Number: A Q 519 (write"none"for two-party) $0 -P9 I am the mans er of this water system. The water system has b en a poved for services. There are presently connection(s) in use.This will be the connection. ❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this (these) connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Print Name of Water System Manager 1 �tiYlr?-A a �c 4 V7n�� Phone ;d 0^11o_C)Zn Signature of Water System Manager �-.�- Date This form may be scanned and available for public view at www.masoncountywa.gov J:\EH Forms\Drinking Water Revised 05/08/2024 Page 1 of2 Group B Water Systems ❑ Satisfactory bacteriological test within last year(attach to application). Individual Water Well ❑ Water well report(attached to application). Depth ft. ❑ Well capacity Test(attached to application) gpm gpd. The well driller often performs well capacity tests at the time the well is constructed. Results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test, a well capacity test, which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. ❑ Satisfactory bacteriological test within last year(attach to application). Individual Spring/Surface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ 1 have reason to believe that this water source can provide at least 800 gallons per day; and/or provides water at a rate of 2 gallons per minute based on the following observations. Author of Statement Date Relationship to Applicant Part 3: Mason County Community Services Evaluation (staff use only) Satisfactory Determination: This determination does not address adequacy of the distribution system, guarantee an adequate supply of water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations. Recommended approval indicates requirements of Sanitary Code, Title 6, Chapter 6.68.040-Determination of Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter 36.70A RCW. ❑ Unsatisfactory Determination: Applicant's water supply does not appear adequate to meet the needs of its intended use for t*-ollowing reason(s). oy �� qG Reviewer's Signatures: C Vlfll*10�'nfi 9 Environ. Health: Date / v � y This form may be scanned and available for public view at www.masoncountywa.gov Page 2 of9 l�ti _--, SPECTRA Laboratories - Kitsap ...Whers u erience mottert COLIFORM BACTERIA ANALYSIS FORM Date Ssrpple Collected Time Sample County Collected `? oy' zy : o Mason Type of Water System(check only one box) ❑Group A O-Group B ❑Other Group A and Group B Systems—Provide from Water Facilities Inventory MFI): ID# A175$`I '? . System Name !3 Contact Person v� Day Phone:(3610-4 b a Z/ Cell Phone:(360, Ernall ggWasaaepud4.)rg Eve.Phone:(360`' RPM mtnnc in,rpm ful name,address and zip code or small above for ela4ronle ropy of reeulb) b. a i ►1 SAMPLE INFORMATION Sample collected by(name): ! �S Specific location wheie sample collected: Special instructions or comments: -To° Type of Sample(check only o he box)- 1.❑Routine Distribution Sample(AIP) I❑Repeat Sample(AIP) 11" Chlornated:Yes [I No Elgromdistribullon systemafter unsat routine) Unsatisfactory routine lab number.Chlorine Residual:Total_.Free3.Ground Water Rule Source SampleUnsatisfactory routine collectdate, 5 —J.—J Chlorinated:Yes No ❑Triggered (A/P) Chlorine Residual:Total_Free b ❑Assessment(AIP) 4,Surface or GWI Raw Source Water Sample(Enumeration) I ; ❑ E coli ❑Fecal laferad Yee—W— I l 5,®,ample Collected for Information Only: LAB USE QNLY DRINKING WATER RESULTS tA USE ONLY ElUnsatisfactory Total Colifolm Present and Satisfactory 11 ❑Ecofipresent ❑Ecolabsent .Bacterial Density Results:Total Coliform mpn1100ml.Ecol mpn/100ml. Fecal Colifortn cfu/100m1. l Replacement Sample Required: ❑TNTC ❑Sample too old j ❑ Sample Volume ❑Damaged Container ❑ I a Lab Reference Nu Receipt TempC': Method r OUNTISM92240 IJ .L I l 7Na npathywderytpMuwdar paaona000poelb i O�eReported MmItbwnrd Any oka** ftd a'ere.neym JUL 25T n woudarbei y. nPhisr.eport in DOH kah-sample# W�OK4� ihau r..perih.gb er have�rae r Apr r.cvhedhr MhEa.M r apW�hY aib•kabmWO.. j oa,pee.ae,a,a I.aeeee.an>! � � • I A�LK90 2 Y- Ono Spectra Labs - Kitsap, LLC (Poulsbo) SPECTRA Laboratories -Kitsap 26276 Twelve Trees Ln NW Ste. C ...Where experience mWters Poulsbo,WA 98370 Phone: (360)779-51 1R E C E!V E D www.spectra-lab.com JUL 31 2024 615 W. Alder Street Spectra Labs- Kitsap,LLC (Poulsbo)received samples for TJ Goos on Wednesday,July 24, 2024 at 4:40 pm. Unless otherwise noted, all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures. A summary of the samples received are outlined below. Sample No. Description Location Sampled 242345-01 Sund Wellhouse 07/24/202410:45 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call (360)779-5141 or email us at www.spectra-lab.com. Attachments 01) This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 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ADU / f a 01 Wo.1a Q S—F— r MEMORANDUM fpn0 1/2'roar of h M LS VW53 M \ ■ ■ por rNnonee wrwy I 1(4-24-X2/) 1 dP� SCALE 1'_20 FEET �d 0 /0 20 10 SOS S • ■ $ °Co I ■ Alai H Cab N twntnpe Ydeen fkinb SAart A�fb4s�Ila JOq a sgft N 9�art Flab rt/p�t0.Lpsab N Ysa ■ \ rag � • sarwA aamr s nW W /�,� ■ Set 2'r 2'wood hub!bth / Os Sdptb tads '•' CO S'ptb deawr / •y^• Op Pew wdt .�. L•_ .� •'g. ® power MW Water To a :ti �/ ❑T Phan pdeetd Sewer From Cabin 'r • s°''0i OL'",4 • 4 O CO D9 IMebr Volvo ♦ W ..'•� .ram� /. ON Water nuhr i i... llrN)wd buMp enNkq •• : r)1111.!W w PLS IUM Coot 4 N SP,pope It(2012) QCS day Labe 13 rJ i'�•' o �. (oo+po'w7 robetb tote dat h I M survey nMe ar a needs Wsa4len rwprtwm�rb a M forth CAC 371-130-M •.s.• sty Dood —ded wWw AudRar'e fN Mm1ar 2t000C1, '�. Rsaerde N Yeron Comb;CWNgfon. �• found Ilr now with asp LS IMW co Psr to- survey 1 1(4-24-2020) MEMORANDUM ADU N SCALE 1" — 20 FEET 0 10 20 40 288 sq ft Parking w \ 1 d • \r A MEMORANDUM * KLUcivCu UOOI� JUL 31 2024 RECORD DRAWING (ASBUILT) pg. 1 615 W. Alder Street MASONCOUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG aC) C 7 —C)0(q 3 Assessor Parcel# Z 201 Applicant Name 3/rAq sartC4 Subdivision (Name/Div/Block/Lot) Applicant Address PO L4 3 :1 City, State, Zip 1-tn=j 1-- 9pS�S' Installer Name 7J la o0 5 Site Address 5.P. 3oy7 L j-., - Designer Name INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type 6-1�Ry'' -j Pretreatment Type >5 ft.from foundation? -- ---------- - ------- - - RN►A ❑YES ❑ No Z >50 ft. from surface water? ----- --- -- - - - - - - -T [yR El Cleanout between building and tank? -- - 3 ❑ ❑ V Tank baffles present? - - - --- -- -- - - -- - - - - _ �] 0 El a24"access risers over each compartment?- - -Ba( -- ❑ [ ❑ NEffluent filter installed?---- - - ---- - - -- - - - - - - -- - ---- ® ❑ Septic tank size 1250 gal Manufacturer 1j!nf---xct v-N O D-box water level and speed levelers used? -- - - - - - - - - - ---- ❑ WA 0 YES ❑ NO 00 Manifold/D-box accessible from surface?- - -- - - - - ---- - -- --U. ❑ ® ❑ mZ Check valves installed? --------- - -- - --- - - - - - -- - ❑ El�2 Transport Line Size Schedule/Class Bedrooms installed(check one) ❑ 2 a3 ❑4 ❑ 5 ❑6 ❑CommerciaVOther >10 ft. from foundation?----- ---- - - - --- - -- - -- - -- - - ® N/A ❑ YES ❑ No 0 >100 ft. from wells?----- ---- ---- - -- --- - - -------- ❑ ® ❑ W >100ft.fromsurfacewater?--- ----- - - - - - -- - - -- ----- ❑ ® ❑ Z >10 ft.from potable water lines?----- --- - --- ---- ------ ❑ ® El Z >5 fL from property lines and easements?- ------- --- ---- - ❑ Im ❑ > 30 fL from downgradient curtaintfoundation drains?- - - - ----- - ❑ 0 ❑ Drainfield level and observation ports present --- - - -- - - --- -- ❑ ® ❑ ❑ Graveless chambers or ER Clean gravel used? (check one) Proper cover installed over drainfield?---- - --- - - -- ----- -- ❑ El ❑ Pump tank setbacks consistant with septic tank?--- - -------- - ❑ N/A ❑. YES ❑ No ZPump tank size gal Manufacturer Q 24'access riser(s)and accessible from surface?-- -- - - ------- ❑ ❑ dAlarm or Control Panel Installed? ----- - --- - -- - ------ -- ❑ ❑ Control Panel equipped with Timer/ETM/Counter- - - ------ -- ❑ ❑ IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other MPump Make/Model ❑ Floats or ❑ Transducer 0=. Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd UpdabdiWrM5 MEMORANDUM MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 42wt - i3- 96 4 ct RECORD DRAWING ❑ Drainfield&manifold orientation&layout w/dimensions for re-location. ❑ Trench/bed dimensions and critical distances within layout ❑ Septidpump tank placement ❑ Location of buildings existing/proposed ❑ Observation ports, clean-out locations, &marufolds/d-boxes ❑ Location of wells, surface water,roads, &waterlines. ❑ Reserve area(s) ❑ North Arrow If the designer or installer feel the need for additional information/comments,it may be attached. Record drawing may also be on a seperate page attached. No.Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped'APPROVED"by Mason dance with the septic design stamped`APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been clearedlapproved by both the designer shown here have been clearedlapproved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all information contained on this form and attached ecord Drawing is accurate. form and attached Record Drawing is accurate. ��— I?-/7 Signature of/nst ller Date ` —,� (ADo5 Printed Name of Signee MASON COUNTY PUBLIC HEALTH r The undersigned approves this Installation Report and 3 Record Drawing on behalf of Mason County Public l ' Health: ` Signature Environm n al Health Specialist Da Fe (designer's stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UP"°d ivr2o" MEMORANDUM Sp 3047 Lopl- �' � 9 zzol-i3.90 44 t APPROVED MC PUBLIC HEALTH AUG 1 1 2017_ ti r� - 1 R14a 1 � � ys Z oa, MEMORANDUM 415 N 6TH STREET, SHELTON WA 98584 MASON COUNTY SHELTON: 360-427-9670, EXT. 400 COMMUNITY SERVICES BELFAIR: 360-275-4467, EXT. 400 ELMA: 360-482-5269, EXT. 400 r►aab� FAX: 360-427-7787 July 31, 2017 Brian Sund PO Box 477 Hoodsport WA 98548 RE: Design for SUND Case No: SWG2017-00193 Parcel No: 422011390441 Your on-site sewage system design for the above referenced parcel has been reviewed and is APPROVED. The system must be installed by a Mason County Certified Installer. A list of installers is available on the Mason County Public Health WEB page at www.HealthyMasonCounty.org Select Environmental Health, then On-site Sewage Systems. In some cases, homeowners may be allowed to install their own system. Prior approval by Mason County Public Health is required. Please refer to the comments section of this letter for any additional information. Please call me at (360) 427-9670, ext. 279 if you have any questions. Sincerely, Alex Paysse Environmental Health Mason County Public Health COMMENTS: 7/31/2017 Page 1 of 1 SWG2017-00193 OFFICIAL USE ONLY MASON COUNTY PUBLIC HEALTH wm ONSITE SEWAGE SYSTEM APPLICATION AVOWREaMM o IS 415NObStreetftq SheltonVKMM qa2 _ cc Snatm o,W 967oaa400 Bevil 36a7T5 4I67ext40D SWG om - GoM o o Om 2 to APPLICANT r PHOlE f AA b tay. vnd 3l00 4go . �� S�i m MAAODwm-STI=T.CIO.$TAIL 2P CODE f _ LNO .U• �'I� ao z or� 4, 9 S� 'd ; 8MA0DMM-8TREEf:cm.zPc0w M NNE OF DESWNER 1 360. 4'Io•Z-7 57 A NAME OF IISTALIM PHONE N C�wy et' SGD�4QD 2Z5`7 � r cmm&LmvucABI.E ffEW DAlitlK3 v1/ATFft SOURCE p NEW CONSTRUCTION O RV HOLDING TANK ONLY O PRIVATE INDIVIDUAL WELL. cc � �] REPLACEMENT SYSTEM 0 NST&LATM P&%W ONLY E1 PRIVATE TWO-PARTY WELL Z A (] TABLE 9 REPAIR 11(SINGLE FAMILY Vf COMMIprITYARWUC WATER SYSTEM� j)� C Q TAW48)ONLY E1 COMMERCIAL SYSTEM NAME: 1-,WAG j/it�Lti1/k1dt r .A (] UPGRADE'TO DUSTING El OTHER BEDROOMS LOT SIZE .P.0 OUSTING FAILURE � 6 G.G v C S w OMIECTIONSTO STIE-BE SPFCMAMAMFM OF ANYNEEDMMFOIUtgM FORACCESS(-wdo.eyoW R H wY Im$ N, fip Su:s+1v01 S. 45-IC PAP. 336 4vrr- L e"'C+ fo `To Vear fZ `t6 S:k&rp L 4606u-j tO 'O -I sena+rlASTaErtAoaec,efaw wlwRouoAND n�erMOLeswus►elrAtwer�TeaT>rDta>ruMeeAs OFFIQAL USE ONLY BELOW THIS LINE Lr6K4kDE!FALURE SOUPoCE pr apa I PA—) 13 voLumuRy LjmAwTEmANcmxunNG p BUI.DwG PERMIT [(HOME&ALf 13COMPLANT OOTHM N48PECTOR am Loos COK§EWM/CONOIIIONS M� X Z - c�0 G,G� Sit OLCoosa; V■V8W apliLLY S=SNO L=UAM 81=SS-T C=MAY E=EXIRE6ELY R=ROOTS GATE APPLICATION E]fPROM DATE BY DATE '1 � a 'Zlo 2020 7 31 1l nlTMF0WI8XCAWiWAWkWFOR plim IIAWN COUNTY VIM ITE RE1AeED 17Rt]A16 DESIGN FORM-PAGE ONE Anessoes Pared Nctm*et.A 0 4 4 l A design Wi be raflewed whew{ggpin of eneb of the foomwiaR are s btlkhNft ''•C mpkted design form that Les boom signed and dated. Scaled layart dwt*including all applicable items an checklist Scaled Plot Plan,including all applicable items ow checklist. -1 Crou seam sketcb,indudinS all applicable ileum on checklist- view some web sow.lldaorlwtan pwsrshw 11"X 17" MRWU•, Permit Number: sW%gO j7' Q I Designer's Name: r i0.r• ��•• Applicant's Name: *Rr,+, ��.�,. Designer's Phone Nam: `f 6(J•49�2'L S�j Mailing Address Pn&41*I Designer's Address: 13a a 4`1`1 140As -r, ,Cky gg5'4$ oat�,oerf j�tl�. QyS'� gtIft zip city ---.--- stole Treaftmew Device •Glendon BnoBltes Q Sand hiller D Maud 0 Stud IJoed Darsfield D Racsrasisilog Filter.Type: •Aerobic Unit MabAiodd ❑Disinfection Unit MakwMadel Dl-i a %- A Gravity ©Press= D Tr=* � Ased o Sob Suut$Ce Drip Septic Taah/ dd Sped6estim l AtUl is Number of Bedrooms ScbeduleX3ass Daily FWw Operating Capswty 'IA O gpd Length 4 S ft Daily Flow:Design Flow 3(a 0 gpd Diameter 9' in Selltic Tauk capacity I-Lo o gall Number 3 Receiving soil Type(1-6) 3 ft R ooeivimg soil AppL Rue .'¢ SAW Ori6oes Required Square Footage 4 SQ f T D dped Square Footage fe it► Percent Reduction Taken •— % S V/- in Trench/Bed Width I U R Msnffedd TradvSM Leargth gs 4'rj R Seheduiexim afton 11SeattnrwseaRsLengthCrr R Original Dtainficid Arse slope � �j- J % Diamdw 4 -in New Slope,If Altered % Prefood m enifold eonfiguratk m used? 11 Yes 19 No Depth of Ewavation B in Trm"rt Pipe f m Original Grade.. Da...1W i .g in Schedule/Class ...�.Y Designed Vertical Separation 4� in I ft Graveliess Chiunbers Regcrired? Dyes 0 No !ft Optional DW meW ¢ in Pump Raped? o Yes KW Dedog and �/Put�mp Chamber P ea Number of do�day P y 1,4 Diffaence in Elevation Between Pump Shutoff and UppaTaost Done gwmdty 801 Orifice ft Chamber Capacity gale Uppermost Orifice D Higbar 0 Lower then PUMP Shatoff Pump controls:Please check those required. Capacity @ Total Pmesure Had gin OTmser GElspse meter ❑Event Counter O dculated Total Pressure Head R U Timer: Plump on ,Pang off Coa"en's TRENCHES NOD THAN: UPSLOPE DOWNSLOP DESIGN FORM—PAGE TWO Assessor's Parcel Number: Permit Numbs- SWG Sorted Plot Plan Layout Sketch Cron-,section Sketch lo Test hole cations j Drainfield orientation and layout Reference depth from original grade: I>lt Sod logs Ir'c ritical tank IX Property lines Diainfield coves 10 g and pmp�wells I>-Haa/Valve box loaWm Rofereace dcpdi from original grade within 100 ft of property l�Septic taok4wV chamber and restrictive strata: Qd Measummerts to cuts,banks,and loons Or Laterals,trtnchAwd,pup and surface water and critical arras lr3'Obwmdion port location bottom )!�l Location and orienuf n of JW Clean-out location Guetam drain collator curtain drain and all abeogdon Manifold placement Sand augmentation. Components Orifice Placement Other on detail: �j Location and di nwsion of placementPlAteral with on pocta/clean-oats Primary system and reserve area to edge of bed Other Information 'O Buildings l�Aaxhb arm rafer+enood Yes No ¢u Direction of slope indictor �Sak of hewn on sale J2( 0 Design staked out t� Waterlines bier 0 0 Recorded Notices attached Roads,easemcuts6 driveways, 0 0 Waivea(s)attached Puking 0 0 Pump curve attached It North arrow and scale drawing g 0 0 Evaluation of f dure shown on scale bar r No>i- estW jmn EXRM00 Wade strength s=i t 0 0 Flo The undersigned designer must be noted by' time Ayes 0 No 7 Signature of Designer Dhe The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be m compliance with state and local ono: Health CAUTION: DESIGN APPROVAL 18 VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health. ` ✓ The Onaft Sewage Permit has not expired,the Permit Expiration Date is:�.J�)!. j [. ;p 1 7,02 C) ✓ Drainfield 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 ' ,ed- 71ds form may to saMned mW a- -0.1h1e fror pubEC vim on uw Mason CouMlr Web aftm Updmd> l2naw 1 h_ • s i...•..-__.-----....,.._._.-._..-_.__-..__.+..-.._ -_..-...._--. --r-_._..___..-_._..,.+..__.,..__.:---;-- !--�---4'--"'_---tom_ �---•-__.. .-_i_._.._ _ ' 1. ay:out �bl ��� Q POP 'o 3 +o rAw GO Op v fie; Yq r l�dvs e fio T.aw►< t/S e yt A l ��.E.. TA,v�c i f ,��� j ! ! I I I �-1_ .I. ._ ... �_.. ' _ ..i._.I�.>�!►.�,ti,.l rl�.�r,.�'u.� ���� ► ;--.. ; 1 . ! I i .; ,. _ � j _ ;. I I � i ! !. ! i ! i- ..�. .. ! . .. J_ _.` ...! . i ��eV• .�!� .,.�:�.t .' .. I ..I .__I..._I+.._..! . . J. .. I . ..I� .� �.. _ I , ; ! . 1� .. i . I _,..i.-- - ! I I I , i _ I_. . ��_, . .1.._. �,gl. _� --�#"z;-I-B�i� , I �, I t I I i •� i -i I t ! �I I ! I ► I I. f. � I I I � ---I I i t . i f LA ol I i ; i + I I• / I 1 I ' I � I � � I I I 1 I ! .. �... .._. '' i, r. G�j� .�4r�.►�- .- 1 I __I �_...c ._ i--- --- •� �! I �. _.,. I... .{ • i I I . . ! �I�-- i2 s��rc. � n�o�{� �� � I I � t 1 �' 1 i I�� j 1 I - _ ( i .i i . .L.. ., _. 1_.. � _ .I . .i j i:.. !_... l..._ ! �,• 1 � i i I 1 I I 1 ! ' . � I ! ! � . `• ..1 ...! . i. I .� !.. + � � _..� __.� ..� .i 11+ �.al�sr ! ! .. .I i I I i I { II � � � j ! I i i ( j ( .j. .i. . l .I !. i. , ! I j ► � � l i I I ! 1 , I I i 1 ,t_ ' ! ; t .� I ! 1 i i . , j �' � ; � .I i i ! � � I i • I I � ! � ' I i j 1 1� ff I ._a Conslructeon Notes For Gravity Septic System 1. Install drainfiield ditches with contour of grand. Keep ends level. 2. Keep 1/4 inch per foot fall from house to septic tank. 3. Keep IA inch to 1/4 inch per foot fall from tank to pump chamber or drainfield. • 4. Observation ports to eadend from final grade to drain rock and original ground interface. 5. Always use T to T type construction 6. Fdw fabric required over drain rock. Ifslram rock.ectends above natural grade,run fiber&bnc at least 2 inches down the travch wall. 7. Divert all storm water and run off away from on-site sewage system 8. Install drain6eld during dry weather conditions. Avoid smearing. Any must be eliminated_J�y hand rafrinS i 9. Inspect septic tank every 3-5 years. Pump septic as needed. 10. Install risers to anface on all openings on septic tank. 11. Deviation from this design without prior approval fim the Designer and Mason County Heakh Department will make this design mull and void. 4 g .EXPRWCPO--1—jS RUC j ?O ,y ip MEMORANDUM /70-�;� * `gym. �1�uaoa4-oob Hill HIM N��IIIII��IIII�� 'ECtIVED JUL 31101V , ,. Amer Street ab CF--A 1 L 31 2024 street PRELIMINARY DESIGN ^ aE ————— — — — — — — (/ ! n n n n n n ' ^ Lo g ---- --- - ----- L J rn � II---- - - -- � Y€ < -J ._:::_YTiJltiIIIIIIIIIII1IIIII t IIIIIIIIIIII1IIIIt i Itsr,EIYwI�lr1w_III IIII1 COUN''._—T r;:E----�R-..�4lIIIIlIIIIFilI1-1'yi"III4jIIIII1trI-�e•-VI.A,:-ii.`.'iili 1IIIIF[(IIIIII1IIIIIII�i'YIIlIIILIIII1IIIIIIIii—E �7j—TIIIIIII1III'iII1IIIIIIIIIIIIII1 IIIIIIIIIII IIIIIIIIIIII- DESK- 1I '•OI�#II Q V�o � Q�C(p=�p�N��nL a�nLLo"E��Fna�af�5e`r�.f€. frE��Ea3ioLIVINGIIH=1 1 1 FLEXI ROOM KITCHEN LIJ Q iI PRIMARY Qal8 BEDROOM 11 II ; II V1 C7 wN F- @ Z REF ---_JJ_ ___11 _1 J, I � F EEIEQO O NTRYI PRIMARY PANTRY BATH WIC MUD RM 1i II MEC I SHEET DESCRIPTION: s B 110NER I O 4•w.T I ■ ■ 6_ vH BENCH TUB — _ m I FLOOR PLAN L — — — — — — — — — — — — — — — — — J L — — — — — — — J 1,665 SF NCRB1 DATE OF ISSUE FLOOR PLAN 29 FEB 2024 SCALE: 1/4'-V-0' REVISIONS: FABCAB PROJECT NUMBER: 2207 A1 .2