HomeMy WebLinkAboutSWG2024-00327 - SWG Application / Design - 7/30/2024 MASONCOUNTY 415Nfi SHELTON:B427-960,EXT 400
$HEL AIR:360-27] 670,EXT 400
BE ELMA.360482-5269,EXT 400
Public Health & Human Services ELMA:360-082-5269,EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2024-00327
APPLICANT MOORE AND BROOKS FAMILY TRUST Phone: 619.818.1164
Address: 2251 WILDFLOWER ST KINGMAN, AZ 86401
OWNER MOORE AND BROOKS FAMILY TRUST Phone: 619.818,1164
Address: 2251 WILDFLOWER ST KINGMAN,AZ 86401
SEPTIC DESIGNER JIM HUNTER` Phone: 360-753-1226
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: 100 E WILLCHAR BLVD
Primary Parcel Number: 220055500021
Permit Description: New 3bd Glendon M32
Permit Submitted Date: 07/30/2024
Permit Issued Date: 10/22/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (additional fees may be reused upon mmanabn or aysteml.
Permit Expiration Date: 08/16/2027 (based on data of nspection)
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 Drainfield installation not to exceed designed upslope and downslope depth specified 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 Designer/Engineer installation approval prior to
backfill ofsystem 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: masoncountywa.gov/health/environmentallonsiteloss-inspection-request.php or call:
360-427.9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH
ONSITE SEWAGE SYSTEM APPLICATION ® y
415 N 60ISM1ee (Bldg 8) Shelton WA,98584 40
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ShelW.360477-967OW400 BeRair.36D7754467ed400 SWG
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APPLICANT PHONE > D
STEVE MOORE 619 818-1164 m m
MAILINGACORESS-STREET CITY STATE LPCODE r
2251 WILDFLOWER ST KINGMAN AZ 86401 3
SITEADDRESS-STREETCITTZIPCOCE Qf
100 E WILLCHAR BLVD SHELTON WA 98584 p
NAME OF DESIGNER PM NE IV
JIM HUNTER 360 753-1226 6�\-1
NAMEOFINSTA-LER PHONE Y_
CIECKALLAPPUCABLEITEMS DRIW.INGMTERSWRCE 10
If NEWCONSTRUCTION ❑ RV HOLDING TANK ONLY RIVATEINDMDUALWELL 5 Ill
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❑ REPLACEMENT SYSTEM [3 INSTALLATIONPERMIT ONLY PRIVATETWO-PARTYWELL 2
❑ TABLES REPAIR SINGLE FAMILY [3 COMMUNITYPUBLIC WATER SYSTEM I I�
❑ TANI ONLY [3 COMMERCIAL SYSTEM NAME:
❑ UPGRADE TO EXISTING E3 OTHER: MOROOMS LOTSIZE A{ p h
0 EXISTING FAILURE RWa 3 =Uu -�LL m IU)
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DIRECTIONS TOSRE-BE SPEOFICANDADNSE CFANY NEEDED INFORMATION FORAWESS In.MNeE qbl I I
PICKERING, SOUTH ON E PHILLIPS LAKE RD, SOUTH ON E PHILLIPS LAKE LOOP
a
RD, EAST ON WILLCHAR TO ISTE ON RIGHT. IC
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SREMUSTBEFLAGGFOFNdYWVNRDAOA MSTMOLESMUSTBEFIAGGEDMtMMTHOLENtMBERS
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAIWRESOIRCEINNY NW�
E]VOLUNTARY E]MAINTENANCEPUMPING O BUILDING PERMIT E3HOMESALE E]COMPLAINT OOTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
26 JUL 3 0 2024 D
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SOIL CODES: Qj'D G-,Zy� .
V=VERY G=GRAVELLY S=SAND L=LOPM SI=SIO C=CLAY E=EXTREMELY R=ROOTS
INSPECTOR SIGNATURE OATS ION EXPIRAT APP ION DATE PPPLIGTIONAPPROVEDBY DATE
61 tit0z--) W ift'a
TWB FGRM MAY BE MED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1Y 015
DESIGN FORM—PAGE ONE Assessor's Parcel Number:2�
A design will be reviewed when 3 copies of each of the following are submitted: r
e Completed design form that has been signed and dated. "Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. v Cross-section sketch,including all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Afaox mum papei size: I"X/7"
PARCEL IDENTIFICATION
Permit Number: SWG � Designer's Name: JIM HUNTER
Applicant's Name: STEVE MOORE Designer's Phone Number: 360-T53-1226
Mailing Address: 2251 WILDFLOWER ST Designer's Address: PO BOX 162
KINGMAN AZ 8aa01 OLYMPIA WA 98507
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
'Glendon Biofilter ❑Sand Filter ❑Moved ❑Sand Lined Drimfield ❑Recirculating Fitter,Type:
I Aerobic Unit Makdhladel ❑Disinfection Unit Make/Model Other:
Drainffeld Type
❑Gmwty ❑Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class SCH40
Daily Flow:Operating Capacity ;t 7 0 gpd Length NIA — ft
Daily Flow:Design Flow 3(p 0 gpd Diameter t•1 1„Q in
Septic Tank Capacity (260 gal Number
Receiving Soil Type(1-6) _ 4 Separation AL ft
Receiving Soil Appl.Rate 0.6 gpd/ft' Orifices
Required Primary Area (4 00 fle Total Number of Orifices N/A
Designed Primary Area 0 017 ftr Diameter __ rf�! A in
Designed Reserve Area 9 0 0 ftr Spacing /11 1,4 in
Trench/Bed Width N/A R Manifold
Trench/Bed Length N/A ft ScheduletClass SCH40
Elevation Measurements Length J�7 . 1t
rea Original Drainfield A Slope 0 % Diameter JJ I li in
New Slope,If Altered 0 % Preferred manifold configuration used? ❑Yes ❑No
Depth of Excavation UpclopeN`A'F p N i Transport Pipe
from Original Grade Dowa-abpe I i Schedule/Class SCH40
Designed Vertical Separation VJr N/A in Length 3 o ft
Gravelless Chambers Required? ❑Yes Y(No O Optional Diameter ( in
Pump Required? NfYes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day PER GLENDON
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal
Orifice ft Chamber Capacity 1250 gal
Uppermost Orifice O Higher 11 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity®Total Pressure Head � r f>� � �Iimer fi(Elapse Meter 6f Event Counter
Calculated Total Pressure Head G If Timer: Pump on Pump off
Comments
MASON COUNTY ENVIRONMENTAL HEALTH
RET
DESIGN FORM—PAGE TWO Assessor's Parcel Number.'9a90 5— 5-5— C) d O W _
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
121 Test hole locations EZ Drainfield orientation and layout Reference depth from original grade:
94 Soil logs Trench/bed dimensions and Ef Septic tank
E9 Property lines critical distances within layout EZ Drainfield cover
1Z Existing and proposed wells E9 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Ef Septic tank/pump chamber and restrictive strata:
Cd Measurements to cuts,banks,and locations ❑ Laterals,trenchlbed,top and
surface water and critical areas 9 Observation port location bottom
Fd Location and orientation of ®• Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 1f Manifold placement ❑ Sand augmentation
components Ef Orifice placement Other cross-section detail:
19 Location and dimension of Ed Lateral placement with distance 9 Observation ports/clean-outs
primary system and reserve area to edge of bed
1Z Buildings Other Information
EfAudible/visual alarm referenced Yes No
9 Direction of slope indicator 1d Scale of drawing shown on scale Gf ❑Design staked out
19 Waterlines bar ❑ ❑ Recorded Notices attached
Ea Roads,easements,driveways, ❑ ❑Waiver(s)attached
parking ❑ ❑ Pump curve attached
19 North arrow,and scale drawing ❑ ❑ Evaluation of failure
shown on scale but Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by iugtafl ti,ln . stallation ❑Yes I f No
(/ 7- 30 •a�
Signature ofygiper Date
The undersigned has reviewed this design onbehalf of Mason County Public Health and determined it to be in
compliance with state and local on-site regulations:
Vc�v� /Zy
Environmental Health S 'ahst Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved'by Mason County Public Health. I)b /I
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: Z
✓ 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 required.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/72015
PAGE
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE*. PARCEL*. 22005b5-0002j
DATE SUBMITTED: 0713W4 LEGAULOTR: WILL-CHAR ADD
TO PHILLIPS LK
SUBMITTED BY: JIM HUNTER TRACTS 21,22
APPLICANT: STE MOORE
ADDRESS: M51 WILDFLOWER ST
KINGMAN.AZ 86401
I.CALCULATIONS
NUMBEROFBEDROOMS= 3
RESIDENTIALGPDFLOW= 360
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE 0 6 GPDIF72
REDUCTION=LEAVE BLANK iF NOT USED
DRAINFIELD SIZING
ABSORPTION AREA= 600 FT2
TRENCH LENGTH OR BED CONFIG.= PER GLENOON
II.WATERPROOF SEPTIC TANK
COMPOSITIONANDSIZE= 12-- GAL.CONCRETE
NEW OREXMTING= NEW
III.DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM= WA
ROCK DEPTH BELOW PIPE= WA
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATER EASONAL SATURATION= WA
FILL DEPTH= WA
TRENCH WIDTH= WA
APPROVED
OCT 22 2021 /
MASON COUNTY ENVIRONMENTAL HEALTH h -3D -zY
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