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Home My WebLink AboutSWG2020-00335 EXPIRED - SWG Inactive - 7/16/2020 415 N 6TH STREET,SHELTON,WA 965M MASON COUNTY SHELTON:360427-9670,EXT 400 a F� 360427-7787 COMMUNITY SERVICES eEELMA 360482-5269,EXT400 ELMA:360-0625269,E%T 400 ENVIRONMENTAL HEALTH REVIEW OF OSS APPLICATION THOMAS WEAVER PO BOX 564 SEABECK,WA 98380 Applicant: McMAHON BRANDON Parcel Owner: McMAHON BRANDON Site Address: NE Haven Way Primary Parcel Number: 223307700030 OSS Permit Number: SWG2020-00335 Permit Description: NEW SFR-41311-Gravity wl waiver Permit Submitted Date: 07116/2020 Permit Review Date: 07I31I2020 The above mentioned Onsite Sewage System Application was reviewed by Environmental Health and found more information is required. Permit final approval pending fling of the attenuation zone recording for the waiver at the auditors office. Please email me at jwilmoth@co.mason.wa.us with the auditors filing number to receive permit approval. If you have questions or concerns let us know. Sincerely, Jeff Wllmoth 360.427-9670 E%t.543 jwilmoth@co.mason.wa.us \ / l�N OFFICIAL USE ONLY MASON COUNTY PUBLIC HEALTH M E -1 ONSITE SEWAGE SYSTEM APPLICATION AMpNlXE D C y 415116th StEE0ld981 Shekonw1,98584 �, N Shehon:3%477-%70W400 khir360-9754467Mt400 SWG O 030 y033a,_�G MPLCNR PHONE ZZ y9 D A Brandon McMahon 360-275-6293 m m MMLINGAOORESB-STREET,LITV.SPTE.2M000E r 221 NE Haven Lake Or; Tahuya, WA 98588 C 0 3 sNEAOOREss-srREET cm'.zrofAOE p, m NE Haven Lake Dr Tahuya 98588 z WMEOFOESKINER PHONE z IN A Thomas Weaver 360-830-5308 o IN NAME OF WSTALLER PHONE P N LHELKAU.MPLILASLE RIMS DUNNING VNTER SOURCE I� NEWCONSTRUCTION 0 RV HOLDING TANK ONLY ❑ PRIVATE INDIWDUALWELL w Iw ❑ REPIACEMENTSYSTEM 0 INSTALLATION PERMIT ONLY PRIVATETWO-PARTYWELL 0 ❑ TABLE 9 REPAIR ❑ SINGLEFAMILY O COMAUNITYIPUBLICWNTERSYSTEM I p ❑ TANKI ONLY 0 COMMERCIAL UpgmdeeXlsdng SYSTEM NAME. I 0 UPGRADETOEXISIING 0 OTHER: MOR'7NE LOT SIZE IV 0 EXISTING FAILUREereDi'N^�'E 4 5.11 Ape m v btlMWYMF' DIRECTIONS TO SITE-SE SPECIFICAHDAWISE OFANYNEEDED INFORMATION FORMCEW(m Nb'JSM) 0 Take Belfair Tahuya Rd to NE Haven way 10 Turn right onto NE Haven Lake Way Ip Turn Left onto NE Haven Lake Dr Go to 470 NE Haven Lake Dr and look for new driveway with blue and pink flagging ro Ip Take this driveway back to 330'z to another set of blue and pink ribbons to the lot iW SIZE M/SrBE MGGEO FRpI rANROAD AND YESTIKKES MISTSEFLAGBFO WTm iEsr NOIENMMBERs O OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE SOURCE ft�yvM9WPMMl DVOLUNTARY OMFINTENANCEMUMPING OBUILDINGPERMIT OHOMESALE DLOMPINNT CIOTHER' INSPECTOR SOIL LOGS LCMIENTSICONUITNN6 SOILCODE9: V-VERY G-GRAVELLY S=S D L=LOAM N=SILT C=CUY E=EXTREMELY R=ROOTS NSPECTpt NATMiE GATE APPLW'ATNIN EXPMTN)H METE APPLICATION APPROVED eY METE �- �7- Li(� 7-71- THIS F M NWBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBS&E REVISED IWMIS FApplicant'sName: ESIGN FORM—PAGE ONE Assessor's Parcel Number: Q 2_3_3_0-- IT -- QQO—GO sign will be reviewed when 3 conies of each of the following are submitted: pleted design form that has been signed and dated. v Scaled layout sketch, including all applicable items on checklist ed plot plan,including all applicable items on checklist v Cross-section sketch,including all applicable items on checklist. Thin form maybe conned and available for public view an the Masan Web site.Marlmum r size: 11"X 17" PARCEL IDENTIFICATION it Number: Swck;i � (.(j, —7 Designer's Name: Tom Weaver BrandonMCMahon Designer's Phone Number: 360-830-5308 ng Address: 221 NE Haven Lake Dr Designer's Address: PO Box 564 Tahtfya, WA 98588 Seabeck. WA 98380 C' state Zi C' state ZiDESIGN PARAMETERS Treatment Device ndon BioRlter ❑Sand Filter f�0 Mound O land Lined Dramfield O Rcci¢ulating Filter,Type: ❑ Aerobic Unit Makc/Model ❑Disinfection Unit Make/Madd Other: Drainfield Type jP Gravity ❑ Pressure W Trench ❑ Bed ❑Sub Surface Drip Septic Tank/Drainfteld Specifications Laterals Number of Bedrooms 4 Schedule/Class 2729 Daily Flow:Operating Capacity _ 460 gpd Length 55 h Daily Flow:Design Flow 480 gpd Diameter 4 in Septic Tank Capacity 1,200 gal Number 5 Receiving Soil Type(1-6) 4 Separation 5 it Receiving Soil Appl. Rate ,6 gpolW Orifices Required Square Footage 800 R2 Total Number of Orifices NA Designed Square Footage BOO W Diameter in Percent Reduction Taken 0 % Spacing in Trench/Bed Width 3 R Manifold Trench/Bed Length G5 ft Schedule/Class NA Elevation Measurements Length ft Original Drainfreld Area Slope 6 % Diameter in New Slope,If Altered NA % Prcfcrred manifold configuration used? 0 Yes 0 No Depth of Excavation UP-si° 10 in Transport Pipe from Original Grade oowa-,I 8 in Schedule/Class 3034 Designed Vertical Separation 18 in Length 20 it Gravelless Chambers Required? []Yes 0 No M Optional Diameter 4 in Pump Required? []Yes Q No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal Orifice fi Chamber Capacity gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm OTimer OElapse Meter ❑Event Counter Calculated Total Pressure Had R If Timer: Pump on ,Pump IT Comments DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2.3_a tt -- Z Z -- Il f1Il 3.0. Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch �f Test hole locations N Drainfield orientation and layout Reference depth from original grade: Soil logs CK Trench/bed dimensions and M Septic tank Property lines critical distances within layout kl Drainfield cover Qf Existing and proposed wells T,1 D-BoxfValve box locations Reference depth from original grade within 100 ft of property Septic mnk/pump chamber and restrictive strata: �f Measurements to cuts, banks,and locations X7 Laterals,trench bed,top and surface water and critical areas $) Observation Pon location bottom ❑ Location and orientation of ❑ Clean-out location ❑ Curtain drain collector curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation components ❑ Orifice placement Other cross-section detail: �I Location and dimension of ❑ Lateral placement with distance gl Observation ports/clean-outs primary system and reserve area to edge of bed Q( Buildings Other Information JO Audible/visual alarm referenced Yes NO Top a bonom leas staxea D( Direction of slope indicator ®A l f hVnf scale ❑ frrl Design staked out fA Waterlines (4' ifgl v VV EE ❑ � Recorded Notices attached C$ Roads,easements,driveways, ❑ Q Waiver(s)attached parking JUL 3 12010 ❑ ER Pump curve attached North arrow and scale drawing MASON COUNTv F ❑ �1 Evaluation of failure shown on scale bar NVIRONMENTAL HEALTH JBW Non-residential strntification ❑ ❑ Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be notified y installer at time of installation ❑ Yes C$ No /i��/ y✓✓�t , July 11, 2020 Signature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance with state and local on vita regu7�C �1�//>//16�/4l� `7-3( -.2 6 /�Airclnlukntal Health Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved" by Mason County Public Health. —7 ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: /_ 7 �Z3 ✓ 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. Revision Date: 1/12/2010 i A `o t� v ice► hD f c 0 u r u a dLU x N l7Tm \ \ T o w y o' \ 9 O M 3e O CL z o n E N d � NOV 3 n 0 c a w d � a a` LL a Y ate" lfl m 0 m Y C _ A A � 3 � L C � n v � � U o LL / u x € c � e > s 5 0 3 d c �QN o 'V g• r. o L � � E a _8 v � LL °1 C W � O _wc � S y z CL o CL h0 o a 0 z a J in g lfl NU X in II N u � 0 u w E � E � w F b D 3 O 3 i i 4 V \ M } 65 � \ } / 0 } ƒ � in f ! f - J c ! � § � , u Typical Observation Ports Spew of clip pap l <'pW f i 4"poopling above SM Dhow cMmDei Vevel 4a:ECMmber r- 1 (it tilipCap r,._��) SriM 1'ypr CAP UI' SIIII (�A)1 , 4" rvC ripe I \'(' I ipy (1.enKth \'epics) O'rngih Vol ics) •� - 1/4a 4" Long I: (4) ra) 9W ApAu Toilet Ring �' � 4" PVC Ie SECURED LIO Y/ON OAS TIGHT SEAL / TL'DNNEIEN ACCf68 R16F.R fM1611 RIUDE r f� TODYYYCNAMRER 1 ROM 8EWADf JR J/Lv/v F/i L d 50UHCf iLMTNO MAT i ADDROYEO ffFrLUEW I FILTER _ SEDIMENTS SEPTIr,TAM MP1��1 Drawing modified from WSDH RS&G's D-Box Details ` Speed levelers inside D-box r (� •'` Use in each leg going to a trench ;. Inlet pipe comes through 2" higher hole G=\ No speed levelers in inlet pipe h -- ' Typical Plastic D-Box for three legs ,r > • a Typical Concrete D-BBox bein Installed -� •{ '�* < � , J\^�i `�J , � .. .� Yid. fr — x: r Iv Return to: Brandon McMahon 221 NE Haven Lake Dr Tahttya WA 98598 LECLARATlON OF COVENANT FOR ON-SITE SEWAGEATTENVA T/ON ZONE I(We)the undersigned grantors hereby declare this covenant and place the same on record. I (We)the gramor(s)herein,am(are)the owners in fee simple of(an interest in)the following dcscrib d real estate situated in Mason County,State of Washington;to wit (Division and Lot Number or Range/Township/Section Number. Note: Range,township,section numbers are the 1"5 digits of the parcel number) OR 2W 23N 30 Subdivision Division Lot Range Section Towrtdtip and having the Tax Parcel Number of-,2 2 'iQ-7 7 •-Q.Q2�4 on which the grantor(s)owns and operates an on-site sewage disposal system which has been granted a Class B W aiver to reduce Minimum Vertical Separation requirements and gmntor(s)is(are)required to maintain a 50-foot horimnml attenuation zone down gradient of the on-site sewage system to facilitate treatment of the sewage e0luent. It is the purpose of these grants and covenants to prevent certain practices hereinafter enumerated in the use of the grantor(s)land which might encumber the land set aside for further sewage treatment and disposal. NOW,THEREFORE,the grantor(s)agree(s)and covenants)that said gtantor(s),his(her)(their)heirs,successors and assigns will not construct or install any trench,channel,ditch,road cut,utility chase,or other structure of excavation what would intercept or serve as a conduit for migrating ground water. Dated on this day of r.-4 2020 . rgnettve +Signal. . State of Washington ) _ County of Mason ) _ 1,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this 2 t day o off 20�D '`Lls-t.8(RC`D:JC L(�personally appeared before me, who is known to be er of the above ins acknowledge tacknowledged that he )(they)signed it. GIVEN under my hand and official seal (j(l, �ov.written. P=�rr`ywoy t „ =act �oTav� 4 Z� Tu �. chary Pub is in d for�3hte of Washingma, 'y 9697] g residing at fya 4&BUXc 3Ny commission expires: to, 2y)2�i �41f#I,10'WA'6' MASON C01jV Public�Health Always waking fora safer heaahler Mason County 415 N firs Street,Bldg 8,Shelton WA 98584, Shelton:(360)427-9670 eat 400 P Belfair:(360)275-4467 ext 400 L Elma:(360)482-5269 ext 400 FAX (360)427-7787 Application for Waiver/Appeal Amount Paid: $255.00 Receipt Number: Instructions 1. Complete Pans I and 2.No determination can be made until these parts are fully completed. 2. Fees may be billed for waivers and appeals,based on the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant/Parcel Identification Name of Applicant Brandon McMahon Telephone 360-2756293 Mailing Address of Applicant 221 NE Haven Lake Dr City Tahuye State WA Zip 98588 12-digit Tax Parcel No. 2_ Z $ $ Q -- L L — Q Q a-- .0— Site Address NE Haven Way Dr.; Tahuya 98588 Subdivision Name and Lot Tract 3 of Survey 6/62 PART 2: Nature of Waiver/Appeal I@ Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements ❑ Building Permit Review Policies ❑ Group B Water System Regulations ❑ Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements ❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines ❑ Mason County Orate Standards ❑ Departmental Determinations ❑ Contractor Certification Requirements ❑ Other (Installer,Pumper,O&M Specialists) Description of Waiver/Appeal(include justification,additional material may be attached.): Reduction of vertical Separation from 36"to 18"; Alderwood series soil, sandy loam with 45% gravel. Well drained alone>3% able to maintain 18"separation over water table No s ufarn water or wells within 200'dnwn (lfadient from drain field I At..hog-enn,ghio non nta„501 axon, At nn 7nno dowr,gradient from prmary nc Applicant Signature: Date: 7/1/20 1:IEH Foma\Waiver-Appeal Macon County Local Revised 1211115 Page 1 of 2 PART 3: Public Health Evaluation (Staff Use On/fir) I. Type of Determination Required: Type of Onsite Waiver(if applicable) i Appeal Waiver ❑ None required Class A 'Class B r-! Class C 2. Identification of Specific Code/Standard/Determination(include date of determination or latest Code/Standard revision) '�. — 611 Z) 3. Nature of Appeal: VCckrcn( yQ/urah&J Fad j/1� 4. Hearing Official: ❑ Board of Health ❑ Health Officer ❑ Pollution Control hearing Board ❑ Public Health Director ❑ Certified Contractor Review Board F— Environmental Health Manager 5. Mitigating Factors: L1a55 b lA/atJRr Woc KS14&'1' 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has sbbeen /submitted,e Staff Signature: �J (� � A(Vim Dater PA4: Determination of the Hearing Officialle hearing official has determined that approval of this request will not adversely affect public ealth and is hereby granted. This decision is based on the following findings and conditions: ❑ The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied. This decision is based on the following findings and conditions: Hearing Official Signature: Date: 3 1:1EH Forms\Waiver-Appeal Mason County Local Revised 1211/15 Page 2 of 2 Granting Waivers from State On-Site Sewage System Regulations Chapter 246-272A WAC Effective Date: July 1,2007 Revised April 2017 On-Site Sewage Systems (Chapter 246-272A WAC) Re oast for Waiver from State Regulations Section 1. (comp7etedbyapplicant) Name (1) Local Health Department/District (2) [3raNda� MGM � .8/. .............. (seeinrtractions) ............... _._. Address: �.�( 4j e µads,,I n kQ dr ._._. - ..- ._-.. G—p.................... {\- ......— .--_-._._.-..-.__ ..... 0.1A✓V A 55 O ................... Telephone: (5(,0) a75 G.2o1-1 Signature: Propeny Identification: (3) Section 11. (completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A— 0230 24"OF V/S REESURE (OR) 12" OF V/S FOR PRESSURE OSS (OR) Subsection: TABLE VI 36"OF V/S FOR GRAVI 8" OF V/S FOR GRAVITY OS Justification(mitigation me c ures to beprovideaTT11 COMPLETED CLASS B WAIVER CHECKLIST ATTACHED, ............ .............— ............-- .. ..... (OUTLINING ADDITIONAL REQUIREMENTS MET) RECORDED DECLARATION OF COVENANT FOR ATTN. .....—.............. .-. _ ..... ZONE(AFN: Section 111. 1 (completed by health officer) Review Criteria: (8) Mitigation Measures(in addition to those proposed): (0) __ ............. _ rt ..__........ I.I..�...--. CI F� ]v C� a I Comments/Conditions: (10) Type of Waiver: (1l) [ ]Cbtss A lass B [ ]Class C—Request DOH review before granting? Yes_ No Neighbor Notification: (12) Required? Yes_ No Ifneeded,are agreements,easements,arc.properly filed? Yes No Section IV. I (completed by health ojrce This Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems. The review criteria applied,and the us %on measures proposed and/or required,have been evaluated for their ability to provide public beal p otecdon at least equ t t ovided by this chapter WAC. [ ] Denied pproved/G i.ect to all comments,conditions and require eats t �tad in Sections II and III. Local Health Offic 3) Date: !N DOH 337-021 Page 26 of 32 ,4,AgoN COUNrA MASON COUNTY PUBLIC HEALTH Public Health CLASS B WAIVER WORKSHEET Always working for asafer healthier Mason County (State and Local waiver forms required) PO Boa 1666,a15 N 6th5beet lilldg el- Sh fta %%,9850a 51he11on:3 2)-96)0eata00 Belfalr M3 225-067eda00 arouum xuaE Rrancinn Mr•.Mnhnn %wwwaen NUNRR WAI pelt) '1.� New.rroRtss 99T NIP Haven Lake Dr cm Tahuya soon WA aP 9R5RR smaoovss NE Haven Lake Dr Tahuya 985BB mr TMMKELNUMRER 22330-7/-00030 maosmeRRn m`E IQ cw.snluuLwam ❑ mmunwNRLPnsseals 1.SOIL SERIES: S.VERTICAL SEPARATION: The wilseriesmustbe Aklerwood,Hantine,Hoodsport, Up-sbpe ver 1separation must be greater than 18' Shelton,or Sinclair Gravelly Sandy tram. for graviryard greater than 12'for pressure. Alderwood Gravelly Sandy Loam....._.................._.L79 ❑ Greater than 12.._._._._.___.___.______._.. ❑ ❑ Harstme Gravelly Sandy Loam........._.__._............ ❑ ❑ Greater than l8'....... ❑ Hoodsport Gravelly Sandy Loam._._.................. ❑ ❑ -Determined by: Shelton Gravelly Sandy Loam._.._..._.__5_ _.❑ ❑ Depth to hardpan.__.____.____.______._. ❑ Sinclair Gravelly Sandy Loam....................._._.❑ ❑ Depth to mottling.._.._._.__._.____ ❑ Other .._.._❑ ❑ Both......................._._._.__.__.._._..._._._ _ ❑ ❑ 2.SOILTYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy Sand,or Sandy If[es[holes show evidenceofasea—al water table Loam.Gravelpemmnt must be less than orequzl to 35%. abowreshictive Wyecacurtalndrainmaybe required Medium Sand..._._._......................____._..._.. ❑ ❑ _ -Evidence of seasonal water table: LoamySand..__.-----------------------__.❑ ❑ B Yes.................-.....................I................._........ _ Sandy Loam._._..___.____ o ___._______._. ❑ 3 No_..._....................................._.__.__...._..__._.__._ ❑ Percent Gravel: -Curtain Drain required: O -Less than or equal to 3596_._.................. Yes_._._.._._..... ❑ ❑ v' ___._. ❑ -Greater than 35%...._..__._._......................__._....❑ ❑ 3 No.._.___._._._.___....�_.____._ � 3 3.SOIL DRAINAGE: 7. HORIZONTAL SETBACKS: 2 N c Soils must be moderatelywell drained to well drained. O Primary Dminfeld must malntaln 200'hrm down-grads- O tent marine shorelines.surface waters and wells o Well Drained......... ❑ Moderately Well Drained................._._._._. ❑ ❑ -Are Increased horizontal setbacks at Other ............ ❑ ❑ Yes...__._................................_..................... _.... ❑ No_.__..__._.__..__�._.____._._._.__.... ❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%m 30%. Gravity B only allowedon slopes from 3%to 15%. A SDfoot horizontal attenuation rone Is required Pressure b allowed on 3%to 3W down-gradient of the primary dainfield. Less than 3%............_................_._.._........................ ❑ ❑ -Is there 50 It or greater between the down 3%to 15% .........................._..._._.................... 19 ❑ gradient side of primary drainfield and 1696to 30%..___._._......._................... ❑ ❑ property boundary: .................... Greater than 30%....................................................... ❑ ❑ Yes.............................................................................. � ❑ No................................................... ❑ ❑ the 50 foot hontor t3l attenuation zorle is required to be recorded on the deed of the property as unbuildable prior to design appwaL The attenuation zone is nor to be used for the wnwRion of roads,deft patim, AFN: parkiNawas kuhrtrzRK,or othersimliar.chuws.Themmrmustagre Wallthese 4ims, Prmlaamaq THIS MWMY NE NNEn ANDa IARLE mWPURLKNEW0NIEIMSp1 Ln11N .Bs11E ultlaaa)a/Mis 40'easement to be vacat IV _ 301 .63'; Ca n CO C) O 4V O , O o O 25� X 80' Building 40'easement Envelop G o to be vacated Four bedroom Home e I � I N �fff��111 1.. 1 00% 1'1Q$Q�r� Edge of 50'attenuation zone T Cn Cn Cn Cn (n � o N W O Cq a y m 3 w ik ik N -4 C, A N _ w W J O A O. O O w 00 3 7 O _ ^ O W NFT D CD ° a M F fD Cr J w C w N O. fD 0 J a w CD N C O CL N J y pt a NCD J O C , -0 J m w C 0 w tQ J t0 CD O. 7 A N O (O V O o 7 O O M J Z 0 ` r w wto CD 4 ¢ N a J (O J N c O to r J m SD x. � .y a a... CD CD fD J r rn J W 0 n p � A O C ^ CD M 7 w N fD N 3 m o - 250.