HomeMy WebLinkAboutSWG2019-00434 EXPIRED - SWG Inactive - 11/1/2019 415 N 6TH STREET,SHELTON,WA 96564
MASON COUNTY SHELTON:360-427-9670.EXT 400
COMMUNITY SERVICES aE ELMA:36D482-5267,EXT 400
ELMA:360da2-5269,EXT 600
aas.a w,.,:y rmnw�a xdm c<,..�,.ar wmm
FAX:360-027-7]8]
ENVIRONMENTAL HEALTH REVIEW OF OSS APPLICATION
JONILUND
2020 123rd Ave E
Edgewood, WA 98372
Applicant: DOUGLAS C BELCHER
Parcel Owner: DOUGLAS C BELCHER
Site Address: E Coon Dr 8
Primary Parcel Number: 222244190073
OSS Permit Number: SWG2019-00434
Permit Description: 3 bd gravity SFR+ shop
Permit Submitted Date: 11/01/2019
Permit Review Date: 1 1/2 712 01 9 _
The above mentioned Onsite Sewage System Application was reviewed by Environmental Health and found more
Information is required.
Please contact Scott Ruedy with the Planning Department as we will require a wetland report for this property before any
permits are to be issued.You can reach him at 360427-9670 exl 287.
Also require clarification on depth of excavation.A 10%slope would result in a 3-4 inch difference between upslope and
downslope excavation. On design page you wrote bin for upslope and Tin for downslope.The trench cross section detail
also illustrates different depths of excavation (19-24in?).Please clarify.
A couple other minor errors on design page.
If you have questions or concerns let us know.
Sincerely,
Rhonda Elliott
360-427-9670 x581
RELLIOTT@co.mason.wa.us
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH
U D
ONSITE SEWAGE SYSTEM APPLICATION M W _ c Do
Do
415H 6th Street(Bldg 8) Shelton WA9S584 < H
NMroR:366427-96MeA,KQBehi,AW2754457ert 400 �
SW OL �l 2 N
AFPLIGNT PIgNE D D
DOUG BELCHER m IF
WILING ADDRESS-STREET,CITY STATE.ZIP CODE r
369 LEWIS AVE BREMERTON WA 98310 1-1
SITE ADDRESS-STREET,CITY,MCCOENAME a DESIGNER PHONEJONILUND 253-249-9763NAME OF INSTPLLER PHONE IIUNKNOWN IN
CIECNPLLAFPLICA&E TIEM6 GRIJNNING NMT£R6WRCE
If
NEWCONSTRUCTION 0 RVHOLDING TANK ONLY DE PRIVATE INDIVIOUALWELL N IN
0 REPIACENIENTSYSTEM C7 INSTALUTION PERMIT ONLY 0 PRIVATETNAPARTYWELL 00
C7 TABLES REPAIR ❑ SINGLEFAMILY O COMMUNITYRUELIC WATER SYSTEM
E3 TANIQB)ONLY [] COMMERCIAL SYSTEM NAME: 1
p UPGRADE TO EXISTING ❑ OTHER: BEDROOMS LOT
EXISTING FAILURE 3 1.71 ACRES ;?
DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS N¢blue pb) 0 I _
TAKE E CREST DR TO COON LAKE DR N TURN RIGHT.THE LOT IS APPROXIMA Y 20O FT JUST BEFORE THE R
TURN TO THE LEFT,DRIVE IS ON RIGHT AND LEFT.HOLES ARE ON RIGHT NEW ORNE AND ON THE
RIGHT. IO
� COOS l7✓ (•.,f r �O
YTLMIRTEB MYMItMDAIOTRI QRABB®MITM RSTHDLFMUWWff IMN
OFFICIAL USE ONL LOWTHIS LINE
UPOMOE/FALIBE 9dMCE flanFeNM WOeeFp
O VOLUMARY OMVNTENANCETUMPINO BUILDING PE OHOME 8.4E QCOMPIAINi �OT11ER:
INEPECRIR 801LLOG6 COMMENTS/CONOmONS
0� ��ems
br (�rn�6 I 0o�
psis k p � 3k NOV p ' 2019
y� z V�I ans r ll f` V BY:------------
�I o- v�Uws, ub sDTn prx,�3
SOIL CODES:
=VERY G=GMY Y BA1D LaLGM &•MLT C=CIAY E•EITREMELY R•RCOTS
INSPECTOR SIGNATURE DATE AP0.IGTCN E%PHUTION DATE APPl1G AT TIONAPPROVEDEY DE
� 11U/1-1 fl �zrizz
THIS FORM NA AR SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MA II COUNTY WE6lOE REVISEDI2STCD15
DESIGN FORM—PAGE ONE Assessor's Parcel Number. 3 00 L_
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. I Scaled layout sketch,including all applicable items on checklist
°Scaled plot plan,including all applicable items on checklist. J Crass-section sketch,including all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Maximum pape,'si_er /I"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG Designer's Name: dONILUND
Applicant's Name: DOUG BELCHER Designer's Phone Number: 253-249-9763
Mailing Address: 369 LEWIS AVE Designer's Address: 2020123RD AVE E
BREMERTON WA 98310 EDGEMOD WA 98372
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑ Glendon Biofdter ❑Send Filter ❑Mound ❑Sand Lined Drainfield ❑Recirculating Filter,Type:
❑ Aerobic Unit Make/Model ❑Disimfenion Unit Make/Model Other: N/A
Drafnfield Type
1f Gravity ❑Pressure ❑Trench ❑Bed ❑Sub Sur Drip
Septic Tanh/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 4" PE TED
Daily Flow:Operating Capacity 1281!r210 gpd Length 50 ft
Daily Flow:Design Flow 360 gpd Diameter 4 —Zoo
Septic Tank Capacity (,Z) 1200,1000 gal Number 4
Receiving Soil Type(1-6) 7 ,3 Separation 10+ ft
Receiving Soil Appl.Rate .6 gpd/ft O ces
Required Primary Arco 450 tit Total No ofQrific N/A
Designed Primary Area 481f b 0 O ftr Diam ` in
Designed Reserve Area 4W (000 ft'- S mg N/A in
TrencbBed Width ,y 3 ft Manifold
Trench/Bed Length T -wZzp ft Sch is SDR 35
Elevation Measurements d Lengt 100 A
Original Drainfield Area Slope 10 % ' Diameter 4 in
New Slope,If Altered N/ o� preferred manifold configuration used? O Yes O No
Depth of Excavation Up-slope O in Transport Pipe
tram Original Grade n°wnal°pc .6' \b in Schedule/Class SDR35
Designed Vertical Separation 36 in Length 190 ft
Gravelless Chambers Required O Yes O No Optional Diameter 4 in
Pump Required? ❑Yes 21 No Dosing and Pump Chamber
Pump phon Specifications Number of doses/day N/A
Difference in Elev Between Pump Shutoff and Uppermost Dose quantity N/A gal
fice °nA ft Chamber Capacity NIA gal
Uppermost ice O Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Total Pressure Head N/A goal OTimer OElapse Meter ❑ Event Counter
Calc ed Total Pressure Head NIA ft If Timer: Pump on ,Pump off.
mmm�nun Sail V"T"" �aS Sb" ; s ax 4
� s\Dpe ez�cavwmun 20, ow d1W(� Stogy �516
3b'l Y5 .
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2. ZZ_1� -- A.J -- _._4LOOjj
Permit Number. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
❑ Test hole locations ❑ Drainfield orientation and layout Reference depth front original grade:
❑ Soil logs ❑ Trench/bed dimensions and ❑ Septic tank
❑ Property lines critical distances within layout ❑ Drainfield cover
❑ Existing and proposed wells ❑ D-BoxfValve box locations Reference depth from original de
within 100 R of property ❑ Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations ❑ Laterals,trenc ,top and
surface water and critical areas ❑ Observation port location bottom
❑ Location and orientation of ❑ Clean-out location ❑ Curtain drai ollector
curtain drain and all absorption ❑ Manifold placement ❑ Sand an oration
components ❑ Orifice placement Other cross-se on detail:
❑ Location and dimension of ❑ Lateral placement with distance ❑ Ob ation ports/cleat-outs
primary system and reserve area to edge of bed
❑ Buildings g Other ormation
❑ Audible/visual alarm referenced Yes
❑ Direction of slope indicator ❑ Scale of drawing shown on scale ❑ Design staked out
❑ Waterlines bar ❑ Recorded Notices attached
❑ Roads,easements,driveways, ❑ Waiver(s)attached
parking ❑ ❑ Pump curve attached
❑ North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar Non-residential Justification
❑ ❑ Waste strength
O ❑ Flow
DESIGN APPY6VAL
The undersigned designer must be notified by installer at C e of installation ❑Yes No
n
ignamre of Desi ate
The undersigned has reviewed this design on b If of Mason County Public Health and determined it to be in
compliance with state and local on-site re ons:
Envir ental Health Specialist Date
CAUTION: DESIGN APPR AL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"A roved" by Mason County Public Health.
✓ The Onsite Sewage Pe it has not expired,the Permit Expiration Date is:
✓ Unit
site con ' ons have not been altered to adversely affect conditions of design approval.
Please N The system must be installed by a certified installer,
unless or authorization is obtained from Mason County Public Health.
A stallation Fee is required.
ThTs form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
cr+ou�omaodw exar�iaaoeaww.n+'u um RNiEO;�zmlueaeru ev:p,+
f n O) A W w A N D 7 00
Z — m
N O Z - r
RJ rOr 1- 4 w 0 r m
4 00 3 3 -i Z,O AA
l� v m 0 m m C C)G)
CO C m to y oYmLK
° rn
m 0 �.....,'<
U � b m ° g ° ° N D 'n
A ui W z 0 CJ G) m m '.z COON
0
z D D D DR.S. Co
OON OR
� tTj
I o\t
L \\ r
v ' D
n ;CD
aO z D Z O 0 w
� I y z . � ... m
c p \\� 00 \ a
2
71
y � m
m r p v
c g ° 5 m m° '� aD r
nl mD
s � m ' g z �1
q -- - - - - _
z � 4i O ' A Cy - -
9 xZ
i y ° J( gdD °z \ COONDR S
ml � I I � ,( Fo \\ m v -- - - -- - - -
; m a � \ ywp�A\. ym \ y� - -
iZ 1O -Dni \\\ \ �? A (n -`\'..'`.. 7zcn ap�i\�? r0j -D{ o
It
n OD ° ° f n
g m
O�J� \ - 09 \ cgs
j L I
y yF J
vvSM . DZIN x4N � xoz '"� PT > c � o \ Q
�7 j c � $ , zom Ty
DDT g ON L" f�j QAA ogy^
u _2 may
_ - -
1 yz o m a m \ \
f�111
m o \ \ -- -
m >
m
o
O I o I \\\ �-80.70+r - - -- - -
rnml
W 0
I o 0
_ 0
O
mz
M� I i
=NLy x0A. � 0 r
y Dp 8Nm PD i g f GI ��
mITT
rN d m
N Z
I Z Oy
1 y O O
j ml " $ z 8
-- ---� 5 m
Ci1W\1WW DaUB BYtlBf1WOTBeM�.Mq VBT EB�IFD'iLCN1BB:2lPN BV:jw
\ o O p v m
Fn
N Z Z _ O 5 N z A N <
lTl 2
Q NA (rlW � � ODmn �
QN N, 13CD
2 O \ ^ 20g
O N C' my \ O_ m z � 3Z
xz \ c5 mOm i
w
N p�swy b Ob `3 �mooy \ p � gmm
ra
`9 \
wtri I m \\
\. p
0 rm
mmm
a0 rpop
X N
y� O x a N i O r � A
m mom Zi Z v . . Omc
ro o
zY'4 $ z �) m . . az w
O mp mz +.
$ m I a c -- - m --- - - --i- -
a o m l m D - - --- - �� -- -0z v
o z a< .. cn - �, I + / m mx mA
F = ZOyZM
a m' $' m
I
-mT�7 COON oR s
r N _ 3N
p m A O A O m \ _ - - _ m D o
< O Z z '^ T O � O
N N O m V) �� N
m pZ
/^� \ O
mzqm
n O Z \ \ � KZTO o
� m
Nb to °' o \ n \ v v r4 $ 7 � O
r[ o I x \ �� \\ mwwo m 00
C7 \ Tk \ m m o \ a s
z l
$ Z
Cn
�7 I,
y 5S
x CIA
n 0 *r c � C N cn Z
� D
r m
m n
y y m y>, 00
wp 3�2m y� zo
r o a O\n r
m O N I71.
wx rm � m
z3m 9IO W O .: 8 0 0
2/ O 4
O r
� o m m o s �,m
o 'r@ 0 co
-I c z
D G I o Z O op T m p m m o x z
'i �p NCN 4n � 0
m i� oy9xv ml NZ m Gy m
r o
DESIGN FORM—PAGE ONE Assessor's Parcel Number:1 ZZz1 — Al
A design will be reviewed when 3 copies of each of the following are submitted:
•Completed design form that has been signed and dated. a 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 maybe scanned and available for public view on the Mason County Web she.Maximum paper.si_e: /1"X/7"
PARCEL EDENTIFICATION
Permit Number: SWG Designer's Name: dONILUND
Applicant's Name: DOUG BELCHER Designer's Phone Number: 253249-9763
Mailing Address: 389 LEWIS AVE Designer's Address: 2020123RD AVE E
BREMERTON WA 98310 • • WA 99372
City State Zip city State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter ❑Sand Filter ❑Mound ❑Sand Lined Ihainfield 0 Recirculating Filter,Type:
❑Aembic Unit Make/Model ❑Disinfection Unit Make/Model Other: N/A
rainfleld Type
15(Gravity ❑Pressure Trench ❑Bed 0 S urface Drip
Septic Tank/Draislfleld Specifications Laterals 'p��� � �1
Nunber of Bedrooms 3 Schedule/Class Z��jq 'j 1lCr rtJlt�l
Daily Flow:Operating Capacity 2'ff gpd Length �jQ ft
Daily Flow:Design Flow gpd
gpd..4. Diameter /I.�1 in
Septic Tank Capacity ( ' gal W Number rry
Receiving Soil Type(1-6) Separation /Q'f ft
Receiving Soil ry pl.Arm
Rate Qr ff gpd/ft' OrificesRequired Primary Area ft Total Number fices +,�V,1/^T
Designed Primary Area /I ft, Diameter T inDesigned Reserve Area [/ Q N ft' Spain in
Trench/Bed Width ft ,,IManifold
Trench/Bed Length J.srj'2017 ft edWdClass <fjQ rj
Elevation Measurements Length //JD ft
Original Drainfield Area Slope % Diameter in
New Slope,If Altered o Preferred manifold configuration used? 0 Yes gf No
Depth of Excavation Up-slope in Transport Pipe
from Original Grade Down-.lope in Schedule/Class 3Q31� 5 5
Designed Vertical Sepamtion in Length i 10 ft
Gravelless Chambers Required? as 0 No 5(Optional Diameter in
Pump Required? Yes E1 No Dosing and Pump Chamber
Pump/Siphon ecifications Number of doses/ y
Difference in Elevation Betw Pump Sh d Uppermost Dose quantity gal
Orifice itChaypber Ca ac' gal
Uppermost Orifice❑ gher O Lower than Pump Shumff Pump o check those required.
Capacity @ Total sure Head AIIA gpm Maine Meter ❑E out Counter
Calculated To ensure Head At 44it f r: Pump on Pump off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number:_____ -- __ --
Permit Number. SWG
DESIGN CHECKLISTS
Sled Plot Plan Sc�7tled Layout Sketch Cross-Section Sketch
Test hole locations f.✓j/Drainfield orientation and layout Refere cc depth from original grade:
Soil logs C� Trench/bed dimensions and eptic tank
f�Property lines /critical distances within layout MDrainfield cover
L Existing and proposed wells d D-Box/Valve box locations Reference depth from original grade
/within 100 ft of property Septic tank/pump chamber and res (rive strata:
C1 Measurements to cuts,banks,and locations Laterals,trench/bed,top and
/surface water and critical areas Observation port location bottom
f3 Location and orientation of f0/Clean-out location 12 earteintfr cirrTo r etor
curtain drain and all absorption �+/ Manifold placement
components p Orifice placement Other�ydss-section il:
Location and dimension of f�latersl placement with distance Pf Obsery n ports/clem-outs
primary system and reserve area to ed a of bed
EdBuildings / g Other I maHon
Audible/visual alarm referenced Ye
a(.J L7 Direction of slope indicator [Scale of drawing shown on scale �esign staked out
dJ Waterlines bar corded Notices attached
h7 Roads,easements,driveways, ❑ iver(s)attached
/parking ❑
d North arrow and scale drawing ❑
shown on scale bar Non-residential Justification
❑ O-Wastestrength
❑ n
DESI 'APPROVAL
The undersigned designer must be notified by i ler at time of installation ❑Yes No
Si ah f Designer Date /q
The undersigned has reviewed this rgo on behalf of Mason County Public Health and determined it to be in
compliance with state and local o ire regulations:
Environmental Health Specialist Date
CAUTION: DES APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is ped"Approved"by Mason County Public Health
✓ The Onsite wage Permit has not expired,the Permit Expiration Date is: _
✓ Dminfie site conditions have not been altered to adversely affect conditions of design approval.
Pie a Note: The system must be installed by a certified installer,
ss prior authorization is obtained from Mason County Public Health.
An Installation Fee is required.
This form maybe scanned and available for public view on the Mason County Web site.
Updated Date. 12,7201
D:VOM11pOp9Omp BBiUBmOpW'BelMr dw LAST EDITED.I VOW19838PM BY:jonp
T 22AF � m
A A [rm 'm
O mm -A
D
ti N ccjmm
per, O m . 0IT
z o m '',..,D
orz CO i a D : Flo
Oz
O O r n mAP m �ml� '.I.
C) O ymA o0 Ip•
Cam z Q = D Z D nm mmz p� •'J y+ IT
IT m0~ ODp
TIA �
b C Z O M � m m � Q
� 1�7 IW (1) mD
v I0 3: Co
0 -0z � m
n p
co
T vny g9
rTIT
l ' m p
0
o � p 0
Z O m �p mm
(m( z m 1 /z D A$ o <zp
Zfl1 � 2m V_' r 0 00 OAS+ m
n
Nim m ' A m �
Im
m D S O F
Ill
A m
Ap A I \'
O ! � D z rt1r in > un. �n m . po uwv- W
. 0 Z A J� m o to H y B� is
Itl I -1 6 HUM D �192-'mDA�Op ZO j�
61 m r ��2� CD�-2(9".OlngA<T_ �o
m;n o co m y�B mmbo Mp yy <55m
�TMTRM �- m ^' mD Ov FDA � Il
5
;o OC ZOmzr� Z 5045 jo8mipo 0
0 A AOlp>y~O 0 NN� 'O 2t— ww
mi y el O_ A6Zrr-ZgCO mZ D m�p Prp2m-� m
_..._ G 18•?1G Am-1��m~p y azmmmm-U2Gm 5S0
f/1 O ;1O] r' f(��1 fpf1 vO NDAp > l z A -I V'N�yDCIm '9 IG
Im
m -DI D 04 A Ui Q C9^ 00~3 Aio �C �ya,fnNQi� O�rI .Zl
Z C1, z;Mir;: PrpA2zONI 5 O
O z z m sm€ 'o W9DOm�mA MOZAmyZOW2 z
Np Ni W . 0 wo
/�_�� A>m T -Zoop v �imSzo> s" �i� Q
I. Z I3 NJ ;d n 0 AOmmo-Tiy cc POpor O DOXO'o y
Oz m DQAO1!r0 mm 'm OOx
tll m O Z m §zs zxm� Ow m OOG�im GlN�mz
v N Z DIZ �gZ $' -. O DMA mi0 mo6zi m_zmmo �
r• �X/ €5 Cc ((nn m-i Q z m
N O o 2 /\ m�= sm �IByDD A 0A.g '>y :>Jy0
m ED O X Z �y OA�mnmr�i z- Om p?m zOT
Z � 0 AyQ O 35A�rD A0E ZyOzyti
�. Q ^^ y M ^ m0 �ozmna� Orz8m DOgyANi
lJ mpzm 2 �S0 � o?��m�
q O D A 0 ozRZ mz o mzp�O �tDitmiyoo�
}{ r {� mi zic � yrmnm y�6cyziQm '030�m
$ O K -..0 '� m v09mm2a S 2pG1NZJ�.12>2041
ODD O y2 o Zm'i0 z0
-y� � cm A % 5 y �mx� c `5
a MmZmr m
N o mNVA{A o� W"OoozF
N zN LS v mfmim�zD Oa '� Oo 590m
A� m Omy �N � A MMM my
Cl) mK cHZH-j o Moo 3 ;z; Mooc
xD �} po S i � D mOy O� 00f3
N0 G Dye Z' O ZZC OZI 0 '0 'T
p;bm ygm mvq y0m
u zZm
O } "g Z. Oy p A N m I Z
0T2Oc m S O y1 m mNm
(�11 mz6m O immy 1n A �o��
O m b m O D Irt11I is
a0 m
x '(n 0'oT O n m y>A A
r H210 y `zmtO 0 DZ OZZO
m Cm- F m Ci IT, m O Z <G1O
D Hm " w is SS m o (P r(P,nn,,
- Qi ; MIQ A e
0
z
m.
0-8 - m
= fn �mr A 15v40 TvT, Om
mAD A i2 D mom _
yy m
I � � I T inA zmyi� O N M.
p O O ma y G II}99 r JJ055 m r
S fyll T pinp D �rB ! A ➢ D mm A0pD
1�1 7Z y D_ 2 Tmz m m w
OB/2 S ! r C A am- 'l p m
Tb O�9 m m m m O 0 'T' m m m O
O zN p C vv- xb �y y x
>Z IB z V O m
D p m m A C) Z m T N B� �y �l Z �o
Dy2� -�I -01 myti 0 nym 0 -i ZA Ny p A D
1^�-n �p 1 p �il L> Q z m 9 Q (/1 m L ITT
O m
� A O z0 O
- — m0
/1 m T �