HomeMy WebLinkAboutSWG2024-00411 - SWG Application - 10/8/2024 ® MASON COUNTY 415 N6SHELTON: ,SHELTO70,EXT 4W
SHELTON:STREET,
ON, EKT484
BELFAIR:360-275-0167,EXT 400
Public Health & Human Services ELMA:360482-5269,ENT 400
FAX:3W427-7787
On-Site Sewage System Permit: SWG2024-00411
APPLICANT CHAMBERLIN MATTHEW Phone:
Address: 3180 E PICKERING RD SHELTON,WA 98584
OWNER CHAMBERLIN MATTHEW Phone:
Address: 3180 E PICKERING RD SHELTON,WA 98584
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360426.5940 j
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
SEPTIC INSTALLER TJ GODS* Phone: 360490-0217
Address: 150 E MARISA PL SHELTON,WA 98584
Site Address: 1061 E Pickering Rd
Primary Parcel Number: 221332150003
Permit Description: New SFR-3BR Gravity Wl CLASS b wAIVER
Permit Submitted Date: 10/0812024
Permit Issued Date: 11112/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $805.00 (addifi—Ifees may bo a,W2I uo.n lnelaMWn
Permit Expiration Date: 10/15/2027 (WiWwdaworinswdbn)
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 of system components.
6 Mason County Asbui/t 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.govihealthienvironmentallonsite/oss-inspection-mquesLphp or call:
360427-9670, extension 400.
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ON-SITE SEWAGE SYSTEM APPLICATION I g APPUcurr PNDNE M
Matthew Chamberlin (360) 349-7968 c
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3180 E. Pickering Rd. Shelton WA 98584 m
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MMEOFCESIGNER PNCNE I N
Dale L. Tahja (360) 426-5940
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T.J. Goos (360) 490-0217
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 3 3 — 2 1 — 5 0 0 0 3
A design will be reviewed when 3 conies of each of the following an submitted:
"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. i Cross-section sketch,including all applicable items on checklist.
This form maybe stunned and available for public view on the Mason County Web site.Maximum pupc,size: 11 'X/7',PARCEL IDENTIFICATION
mit Per Number: SWG 702K - Ot9q ll Designer's Name: Dale Tahjo
Applicant's Name: Matthew Chamberlin Designer's Phone Number: (360)426,%40 - _
Mailing Address: 3180 E.Pickering Rd. Designer's Address: 2450 W Deegan Rd W
Shelton WA saw Sheeran WA 98584
Cittz State Zi C' State Zip
Treatment Device
❑Glendon Biofilaa ❑Sand Filter ❑Mound ❑Sand Lined Drainfieid ❑Recirculating Filter,"type:
❑Aerobic Unit Makr/Mudel IJDisind6ction Unit hfake/Model Other: N/A
Drainfield Type
9 Gravity ❑Pressure G(Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length 50 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1,250 gal Number 4
Receiving Soil Type(1-6) 4 Separation 6 ft
Receiving Soil Appl.Rate 0.6 gpd/flz Orifices
Required Primary Area 600 ff' Total Number of Orifices Gravity
Designed Primary Am 600 ft, Diameter in
Designed Reserve Area 600 ft2 Spacing in
Trench/Bed Width 3 ft Manifold
TinnwhBed Length 200 ft Schedule/Class 3034
Elevation Measurements Length 40 ft
Original Dminfield Area Slope 5 % Diameter 4 in
New Slope,If Altered 4 % Preferred manifold configuration used? O Yes 9f No
Depth of Excavation np4nre 1s in Transport Pipe
from Original Grade row„ , 16 in ScheduleXhiss 3034
Designed Vertical Separation 18 in Length 120 ft
Gravelless Chambers Required? ❑Yes O No 90ptiond Diameter 4 in
Pump Required? ❑Yes EfNo Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day Gravity
Diff.in Elevation Between Pump&Uppermost Orifice_ft Dorn quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(Flood) gal
Uppermost Orifice O Higher Cl Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm OTimer OElapse Meter ❑Event Counter
Calculated Total Pressum Heed it If ' on Pump off
Comments
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NOV 12 2024
' """ ' .MENTAL HEALTH
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DESIGN FORM-PAGE TWO Assessor's Parcel Numbar.2 2 1 3 3 - 2 1 - 5 0 0 0 3
----- -- -----
PermitNumber: SWG
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Sealed Plot Plan Scaled Layout Sketch Cross-Section Sketch
16 Test hole locations 16 Drainfield orientation and layout Reference depth from original grade:
m Soil logs 56 Trench/bed dimensions and 56 Septic tank
IZ Property bees critical distances within layout 19 Drainfield cover
19 Existing and proposed wells � D-BoxfValve box locations
tmg Pt'oPce Roference depth from original grade
within 100 ft of property 64 Septic two dpump chamber and restrictive strata:
m Measurements to outs, banks,and locations lif Laterals,trench/bed,top and
surface water and critical areas 19 Observation port location bottom
Ib Location and orientation of 19 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption R1 Manifold placement ❑ Sand augmentation
components ❑ Orificeplaceenent Other cross-section detail:
16 Location and dimension of R1 Lateral placement with distance ❑ Observation ports/clemouts
primary system and reserve area to edg0 of bed
0 Buildings Other Information
❑ Audibldvisual alarm referenced Yes No
id Direction of slope indicator 51 Scale of drawing shown on scale Ef ❑Design staked out
id Waterlines bar ❑ ❑Recorded Notices attached
m Roads,easements,driveways, Rf ❑Waiver(s)attached
parking P R O V E ❑ ❑Pump curve attached
ld North arrow and scale drawing ❑ ❑Evaluation of failure
shown on scale bar NOV 12 2024 Non-residential justification
d:1SON COUNTY ENVIRONMENTAL HEALTH ❑ ❑ Waste strength
18 JAj ❑ ❑ Flow
DESIGN APPROVAL
The undersigned designe ust be noti5 i9s< at time of in(stallge[ion q��Ye�s ❑ No
Signature ofDest er " u- Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determ in
compliance with state and local on-site regulations:
Url to-24- 2 6
J .
ental Health Specialist _'Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING COND
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: (O-1S-2.7
✓ 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: 12/7/2015
Mason County WA GIS Web Map
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Installation/Maintenance
Gravity Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Divert all storm water run-off away from septic system components.
4. No curtain(french) drains allowed within loft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain(french) drains allowed within 301 of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
11.Locate all utilities prior to starting installation.
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NOV 11 2024
MASON COUNTY EN'dIRONMENTAt HEALTH
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