HomeMy WebLinkAboutSWG2024-00436 - SWG Application / Design - 11/6/2024 MASON COUNTY 415 NBTHELTON:STREET,SHELTON,
967 WA 98584
SHELTON:3 275-9870.EXT 400
BELFAIR:38P275-44fi7,EM 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-77B7
On-Site Sewage System Permit: SWG2024-00436
APPLICANT Brad Campbell Phone:
Address: 141 E Jared Rd SHELTON,WA 98584
OWNER Brad Campbell Phone:
Address: 141 E Jared Rd SHELTON,WA 98584
SEPTIC DESIGNER ROD LEFT' Phone: 360-698-8488
Address: PO BOX 2954 SILVERDALE,WA 98383
Site Address: 141 E Jared Rd
Primary Parcel Number: 220257600140
Permit Description: New 3-bedroom Gravity System
Permit Submitted Date: 11/06/2024
Permit Issued Date: 1111812024
Issued By: David Anderson
Current Permit Fees Paid: $540.00 (additional fees may oan,,n'red upon in-tall-don of system).
Permit Expiration Date: 11112/2027 aased on dale of mslxcdon)
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 Drainffeld 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 backfi/l of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system 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/environmentaUonsite/ws-inspection-request.php or call:
360.427-9670,extension 400.
OFFICIAL USE ONLY
GATE MCFMO / 6 . ?�
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BRAD CAMPBELL _
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SOILCODER:
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WSPE flSIGXANRE DATE MRICATN)N EAPI0.ATION DATE hl P110VEVI LS4VFD BY GATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUITYWEBSOE REVISED ILUaIs
DESIGN FORM—PAGE ONE Assessors Parcel Nunber: 2 2 0 2 5
A design will be reviewed when 3 conies of each of the fallowing are submitted:
a Completed design form that has been signed and dated. °Scaled layout sketch,including all applicable items on checklist
a Scaled plot plan,including all applicable items on checklist o Cmss-aection sketch,including all applicable items on checklist.
This form may be Banned and available for i
bile Wellson the Meson M Webahe.Maximum super size: 11"X/7"
Pe[mit Number: SWG ZOZ"�-�Oy3{a Designer's Name:
ROD LEFT
BRAD CAMPBELL Designer's Phone Number. 360-698-8488
Applicant's Name: Bn
141 E.JAREO RD Deeignei s Address: P.O.BOX 2954
Mailing Address: SILVEflDQE WA 99393
SHELTON WA 99684
City
State 2i city Stele ZiIs
Treatment Device
❑Gltm a BioBlW ❑Sand Filter Cl Mound ❑Send Lined DrainfiNd ❑Earirculating Fill ,Type:
❑Aerobic That MA.Wdel ❑Disinfection Unit Makr/Model Other
Draimfield Type
Gravity ❑Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Dralnfseld Specifications Laterals
�
Numberof Bedrooms 3 Schedule/Class � o 7 L�
Daily Flow:Operating Capacity a,10_ god Length 68 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
25
Septic Tank Capacity 10T gal Number 3
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl.Rate .6 - gpd/ftr Orifices
Required Primary Area 600 - to Total Number of Orifices N/A
Designed Primary Arm 600 - ft Diameter NIA in
Designed Reserve Arca 600 ftl Spacing d/A _ to
Trencb/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class N/A
Elevation Measurements Length 141A ft
Original Drainfield Area Slope 1-2 e/ Diameter m 1h in
New Slope,If Altered 1-2 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation UP`dt 22 in Transport Pipe
from Original Grade pa�.etape 22 in Schedule/Class 40
Designed Vertical Separation 36 in Length 60 ft
Gmvelless Chambers Required? ❑Yes RfNo 0 Optional Diameter 4 i"
Pump Required? ❑Yes Rf No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day NIA
Difference in Elevation Between Pump Shumffand Uppermost Dose quantity %IA; gal
Orifice WA it Chamber Capacity NIA gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head NIA gpm OTimer OElapse Meter ❑Event Comber
Calculated Total Pressure Head itIf Timer: Pump on ,Purnp off
Comments
•DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 0 2 5 -- 7 6 — 0 0 1 4 0
Permit Number: SWG
DESIGN CHECKLISTS : trl,jx
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ed Test hole locations 1Z Drainfield orientation and layout Reference depth from original gmde:
16 Soil logs R1 Trench/bed dimensions and E6 Septic tank
m Property lines
critical distances within layout 0 Drainfreld cover
19 Existing box locations Existing and proposed wells Reference depth from original grade
within 100 ft of property ❑ Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations bd Laterals,trench/bed,top and
surface water and critical areas 69 Observation port location bottom
❑ Location and orientation of 6d Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
19 Location and dimension of 66 Lateral placement with distance Ed Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
19 Buildings ❑ Audible/visual alarm referenced Yes No
m Direction of slope indicator 66 Scale of drawing shown on scale ❑ 06 Design staked out
6d Waterlines bar ❑ 6j Recorded Notices attached
Wi Roads,easements,driveways, El if Wmver(s)attached
puking 66 Pump curve attached
61 North screw and scale drawing ❑ 19 Evaluation of failure
shown on scale bar Nan-residential justification
Cl6j Waste strength
❑ C9Plow
- DESIGN APPROVAL
The undersigned designer must be notified by installer t time of mate ation Yes ❑ No
Si of igner Date A
The undersigned has reviewed this design on behalf of Mason County Public Healt6and determ psit it to
compliance with state and local Nc
on-site lions: "F U r_
SQ �uNryFN
Bnvironmental Hearin Specialist Date QJq N,HE�
ASH
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: �(jH
✓ The design is stamped"Approved"by Mason County Public Health. I'//` '�O y
✓ The omite Sewage Permit has not expired,the Permit Expiration Date is: T
✓ Drainfreld 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.
aInstallation Fee is re uired.
This form may be scanned and available for public view on the Mason County Web site.dated Dace: 12/7Y2015
Mason County WA GIS Web Map
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