HomeMy WebLinkAboutWEC2020-00149 - WEC Application - 8/27/2020 (2) / 415 N 6m STREET,SHELTON.WA 98564
MASON COUNTY SHELTON.360427-9670,EXT.400
COMMUNITY SERVICES BELFAIR 360-2754467,EXT 400
ELMA.380482-5269,FXT.400
FAX.3W427-7787
NOTICE OF INTENT TO CONSTRUCT A WELL
Pemrit Number Pavment lnformatlm Imbucaons
yyss � 1. Canpbta Pad t.Incomplete applications will be rejected
�WEC Recept Number :J 4^/ 2. Attach a plot plan and vicinity map
�U ❑ Cash 3. Submit this completed application with appropriate fee a minimum
❑ Check of 24 noun:in advance of initiating well wnsw ion. Refer to
/ae�� �.ys� Mason County Emimmmemal Health Re schedule for wst.
W��v-- I� S Date of Payment W•1 a4CO 4. Mason County Public must revive noblication at least 24 Irours
Prior to the drilling of the well.
PART 1:Applicant/Parcel Identification
Site Address Mason Benson Rd _ Stan Cad of WE40411
Drilling Firm Arcadia Drilling Inc pharo 3W 426-3395
Applicant Alan Furrow
Phone 425-773-5072
Mailing Address PO Box 1790
COY Shelton State WA Zip 98584
Parcel Number 22110-32-90024
Directions to Site See attached map.
Is the veil site within 100 feel Of sat/seawater? ❑Yes ®NO
If yes,a variance from DOE is required. Have you applied I received(circle one)a vanance? ❑Yes ®No
NOTICE,"proposed comw:tfors N rev wets are su0jecf f0 water xlryuacy n0uiremeMs er tere orboiMhn9 permd per Mason County T44 6.60
Wehv uae9e resekmns end eddaioralfees maY aPPfY fo ell new wells dwAwd aRm Jarxrery 1!Y',XIS per ESSB W91.
Applicant/Agent Signature
PART 2:Heath Department Review(Staff Use OnW "" � to-
Cl
NO TAG e _ Called In _%O�$�20 /e/t ..A44 tote-
❑ ❑ Driller on Sile7
p��$�2E rOJ\ I 0 i iz7
❑ ❑ Is the well capped and Vented?
❑ ❑ Is there evidence of a surface seal? �Ly ly tJ 2.S[757 '�
❑ ❑ Is there a 2-annular space on all sides of the casing? LS V 11771!{;:IIi11JJ111,
❑ ❑ Has the seal Slumped? AUG 2 7 7020
❑ ❑ Is the well flowing or is there evidence of other leakage?
❑ ❑ Is there evidence of cascading water? BY__ ____ _____
❑ ❑ Is there evidence that the seal is at least 18 feet long?
❑ ❑ Do the well site setbacks appear to be appropriate?
Comments 11IOY IAISPfC7F�
❑Pass ❑Fail Inspects Date
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DIMENSIONS ARE R /
W F NOT DEVIATE FROMM DE OESION.
USE EXTREME CAF.. -. . 73 PREP.
SEE ALL ATTACHED CONSTRUCTION NOTES
.ALL SANDY(OYYJYMWW S NW/M'DARE ,bk
NO YFNI(YW TRAFFIC ON SUMO SYSRW. PDP OVER
WON DRAW ls^btKQW Al DO TM C]ml�v
AURAS TO FOLLOW<ORNDYN OF 3.(5 el Q[
NKTAU TPBFNE9NOOEEPENTHAN J✓},'� OT ,1A
INSTALL SYSTEM ONLY WHEN SOII$s�ro�" i°• {�T
ARE PROPERLY
MAINTAIN A MINIMUM OF ' t+�1Llirt
VERTCAL SEPAIUTON DISTANCE i 1
NNNTAIN IOC FROM Wa SA SHRFA(EWATM 1
ONSAT No TOFSOL DURINGSTSNp
OWNER 10 NAM GRASS OVER STOW
WDAUIXIdIM OIIOWTIL
E E➢NC SYSTEM OESON ONLYT
TRISD.SA.SUNIECTTOOT,ER /
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DESIGNER NOTE:
15T LATERAL DEPTH - 32"
REMAINING LATERALS DEPTH =24"
1 APPROX. EXIST. HOME
EXIST, FENCE
1 OB PORTS
1 3'
1 1ST �
1 LATERAL
I
10,
I I I I
1 D-BOX
f3%SLOPE
O O \1200 GAL. V �V
SEPTIC TANK PAN
1 I I
1 I I
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I APPROX. PROPOSED
ADV NOV 17 2015
1 I CEW
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cusrontm:cc R�rw annc scue r.+v �
PIONEER DIGGING, INC- PAR i.22ll03290023 TESTHO,Et TIMHOU2
SEPTIC DESIGNS ADDRESS: 79 MASON BEINWN 0.D , o�ccs N2 as
3m3eMAEO,J gv�sOry w. rJlAl'Ev1Ew,wA9assn DESIGNER: AD T PAYSSE
oEFxF-xw m FAX wom 3 DESIGN PAGE _OF�
FABRIC
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GLUED TEE I I
DESIGNER NOTE:
DEPTHI REMAINING LATERALS 240
INSTALL
d�
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USE 6 HOLE D-BOX WITH EQUALIZERS . DIVIDE
r TO : D—BOX TO FINISHED GRADE FORMAINTENANCE-APPROVED
. . . •
NOV 17 2015
.:,•
11110,
I I I
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I EXIST. HOME
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I IXIST. TANKS
3RD SVRVEY
FROM 5E CORNER
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PROPOSED ADV I
SEPTIC SYSTEM r —�
I I I Ex es
�I I r--- -, ZONEATTN.
ZONE
PROPOSEDADV I I
I IiI���II^Ij/�
I�1 EXIST. PRIMARY
BEST I EXIST. RESERVE•
LOCATIO WATERLINE
LOCATION: INSTALLER
TO VERIFY PRIOR
TO INSTALLATION
EXISTING HOME
I AND SEPTIC SYSTEM
AREAPPROX.
LOCATIONS BASED
ON FIELD VISIT, GIS,
AF *6VED
MC PI IRI IC HFALTH
NOV 17 2015
EXIST. WELL 9-Nod �\ \�`rEW
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1 SECORNER f 163'-5" �?---
scnit r�or��
PIONEER DIGGING, INC �C°I
TEST FiJLEt TEST HJLE2
PIba ORw
j SEPTIC DESIGNS �' �� wncc Ix-70c
I 3bP42 30d3LMAAlNBeJ9JN CAnf4vtW.wn9fl5a6 DESIGNER: 0.0BDtT P OF
OF
IJ JR10E IW3 1AX-3�7 DESIGN PAGE _
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 1 1 0 - 3 2 - 9 0 0 2 3
Permit Number. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
■ Test hole locations ■ Drainfield orientation and layout Reference depth from original grade:
■ Soil logs ■ Trenchted dimensions and ■ Septic tank
■ Property Imes critical distances within layout ■ Drainfield cover
■ Existing and proposed wells ■ D-BoxNalve box locations Reference depth from original grade
within 100 ft of property ■ Septic tank/pump chamber and restrictive strata:
■ Measurements to cuts,banks,and locations ■ Laterals,trench/bed,top and
surface water and critical areas ■ Observation port location bottom
■ Location and orientation of ■ Clean-aut location ❑ Curtain drain collector
curtain drain and all absorption ■ Manifold placement ❑ Sand augmentation
components ■ Orifice placement Other cross-section detail:
■ Location and dimension of ■ Lateral placement with distance ■ Observation ports(clean-ours
primary system and reserve area to edge of bed Other Information
■ Buildings ■ Audblelvisual alarm referenced Yes No
■ Direction of slope indicator ■ Scale of drawing shown an scale ■ ❑Design staked out
■ Waterlines bar ❑ ■Recorded Notices attached
■ Roads,easements,driveways, El Waver(s)attached
parking ❑ ■pump curve enriched
■ North arrow and scale drawing pIDNEER DIGGING ❑ ■Evaluation offalure
shown on scale bar Non-readenl al justill"6011
360.4W./803 ❑ ■Waste strength
oortotrrr ❑ ■Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer a time of installation ■ Yes ❑ No
Q6n*V-i aQ Ivil215
Signature of Desigrref Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
wmpliance with state and local on-site ones:
L.
1 ��17 ' Is
—EnvironmentA Health Specialist Date
I
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. ' I
I The Onsite Sewage Permit has not expired,the Permit Expiration Date is: I I 1 7—
� Drainfield site conditions have not been altered to adversely affect conditions of design approve.
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.
Revision Date:8/18107
i
DESIGN FORM—PAGE ONE Assessor's Parcel Number. 2 2 1 1 0 - 3 2 - 9 0 0 2 3
A design will be reviewed when 3 copis of each of the following arc submitted:
"Completed design farm that has been signed and dared. 'Scaled layout sketch,including all applicable items on checklist
r Scaled plot plan,including all applicable items on checklist. r Cross-section sketch,including all applicable items on checklist.
Mmrimrun rsire. 11"X17"
Permit NumMn: SWG2-0/1--00ad°1 Designer's Nerve: ROBERT H.PAYSSE
Applicant's Name: JUSTINCLAIR Designer's Phone Number: 360426-1803
Mailing Address: 19418-24TH STREET.KPS Designer's Address: 3083 E.MASON BENSON RD
LAKEBAY,WA 98349 GRAPEVIEW WA 98546
C' State Zi State Zi
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Treatment Device
❑01todun Rinfinw, ❑Sard Pilrcr ❑mmod ❑Sand Load Drainfield ❑Rec'uculeting Film,Type:
❑Aerobic Unit Make/Model ❑Distakation Unit Make Model Other:
Drainfield Type
■Gravity ❑Pressure ■Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfreld Specifications Lateral
Number off3crim ens TWO Sched.16Class 2729
Daily Flow:Opmating Capacity 240 gpd Length 20 it
Daily Flow:Design Flow 240 Rind Diameter 4 in
Septic Tank Capacity 1200 gal Number 4
Receiving Soil Type(1-6) 2 Separation 10 ft
Receiving Soil Appl.Rate 1.0 gpd/ft' Orifices
Required Square Footage 240 W Total NumberofOrifices
Designed Square Foougc 240 ft Diameter in
Percent Reduction Taken NA % Spacing in
Trench/Bed Width 3 ft Manifold
Tmch/Bed Length 80 it Schedue/Class 3034
Elevation Measurements lagrh 30 R
Original Dodedic d Arta Slope 3 % Diameter 4 in
New Slope,If Altered 3 % FreferrM manifold configuration used? ■Yes O No
Depth of Excavation Upalo,e 33&25 in Tcaosport Pipe
fimo Original Garde on m.aiope 32&24 in Schedule/Class
3034
Designed Vertical Separation 36+ in Length 10 R
Grevelless Chambers Required? ❑Yes ■No O Optional Diameter 4 in
Pump Required? ❑Yes ■No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdosWday
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal
Orifice R Chamber Capacity gal
Uppermost Orifice O Higher O lower than Pump Shuuff Pump controls:Please check those required.
Capacity @ Total Pressure Head giant, OTimm DElapse Meter D Event Counter
Calculated Total Pressure Had R If Timer:
PP ROVED
MC PI IRI Ir, Weal TH
NOV 17 2015
CEW
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OFFKUILUSEONLY
MASON COUNTY PUBLIC HEALTH
ONSITE SEWAGE SYSTEM APPLICATION
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19418-24TH STREET KPS - LAKEBAY,WA 98349 ;
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751 E MASON BENSON ROAD - GRAPEVIEW,WA 98546 a
NN ROBERT —LE I N
RO3 H.PAYSSE 60-426-1803
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FROM SHELTON: NORTH ON HWY 3TO LEFT ON MASON BENSON ROAD. DRIVETO ADDRESS
751,TURN AT MAILBOX. TRAVEL ABOUT 1/4 MILE INTO SITE.
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Public' Health
Always worldng for a safer hIalthier Mason County
November 17, 2015
Pioneer Digging
3083 E Mason Benson Rd
Grapeview WA 98546
RE: Design for CLAIR
Case No: SWG2015-00285
Parcel No: 221103290023
Your on-site sewage system design for the above referenced parcel has been
reviewed and is APPROVED. The system must be installed by a Mason County
Certified Installer. A list of installers is available on the Mason County Public Health
WEB page at www.HealthyMasonCounty.org Select Environmental Health, then
On-site Sewage Systems.
In some cases, homeowners may be allowed to install their own system. Prior
approval by Mason County Public Health is required.
Please refer to the comments section of this letter for any additional information.
Please call me at (360)427-9670, ext. 353 if you have any questions.
Sincerely,
aL �
Environmental Health
Mason County Public Health
COMMENTS:
11/1 712 01 5 Page 1 of 1 SWG2015-00285
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Designer Notes for: Conventional Gravity Septic System
Installer must contact designer prior to installation to arrange a pre-site meeting.
:• After installation, designer will inspect system and perform an asbuilt. An additional sign-off fee of
$300.00 may apply for this service.
4• Install risers to surface on Septic Tank and D-Box(s)as per design.
System must gravity flow from component to component
❖ No curtain drains allowed within 10' of the upslope edge and 30' of the downslope edge of
drainfield or reserve area.
fi All materials and workmanship must meet County and State Regulations
❖ Deviation from this design without prior written approval from the designer and Mason County
Health Dept. will make this design null and void.
v The prepared plot plan is not a survey; it is the owner's responsibility to verify property line
locations,all easements, and encroachments prior to installation. Any discrepancies must be
reported to the designer immediately.
t This design is intended to meet State and local health dept. requirements that are related to the
system being proposed. Any placement of proposed buildings, proposed wells or other non related
items on these drawings may or may not meet local and or state requirements. It is the property
owner's responsibility to determine what is acceptable to the various departments for non-related
items.
❖ Install this system in dry weather.
❖ Always clear drainfield area(of trees and debris)carefully to not disturb soil depth.
❖ Septic Tank should be installed level on original soil as per manufacturers instructions.
e For protection of the drainfield, no traffic is allowed on top of the proposed drainfield areas.
•:• Encroachment of house and/or driveway into drainfield areas may render this design and site
unusable.
❖ All roof drains and downspouts shall be directed away from drainfield areas.
f• Installer must follow Mason County Health Department regulations for final inspection.
PIONEER DIGGING, ING MC PIPROVED H
SEPTIC DESIGNS N6\0f 2015
3�
"3EMASJNKE &A Ka GRAKVWW %Mt
, 426IW3 F .WA
tk:E A 27n53 CEW
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
426 W CEDAR ST, PO BOX 1666. SHELTON WA 98534
SHELTON (360)427-9670 ELMA (360)482-5269 BELFAIR (360)275-4467
WEB htW/A~v.co.mason.wa.us FAX (360)427-7798
APPLICATION FOR WELL SURFACE SEAL CONSTRUCTION PERMIT
RFf EIVED Receipt Number �gU6j-/5 WEC: off` f
1. Complete Part 1, incomplete applications will not be accepted
JAIL 2 6 Rm u 2. Attach a plot plan and vicinity map
3. Submit this completed application with appropriate feels)a minima n of 24 hours
gyp'7j,,1 (Cp,, in advance of initiating well construction.
(7y�T4(%1Cq ICE , E14. The Mason County Health Dept must receive notification at least 24 hours prior to
the drilling of the well
PART 1:Applicant/Parcel IdentMution 1
Site Address -r/�,S //�E� �'✓�(��i,$o.� (�2v\5C, k d Start Card 0 W 1 (p
Dnllmg Firm Tog 'N Df: WI.4 CD PII.36e "4 .f•-2Sal
Applicant � �ro �'y{� �- —/^ Phan 34 4_ 22 7-223 2
Mailing Address 7�w ✓'e, c
city 4.`1 A (tq r�
f �1 still, A zipParcel Numbx `0% l 012 dG� mac
Directions to Site LA -✓Y 3 � /ry' 1#s iD j3p- e a� l�
_ .5,4 &CLe35 d--�
A
Is the well site within 100 feet of gait/seawater? Oyes.NNO
If yes,a ance from DOE is required. Have you applied/received(circle one)a variance? ❑Yea ❑No
Appk*t/Agent Signature
PART 3: Health 13"mnem Review(Staff Use Only)
VES NQ TAG a PVC)5 Z G Called In
1P9j• Driller on Site?
Is the well capped and Vented?
❑ Is Here evidence of a surface seal?
❑ Is there a 2'annular space on all sides of the casing?
Has the seal Slumped?
❑ Is the well flowing or is Mere evidence of other leakage?
Is Mere evidence of cascading water?
Is Mere evidence that the seal Is at least 18 feet long?
❑ Do the well she set-backs appear to be appropriate?
Comments
Paaa Fail Inspector Data Z3 O
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