HomeMy WebLinkAboutSWG2024-00017 - SWG Application / Design - 1/12/2024 415 N BTH STREET,SHELTON,WA98584
ON SH
MASON COUNTY ELT :360427-9670,EXT 400
HELON:360-275 ,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00017
APPLICANT CROOKS
R g NOR HAA KE WAY NW BREMERTO NDER Phone:
98312 253-269-8880
Address:
OWNER CROOKS ISAAC 3318 NOR HLAKE WAY XANDER Pone:NWNW REMERTON h 253-269-8880
Address: WA 98312
SEPTIC DESIGNER ROD LEFT' Phone: 360-698-8488
Address: PO BOX 2954 SILVERDALE,WA 98383
Site Address: 20 NE Cheyenne Hill Dr
Primary Parcel Number: 222057500020
Permit Description: New SFR-3BR Pressure
Permit Submitted Date: 0111212024
Permit Issued Date: 02/1012025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $540.00 laddloonai fees may be required a000 lmtaliadoo a sysremy
Permit Expiration Date: 0212012027 leased on data of mspeodool
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Titte 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 speed 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 DesignerfEngineer 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.govlhealthlenvimnmentallonsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
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• OFFICIAL USE ONLY
G.RPFCENFD _ JAN 162024
MASON COUNTY
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Kali Vickery & Isaac Crooks
MNLINGI.oLHE55-STREET LIIT.3lATE.SIPLWE 1 Belfair WA 98528 m
PO Box 701
SIIEADCR,S,-STREET.CDTHPOODE s '1. Belfair WA 98528 "'
�pjc NE Cheyenne Hill Dr PHONE
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Rod Left ` PM NE o_ ^'
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[OD'ESIGN FORM(REWIRED) ®SEPTIC DESIGN(REWIRED) BEDRlYJt6 3 Swf -323,650
LAInAIVER(S)(IF APPLICABLE) 10
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OFFICIAL USE ONLY BELOW THIS LINE
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❑VOLUNTARY ❑MAIMENANLEIPUMPING ❑BUILDING PERMIT ❑HOME BALE ❑COMPLAINT ❑MTNTS)�Noffn R
INSPECTOR SgLLOGS
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f C, L 5 FEB 10 2025 D
COUNTY ENVIRONMENTAL HEALTH
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REgMD MAVIING..ND IMTK—ON REED'
SOILLOOES: REOUIRESICNFI1LLMPROVAL
V=VERY G-GMVEILY S-SAAD ✓LONA S-SILT CLAY E-E EMELY R-SUCTS �.NAMFOVEWIWUEO SY
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MI FO YBE SCANNED AND AVAILABLE FOR PUBLIC AMONy THE„/MASONN CCOUNTV WEBSITE
DESIGN FORM—PACE ONE Assessoi s Parcel Number: 2 2 2 0 5 — 7 5 — 0 0 0 2 0
A design will be reviewed when 3 copies of each of the following are submitted:
v Completed design form that has been signed and dated. °Scaled layout sketch,including all applicable items on checklist
• Staled plot plan,including ell ap& cble items on checklist °Cmss-secnon sketch,including all applicable items on checklist.
This form may be scanned and available for public view an the Mason county Web site.Mosimum oper x ize: 1 i"X 17"
PARCEI;IDE,1'TIFICATION
C9017 Desi er's Name: Rod Left _
PermitAumber. SWG���!� g°
Kali Vickery� IS�ljD (t(3LS Designer's Phone Number: 360-698-8488
Applicant's Name: PO Box 2954
Mailing Address: PO Box 701 Designer's Address:
9edalr WA 98528 61Nerdale WA 98383
Cit V State Zi Cit State Zi
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofiaa ❑Sand Filter ❑Mound ElSend Lived Dtalvfield ❑lbsomolaing Filter,Type:
[3 Amebic Unit MakdModel ElDidnfecdon Unit MnkelModel Other:
Drainfield Type
G(Gravity ❑Pressure hf Teench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfseld Specifications Laterals
NumberofBedrooms 3 Schedule/Class 40
Daily Flow:Operating Capacity 360 gpd Length 50 it
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity a.50 gal Number 4
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Anal.Rate .6 gpd/ftr Orifices
Required Peary Area 600 ft Trust Number of Orifices NA
Designed Primary Area 600 ftr Diameter NA in
Designed Reserve Area 600 1t2 Spacing NA in
Teench/Bed Width 3 ft Manifold
Trencbed Length 200 ft Schedule/Class 40
B
Elevation Measurements Lengtb 37 ft
Original Drainfield Area Slope 3-5 % Diameter 4 In
New Slope,If Altered 3-5 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-ate 20 in Transport Pipe
ftom Original Grade N.,j pe 17 in Schedule/Class 40
Designed Vertical Separation 36 in Length 40 ft
Gravelless Chambers Required? ❑Yes 0 No f60pflopal Diameter 4 in
Pump Required? ❑Yes 56No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day NA
Difference in Elevation Between Pump Shutoff and Uppertvos[ Dose quantity
NA gal
Onfice NA ft Chamber Capacity NA gal
Uppermost Orifice O Higher 0 Lower than Pump Shumff Pump controls:Please check those required.
Capacity Q Total Pressure Head Spur OTimer DElapse Meter ❑Event Counter
Calculated Total Pressure Head ft If Timer: Pump on .Pump off
Comments P P R O V I
MASONCOuNTY FNVIRONr I'P41.�E LTN
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DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 2 0 5 — 7 5 -- 0 0 0
Permit Number: SWG
DESIGN CHECKLISTS `
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch '
Ed Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
Ed Soil logs Ed Trench/bed dimensions and Rf Septic tank
R1 Property lines
critical distances within layout ❑ Drandeld cover
D-Box/Valve box locations
III Existing and proposed wells Reference depth from original grade
within 100 ft of property 56 Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations [9 Laterals,trench/bed,top and
surface water and critical was 59 Observation port location bottom
❑ Location and orientation of 19 Clean-0ut location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
m Location and dimension of Rf Lateral placement with distance (9 Observation ports/cleanouts
primary system and reserve area to edge of bed Other Information
!a Buildings ❑ Audible/visual alarm referenced Yes No
Ed Direction of slope indicator R1 Scale of drawing shown on scale ❑ d Design staked out
m Waterlines bar ❑ Rf Recorded Notices attached
Roads,easements,driveways, ❑ Rf W aiver(s)attached
ping ❑ Gd Pump curve attached
19 North arrow and scale drawing
❑ [9 Evaluation of failure
shown on scale bar Non-residential justification
El R Writestrength
❑ 5 Flow
DESIGN APPROVAL
The undersigned designer must be notified by ia5taller at time o installation I�Yes ❑ No
/V To,^ aea'l
Si eofDesigner Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
H
compliance with state and local oo- regulations:
Fur 'Wealth Specialist Date
CAUTION: DESIGN APP VAL 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
✓ 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 re uired.
This form y I r puhlic view on the Mason County Web site.
Updated Dete. 12/]2015
fE6 10 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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