HomeMy WebLinkAboutSWG2024-00437 - SWG Application / Design - 11/8/2024 LTON,WA
MASON COUNTY 415NBTH STREET,SHE7-967 ,E98584
$HELTON:360>27-4467,EXT 400
BELFAIR:3fi0.275-0487,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX 360427-7787
On-Site Sewage System Permit: SWG2024-00437
APPLICANT ILIFF REVOCABLE TRUST ET AL Phone: 540-931-3630
KERRY PATRICE
Address: 38283 COLES CT HAMILTON, VA 20158
OWNER ILIFF REVOCABLE TRUST ET AL Phone: 540-931-3630
KERRY PATRICE
Address: 38283 COLES CT HAMILTON,VA 20158
SEPTIC DESIGNER DALE TAHJA' Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON,WA 98584
Site Address: 2561 E Harstine Island Rd N
Primary Parcel Number: 221354190040
Permit Description: New 5-bedroom gravity system wl Class B waiver
Permit Submitted Date: 11108/2024
Permit Issued Date: 02/05/2025
Issued By: David Anderson
Current Permit Fees Paid: $805.00 (additional fees may ve reaasea ayon hstallatlor ofayslanni
Permit Expiration Date: 12104/2027 (based on dale of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staflper 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 Asbuilt Farm, 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/environmentallonSite/055-inspection-request.php or call:
360-427.9670, extension 400.
OFFICIAL USE ONLY
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APPLIGN!
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Samantha Hill (540) 931-3630 c
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19321 40th Ave. W. Unit 62 o m nnwood WA 98036 z
STf ADDRESS-STREET.CITY ZIP CODE o .
2561 E. Harstine Island Rd. N. o helton WA 98584 ^�
NANSa MSGNER PHONE I N
Dale L. Tahja o T (360) 426-5940
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Go onto Harstine Island, turn left onto North Island Dr., right at the Community Center onto
Harstine Island Dr. N., property directly across from Yates Rd. Due to locked gates, please r
schedule inspection with Dale Tahja at (360)426-5940.
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OFFICIAL USE ONLY BELOW THIS LINE
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THL4 FORM NAY BE SCANNED AND AVARABLE FOR PUIILIC VIEW ON THE MASCN COUNTY EAEBSITE REVISED IW=15
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 3 5 — 4 1 — 9 0 0 4 0
A design will be reviewed when 3 conies of each of the following are 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. •Cross-section sketch,including all applicable items on checklist.
This torn maybe scanned and available for public view on the Mason County Web site.Mmimum paper size: 11"X 17"
PARCEL IDENTIFICA
Permit Nmnber: SWG 2024-00437 Designer's Name: Dale Tahja
Applicant's Name: Samantha 19rt Designer's Phone Number. (360)463A023
Mailing Address: 19321 4091 Ave.W.Unit B2 Designer's Address: 2450 W Deegan Rd W
Lynnwood WA 98m8 Station WA 96584
C' State Zi C pute Zi
Treatment Device
O Glendon Biofilmr ❑Sand Filter [I Mound ❑Sand Lined Dminfield ❑RecacWeting Filter,Type:
❑Aerobic Unit Maim/Model ❑Disinfection Unit Make/Model Other: WA
..! Drainfleld Type
m Gm,ity ❑pressure hiTresch ❑Bed ❑Sub Surfine Drip
Septic Tank/Drainfieid Specifications Laterals
Number of Bedrooms 5 Schedule/Class 3034
Daily Flow:Operating Capacity 450 gpd Length 64 11
Daily Flow:Design Flow 600 god Diameter 4 in
Septic Tank Capacity(working) 1,500 gal Number 4
Receiving Soil Type(16) 3 Separation 6 ft
Receiving Soil Appl.Rate 0.8 gp&fe Orifices
Required Primary Ares 750 ft Total Number of Orifices Pert. Pipe
Designed Primary Area 750 if Diameter in
Designed Reserve Ares 750 ftz Spacing in
Treach/Bed Width 3 ft Manifold
Trench/Bed Length 256 ft Schedule/Class 3034
Elevation Measurements Length 60 It
Original Drawfield Mcasope 6 % Diameter 4 in
New Slope,If Altered 5 % Preferred manifold configuration used? ❑Yes RrNo
Depth of Excavation Urdgp 18 in Transport Pipe
from Original Grade Ibv ,1. 16 in Schedule/Class 3034
Designed Vertical Separation 24 in Length 10 ft
Gmvellcw Chambers Required? ❑Yes O No RfOpdoml Diameter 4 in
Pump Required? ❑Yes RfNo Daring and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day Gravity
Diff.in Elevation Between Pump&Uppermost Orifice X ft Dose quantity X gal
Dminfield Squirt Height/Selected Residual(head) X ft Chamber Capacity(flood) X gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head Gravity spin OTimer OElapse Meter O Event Counter
Calculated Total Pressure Had X it If Timer: Pump on X .Pump off X
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Nu nber:2 2 1 3 5u — 4 1 — 9 0 0 4 0
Permit Number: SWG�oS'.k'ob \3�
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
ld Test hole locations 16 Drainfield orientation and layout Reference depth from original grade:
ld Soil logs ld Trench bed dimensions and Ed Septic tank
Id Property lines critical distances within layout 61 Drainfield cover
id Existingand wells li! D-BoxNalve box locations
proposed Reference depth from original grade
within 100 ft of property 16 Septic tank/pump chamber and restrictive strata:
9 Measurements to cuts,banks,and locations [9 Laterals,trench/bed,top and
surface water and critical areas 16 Observation port location bottom
19 Location and orientation of Ill Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Ed Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
id Location and dimension of Ed Lateral placement with distance 56 Observation ports/clean-outs
primary system and reserve area a of bed
to�8 Other Information
11 Buildings ❑ Audiblelvisual slarm referenced Yes No
Is Direction of slope indicator Id Scale of drawing shown on scale Bf ❑Design staked out
16 Waterlines ❑ ❑RecordedNotices attached
Ia Roads,easements,driveways, E6 ❑Waiver(s)attached
parking ❑ ❑Pump curve attached
Id North arrow and scale drawing ❑ ❑Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer m \ben otifi b 'rate ered [time of installation Ed Yes
❑ No
Signature o Designer Date ¢ ¢
I�/ y
revrewed this design ou behalf of Mason County Public Health and it to hj
d local on ' gulations: �v o
o
pV4O,1yFyT Environmental Health Specialist - Dete SyM�1iS� c
CAUTION:kSIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING COND
✓ The design £jamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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*
e uired.
This form army be meanned and available for public iew on the Mason County Web site.
Updated Date: 12IT2015
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MASON COUNTY ENVIRONMENTAL HEALTH
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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 30ft. 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.
I LLocate all utilities prior to starting installation.
APPROVE p
FED 0 5 2025
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