HomeMy WebLinkAboutSWG2024-00415 - SWG Application / Design - 10/14/2024 MASON COUNTY 415N6 SHELTON: , 0427-97 ,EXT 400
SH STREET,
,SHEL-ON,W XT 400
BELFAIR:360-275-4467,UT400
Public Health & Human Services ELMA:360482526%EXT 400
FAX 360-427-7787
On-Site Sewage System Permit: SWG2024-00415
APPLICANT Dean Goldy Phone:
Address: PO Box 159 MATLOCK, WA 98560
OWNER SANTA RITA BUILDERS LLC Phone:
Address: 813 HOSPITAL DR ANDREWS, TX 79714
SEPTIC DESIGNER ADAM HUNTER` Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
SEPTIC INSTALLER TRAVIS VILLINES' Phone: 360-789-1365
Address. PO BOX 11790 OLYMPIA, WA 98508
Site Address: 31 E ASPEN CT
Primary Parcel Number: 220075000065
Permit Description: Conforming 3bd upgrade/repair ATU to subsurface drip
Permit Submitted Date: 10/14/2024
Permit Issued Date: 12120/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid. $805.00 (additional ees my be required upon installation ofsystem).
Permit Expiration Date: 10/29/2027 (basedon date onnepectbn)
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 DesignedEngineer 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/environmental/onsite/oss-inspection-request.php or call:
360-427.9670,extension 400.
i
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH °" ""`"°' 10/14/2024
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ONSITE SEWAGE SYSTEM APPLICATION MOERRaFn 0: goy " ° °°" online
415 N St,4rce4(Bldg B) Shelton WA,90584 ° IT
SheIMn:3fi0.4D-9670eM400 BeRair.36PD5d4fi7e>2400 SWG 2024-00415
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APPLICANT PHONE Z D
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DEAN GOLDY 3605846062 m O
MNONGADDRESS-STREU,,CITY.STATE,ZIP CODE
PO BOX 159 MATLOCK WA 98560 c
SITE ADDRESS-STREET.CITY,ZIP CODE m
31 E ASPEN CT SHELTON WA 98584 z
NAME OF DESIGNER PHONE
ADAM HUNTER 3607531226
NAME OF INSTALLER PHONE
TRAVIS VILLINES nN
CHECKAU.APPLN:ABIF ITEMS DRINKING MNTER SOURCE I,^v
❑ NEWCONSTRUCTION 0 RV HOLDING TANK ONLY 0 PRNATEINDNIDUALWELL < v
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Ld REPIACEMENTSYSTEM ❑ INSTALIATIONPERMITONLY ❑ PRIVATETWO-PARTYWELL O
[] TABLE B REPAIR O SINGLE FAMILY Lq COMMUNITY/PUBLIC YWTER SYSTEM Z
❑ TANKS)ONLY [] COMMERCIAL SYSTEM NAME: �1
UPGRADE TO EXISTING 0 OTHER: BEDROOMS LOTSRE Imo '
Lq EXISTING FAILURE "Re[pp McMnp requNed 3 U 18 W O
MwlniWlwme" r B
DIRECIHINS TO SITE-BE SPECRICANDAONSE OFANY NEEDED INFORMATION FORACCESS PA,Iu hems) O IO—
TIMBERLAKE TO A LEFT ON ASPEN PL TO A RIGHT ON ASPEN CT K )
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SREMUST SE FLAGGED FROMWVNIIOApgryD TESTHOLESMUSTSEFLAGGED NTTM TESTNOIENUMBERS
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE nor H"pR l
❑VOLUNTARY DMAINTENANCEIPUMPING O BUILDING PERMIT ❑HOMESALE []COMPLAINT OOTHER'.
INSPECTOR SOIL LOGS COMMENTS/CONDRIONS
TH1: 0-28 GSL, 28+ mott
TH2: 0-22 GSL, 22+ mott
SOILGODES:
V=VERY G=GMVEMY S=SAND --LOAM V=SILT C=CLAY E=EMREMELY R=ROOTS
INSPECTOR SIGNATURE ATE APPLICATION EXPIRATION DATE APPLICATION APPROVED BY DAIS
>yT�DSIWL 10/29/24 10/29/27 v r or• p5 12/20/24
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WESSITE REVISED I2TW5
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 22007-50-00065
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. v Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. 0 Cross-section sketch, including all applicable items on checklist.
This form maybe scanned and available for public view on the Mason County Web site.M=imum paper size: /1"Xl7"
PARCEL IDENTIFICATION
Permit Number: SWG 2024-00415 Designer's Name: ADAM HUNTER
Applicant's Name: DEAN GOLDY Designer's Phone Number: 360-753-1226
Mailing Address: PO BOX 159 Designer's Address: PO BOX 162
MATLOCK WA 98560 OLYMPIA WA 98507
City State Zip city State Zip
DESIGN PARAMETERS
Treatment Device
❑ Glendon Biofilter ❑ Sand Filter ❑Mound ❑Sand Lined Dminfield ❑ Recirculating Filter,Type:
6YAembic Unit Mske/Modcl BNR-600 ❑Disinfection Unit Make/Model Other:
Drainfield Type
❑ Gravity ❑Pressure ❑Trench 0 Bed EYSUb Surface Drip
Septic Tank(Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class DRIP
Daily Flow:Operating Capacity 270 gpd Length 90-110 tt
Daily Flow:Design Flow 360 gpd Diameter 12 in
Septic Tank Capacity BNR600 gal Number 5
Receiving Soil Typo(1-6) 4 Separation 1.5 ft
Receiving Soil Appl.Raze 0.6 gpd/ft Orifices
Required Primary Area 675 ft, Total Number of Orifices DRIP 450
Designed Primary Area 675 ft, Diameter DRIP in
Designed Reserve Area 900 P&PAk1� ftc Spacing DRIP 12 in
Trench/Bed Width VARIES ft Manifold
Trench/Bed Length VARIES ft Schedule/Class 40
Elevation Measurements Length 15 ft
Original Drainfield Area Slope 2 % Diameter 1 in
New Slope,If Altered 2 % Preferred manifold configuration used? IYYes O No
Depth of Excavation Up-stope 9 in Transport Pipe
from Original Grade Down-slape 9 in Schedule/Class 40
Designed Vertical Separation 12 in Length 15 ft
Gravelless Chambers Required? ❑ Yes dNo 17 Optional Diameter 1 in
Pump Required? E�Yes D No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day 12
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity 30 gal
Orifice ' ft Chamber Capacity 1200 gal
Uppermost Orifice dHigher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head 132 gpm EyTimer R$lapse Meter V Event Counter
Calculated Total Pressure Head 112.7 R If Timer: Pump on 30GAL ,Pump off 2HRS
Comments
EH APPROVED
Rhonda Thompson 12/2012024
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 22007-550-09005____
Permit Number: SWG 2024-00415
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Rf Test hole locations EZ Drainfield orientation and layout Reference depth from original grade:
19 Soil logs 9 Trench/bed dimensions and 9 Septic tank
9 Property lines critical distances within layout EZ Drainfield cover
[9 Existing and proposed wells 9 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 9 Septic tank/pump chamber and restrictive strata:
13 Measurements to cuts,banks,and locations ❑ Laterals,trench/bed,top and
surface water and critical areas 1Z Observation port location bottom
IZ Location and orientation of 9 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Rf Manifold placement ❑ Sand augmentation
components 1Z Orifice placement Other cross-section detail:
E9 Location and dimension of 9 Lateral placement with distance 9 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
0 Buildings
9 Audible/visual alarm referenced Yes No
E9 Direction of slope indicator E9 Scale of drawing shown on scale Design
d ❑ staked out
E9 Waterlines but ❑ ❑ Recorded Notices attached
IA Roads,easements,driveways, ❑ ❑ Waiver(s)attached
parking ❑ ❑ Pump curve attached
E9 North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer mus a noti let at time of installation d Yes ❑ No
10/14/24
t re of Designer Date
The undersigned has reviewed this gn on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site regulations
1P �IN�L 12/20/24
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. 10/29/27
✓ 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.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/72015
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