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HomeMy WebLinkAboutSWG2025-00097 - SWG Application / Design - 3/25/2025 415 N 6TH STREET,SHELTON,WA 98584 a" . MASON COUNTY SHELTON:360-427-9670,EXT 400 BELFAIR:360-275.4467,EXT 400 Public Health & Human Services ELMA:360.482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2025-00097 APPLICANT CHRIS ELSTROTT* Phone: 360-561-5000 I Address: 128 NORTH RIVER STREET MONTESANO, WA 98563 OWNER ENGER MELVIN D Phone: 360-780-3999 Address: 8391 E STATE ROUTE 3 SHELTON, WA 98584 Site Address: 1170 E Bertlesen Rd Primary Parcel Number: 220072250020 Permit Description: New 3-bedroom pressure system w/Class B waiver I Permit Submitted Date: 03/25/2025 Permit Issued Date: 05/07/2025 Issued By: David Anderson Current Permit Fees Paid: $555.00 (additional fees may be required upon installation or system). Permit Expiration Date: 04/23/2028 (based on date of inspection) Permit Conditions: 1 Proposed development subject to zoning requirements and approval by the planning ii 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 Drain field 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 backlit!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/healthlenvironmentallonsiteloss-inspection-request.php or call: 360-427-9670, extension 400. 1 OFFICIAL USE ONLY oATERECENEo � � �� 7� MASON COUNTY S C 0 N COMMUNITY SERVICES ANAUNTRKEIJE RECENTOIBE o 0 S�; Gh�l z v PubtIc Health(Cornmonily Health/Envirumnentalhealth) �� � O 1tOa %77- T6.e.�'.OaSt?17S-ct6T,e 2 e10 SWG Zags 415 N 6N SttNt•StAoh.NA<SSst O Z In ON-SITE SEWAGE SYSTEM APPLICATION z x m PHONE Ill APPLICANT m 1/044 c./2 . )/-/574"- y3 e— 785, — 3 mil'5 9 c h1A1LINGADDRESS-STREET,CITY.STATE,ZIP CODE W Flo le/ 1< s STD C S3 44•1/ lri�9 q s2" 73 m SITE ADDRESS-STREET.CITY,ZIP CODE / / //70 0 Ber /e se., .Pot. Sd eiJ7�r. .L✓'� 7 se% li NAME OF DESIGNER / PHONE IN eA,,,s e/s/ro - 3 6 0- .-d / - 5-0a 0 NAME OF INSTALLER PHONE 0 I0 N Io PERMIT�� TYPE�(select one) DRINKING WATER SOURCE Q 1 ,RESIDENTIAL OSS 1J COMMUNITY OSS VI COMMERCIAL OSS L rHIVATE INDIVIDUAL WELL : RIVATE TWO-PARTY WELL Z p'PUBLIC WATER SYSTEM TYPE OF WOOR (sa:xt or.) I fEW CONSTRUCTION I UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(.s&&eT that apply) El TABLE IX REPAIR t) 0 SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE W I SUBldiTTa,.. - S �-ION FORM(REQUIRED) PTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE T" 16.0W ii /7.5 4tC r 1 0 �WIUVER(S)(IF APPLICABLE) I DIRECTIONS TO SITE AND SITE CONDITIONS.(er.kxkad vale) t //7t' E. fame/.7Ir-lseA A- . Sec fvAv /iy'' _'1 t �� „ O 100.,:i //7),A, 4,44 7) X,0,,,,,_ T 4 e /Ale /-alicd o lei -I It) SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I OFFICIAL USE ONLY BELOW THIS LINE - UPGRADE/FAILURE SOURCE(for repotting purposes) ❑VOLUNTARY ❑MAINTENANCEJPUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS 7t1i•0 .7Y' 6 c6 (? , a ) tied- Pr v( u Ono ic TNz: 0 . 2Y '' Est 10-4f Zy" '( ill I 4 Ma f ift :O- f ' (75t NCI at1f' '1 ft tf/ f( fztd,L RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: V=VERY G=GRAVELLY S=SAND l=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. NSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE MPL)//Iljj/Gf/,ij�/�/f])[1IIONAPPROVED/ISSSUEDBY DATE IfiN- W/7/ 7015- I V 5 37?1r 207 5 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/72015 DESIGN FORM-PAGE ONE Assessor's Parcel Number: 2 2 d O 7 -- 2-2- -- 5-d 0 2_Q A design will he 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. v Cross-section sketch,including all applicable items on checklist. • This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"A'17" PARCEL IDENTIFICATION Permit Number: SWU ?fJ V -00 0 7- Designer's Name: Chris £/ "-co Applicant's Name: /37a,•2q e fie. 6i.iS7/7ac.*)..r Designer's Phone Number: 3C0- g-d./-.t"ae.xii ___. Mailing Address: /I61 tJ k.Si: .S ' C. Designer's Address: /2e N- Riti.E,Q sT- SA e/,`a,,, w >J 4 ges ma.r/csa r70,A//4 98s-d 3' 1 City State Zip City State Zip DESIGN PARAMETERS Treatment Device ❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: ❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Pfess, .Us7`. Dnfield Type ❑Gravity ressure aTrench 0 Bed 0 Sub Surface Drip Septic'1'ank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 50 Daily Flow:Operating Capacity 2 41,. 25est.., gpd Length S-0 ft Daily Flow: Design Flow 31,p gpd Diameter /y in Septic Tank Capacity(working) /2ofl gal Number y 0 Receiving Soil Type(1-6) y Separation e ft Receiving Soil Appl.Rate D,6 gpd/ft2 Orifices Required Primary Area (Gd ft2 Total Number of Orifices off Designed Primary Area 'op ft2 Diameter 2//6 in Designed Reserve Area 660 ft2 Spacing 3d in Trench/Bed Width ,3 ft Manifold Trench/Bed Length 204 ft SO_hedul /Class Vo Elevation Measurements Length .y ft Original Drainfield Area Slope 3 % Diameter 2 in New Slope,If Altered % Preferred manifold configuration used? 0 Yes ©'No Depth of Excavation U1)1100c g in Transport Pipe from Original Grade Down slope 2 ` in Schedule/Class S/o Designed Vertical Separation /3 in Length 7C ft Graveness Chambers Required? Ds 0 No 0 Optional Diameter 2 in Pump Required? I 0 No Dosing and Pump Chamber Pump/Siphon Specifications /M Number of doses/day NY Dill'in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity /2G gal r.Ai: Drainfield Squirt I'eight/Selected Residual(head) S ft Chamber Capacity(flood) /245) gal Uppermost Orifice Higher 0 Lower than Pump Shutoff Pump�ccontr�_�ols: Please check those required. Capacity @ Total Pressure Head S3 gpm CtTrmer apse Meter vent Counter Calculated Total Pressure Head if ft if Tinier: Pump on ja e3e"S•cr`,Pump off Comments 10r.3R1sr ei,a,7o41 1 DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 O o Z -- 2 2. -- S 0 0 2 Permit Number: SWG DESIGN CHECKLISTS Scaledle Plot Plan Scat Layout Sketch Cross-Section Sketch Ill best hole locations Dr infield orientation and layout Reference depth from original grade: I,- oil logs f bed dimensions and iptic tank Q.—perty lines critical distances within layout [5 Drainfield cover kf D-13ox/Valve box locations 0-'Existing and proposed wells Reference depth from original grade within 100 ft of property Septic tank/pump chamber and restrictive�__�� strata: 32( Measurements to cuts,banks,and locations D' Laterals,trench/bed,top and surface water and critical areas a -Observation port location bottom of Location and orientation of' Clean-out location ,Er Curtain drain collector curtain drain and all absorption [ �i[ ifold placement V Sand augmentation �mponents CI'Or' ice placement Other cross-section detail: [3 Location and dimension of Lateral placement with distance 0 Observation ports/clean-outs primary system and reserve area toe ge of bed Other Information Direction edible/visual alarm referenced Yes No C9�lljrection of slope indicator ❑.Scale of drawing shown on scale 0 esign staked out ❑ W terlines bar �1 Recorded Notices attached a-'Roads,easements,driveways, IIK 0 Waiver(s)attached par ng Qom❑� P}9�►np curve attached orth arrow and scale drawing 0 Cd'Evaluation of failure shown on scale bar Non-r ential justification Waste strength ow DESIGN APPROVAL The undersigned designer must he notified by installer at time of installation es 0 No 3-2r'"Zr' S nature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be ir, compliance with state and local on-site ' lations: ) - F7P( / 52— ef Env •onmental Health Specialist DatV'C,Cl„ fr CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CdIl1,,ITIOI ✓ The design is stamped"Approved"by Mason County Public Health. ` n e"�j ,%?tge ✓ The Onsitc Sewage Permit has riot expired,the Permit Expiration Date is: 7(2 j / Drainfield site conditions have not been altered to adversely affect conditions of design approval. ? y,.` 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: 12/7/2015 . . . . . • . NELD ............ k��8 ! i — in�ti** r p is•saaassis RrP d 1111 glii s �a 1 •■■i d O IP is ":XEYLCGt1 a > a 'i ° y b 1g i ili { .III �a Gtn ar n : i " E i C .��t�r'a� V\ f. —-44—' tiN : 00: . ''''' '"' " ,r1 K s raluisill :" "di . IIIFfignini Pi 111111. .., avi.a a _ 0 ': Aar; a "" olio 1:. � i 111. i e, _..i , -a _ v b...... sR� o g;" 4' oil ■►I�� "t i ivy vs m Ps L r ` _, ° 4.44c.i ti .31 ON Cn r - A c� - z n%Ink r ,... - ,- - , ,, , U , ,,.. ,, $ o % oiio ; `• , n e5 • M • tee y fi > T1 aiii ' b -'7' ' . t'''c- ...1 CN 14 N\,,,, i il �. , a ,�,. __�r, igr mil __ •_ `1:. 0 > I 3g 1 g g : I ------1, ..-A r=--- • i ,,k,..: i ' :e's® 0 N L., lib* i rs' .v. f•-•-• G.= g-,... '', dr / S i „„11011 -a --71 0Z 1. !ii i d • cD /J,„, D. f r.,„ 4 l rn --4C C/1/ CJ ;G C 1 44 t.. CD v X. 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