Loading...
HomeMy WebLinkAboutSWG2025-00162 - SWG Application / Design - 5/2/2025 MASONCOUNTY 415 N 6TH STREET,SHELTON. ,E 400 96 584 5HELTON:360-027-9679670XT 400 BELFAIR:360-2754467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2025-00162 OWNER HOOD CANAL CO OP INC Phone: Address: PO BOX 210363 AUKE BAY,AK 99821 APPLICANT PAUL JONES Phone: Address: 4333 PROVIDENCE POINT PLACE SE ISSAQUAH,WA 98029 SEPTIC INSTALLER SHAE OIEN` Phone: 360-340-1981 Address: 773 GRAND FIR DRIVE ATHOL, ID 83801 Site Address: UNKNOWN Primary Parcel Number: 322052000230 Permit Description: After the Fact tank replacement Permit Submitted Date: 05/02/2025 Permit Issued Date: 05/05/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $540.00 (additional tees may be required upon Installation of system). Permit Expiration Date: 051D517,UZ4 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Public Water System Additional Details: Septic tank Permit Conditions: 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 2 Permit must be Installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 3 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/OR 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/onslteloss-Inspection-request.php or call: 360-427-9870,extension 400. . noOFFICIAL USE ONLY DATE RECEIVED: 5- MASON COUNTY - c N 7 COMMUNITY SERVICES AMOUR(RE I'f CO ;KE`fl�D+�0 °° cn Public Health(CommunityHealth/EnvironmentalHealth) ` — g U1 415N.7i 70,tatStmet- art WA ezt,� SWG o& 5 - ©016a z 2 115 tf.6lh SUwt-SheF.on WA ft5e4 17 1. ON-SITE SEWAGE TANK ONLY APPLICATION Z n m n APPUCAN r PHONE mr Paul Jones (206) 310-0106 z c MAIUNG ADDRESS-STREET,CITY,STATE,ZIP CODE C 03 4333 Providence Point Place SE Issaquah, Wa 98029 m SITE ADDRESS-STREET,CITY,ZIP CODE 22491-181 NE North Shore Rd Tahuya W , NAME OF DESIGNER PHONE lJ NAME OF INSTALLER PHONE Q 7. Oien Construction Inc (360)340-1981 TYPE OF WORK(select one) DRINKING WATER SOURCE O NEW CONSTRUCTION/UPGRADES III REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL Cl PRIVATE TWO-PARTY WELL Z 0 COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM — I (D SEPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE N ❑ OTHER_ 2 Circle, 60`Diameter Cu — r O OTHER DETAILS(selecl Other apply) TANK(S)SETBACK CHECKUST Q CISURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CI100FT+PUBLIC/COMMUNITY WELLS 00 SUBhYTTAL$ 0 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS ❑ 10FT+DRINKING WATER SUPPLY LINES 0 PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REQUIRED) O ❑PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ❑ SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST I0 ll ❑ PROPERTY LINES AND EASEMENTS ❑ EXISTING/PROPOSED STRUCTURES CIEXISTING/PROPOSED OSS COMPONENTS AND LINES 0 WELLS WITHIN 100FT El WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... 0 DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS El NORTH ARROW 0 SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gale) From the Dewatto side of NE North Shore Rd. Head west on north shore for 2.2 miles.Co-Op gate on right,yellow gate, Gate code is 1961. Follow toward water and stay to to �"s7 the left. Jones site will be on the second left up hill. igiCT, ,....., c,„ OFFICIAL USE ONLY BELOW THIS LINE I tv 4 I UPGRADE/FAILURE SOURCE(tor repotting purposes) I ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALL ❑COMPLAINT ❑OTHER: I !' COMMENTS/CONDITIONS la �1n1 r�,p �X��-- SEWAGE TANKS MUST BE LISTED UNDER DOH'UST OF REGISTERED SEWAGE TANKS'.TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AM)INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE S!/7A (0/13 31-1,3T THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED IZ/72015 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG Parcel# 3 7ZOSZC'Q 230 Applicant Name Ppm\ '*- trite-) Subdivision (Name/Div/Block/Lot) Applicant Address LI 33 3 Pn v;Ca•cc Qu,..t PI SE Hoe4 Ana 1 Cc- o/o - - City, State, Zip '55c6(Ac,I., k10 9SUZ°l Installer Name Oieh Ca„54"0.,i1�. _11,4 Site Address 224 11-16)NC'/kvl silts (th Designer Name INSTALLATION CHECKLIST ❑ Full System Instal lion !XI Tank(s)Only El Drainfield Only El Repair El Other System Typ GIA,ayiG� Puy iv G-vMui Pretreatment Type >5 ft. from foundation? - -- 0 N/A III YES ❑ NO l >50 ft.from wells? - -- 0 ® 0 Z >50 ft. from surface water? - - ❑ ® ❑ H El between building and tank? - •- 0 K1 ✓ Tank baffles present? - - 0 (1 0 a24"access risers over each compartment?- - ElOi 0 W Effluent filter installed?- -- 0 // 1 � 0 to Septic tank capacity (working) /coo gal Manufacturer ,-�►.tf 17-a7u- 9 D-box water level and speed levelers used? - - ❑ N/A ❑YES ❑ NO O Manifold/D-box accessible from surface?- - 0 0 0 mZ Check valves installed? - - 0 0 El a2 Transport Line Size L ` �', Schedule/Class 'Sri 6Atic L/0 Bedrooms installed (check one) IVI 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ NIA ❑ YES 0 NO G >100 ft. from wells?- - 0 0 0 W >100 ft.from surface water? - -- 0 0 0 ii >10 ft.from potable water lines?- -- 0 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 0 d > 30 ft.from downgradient curtain/foundation drains? - - 0 0 0 o Drainfield level and observation ports present - - 0 0 0 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- .- 0 0 0 Pump tank setbacks consistent with septic tank? - - n �❑ N/A El YES 0 NO Z Pump tank capacity(flood) ) 20 gal Manufacturer . 1/ l- < 24"access riser(s) and accessible from surface?- - 0 IN ❑ a ..____Alarm_or Control Panel Installed? - - ❑ ® ❑ • Control Panel equipped with Timer/ETM/Counter- - ❑ 0 0 d Pump installed in ❑ Bucket or ® On Block or ❑ Other l a• Pump Make/Model l i v-)) ?Ito IN Floats or 0 Transducer aTank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updaled 8/21/2018 . Mason County OSS Installation Report pg. 2 Parcel# 3 Z 10 SZ CoO 2 3 0 ABANDONMENT RECORD Were existing septic components abandoned11 as part of this project? - - [� YES El NO • If yes, please describe: SC.��T�C '�'�,w k ti ke'` t9r.f k fr cy-Ltd Were all components pumped out and properly abandoned per WAC248-272A-0300? - - 1Z1 YES 0 NO RECORD DRAWING This fs a permanent record and must be accurate and descriptive enough to re-locate In tho need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainteld,existing and proposed buildings,location of wells,waterlines, wells,observetkxr ports,cieanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. gl Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that I installed the system in accordance with i certify that the system has been installed in accor- the septic design stamped'APPROVED"by Mason dance with the septic design stamped "APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes i further certify that all information contained on this I further certify that all Information contained on this form attacp ed Record Drawing is accurate. form and attached Record Drawing is accurate. A 4-2-1-20z5- Signature of Installer Date 5 v'la Oiti Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public HealthNiviet tCalll cls✓� Signature of Environmehtat Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a121ao18 RECORD DRAWING (continued) la✓'C2t 32.2.05-20ao z3O 22.411 — l AV 6 /Va.'' Stu M 4h-7N ! � I f d� \ APPROVED MAY 05 2025 3,',ASQN COUNTY E IRT ENTAL HEALTH RET / . IM-1060 INFILTRATOR septic tanks Features&Benefits • Strong injection molded polypropylene construction i 1 i 1 • Lightweight plastic construction and 1 inboard lifting lugs allow for easy ` (((f Jdelivery and handling 'frrfrfl ('i( /l y I • Integral heavy-duty green lids that interconnect with TWTM risers and pipe f r ; riser solutions rogtr.tKKotW torK yr Waif if I Mil Wi wa ar • r,W/; • Structurally reinforced access ports eliminate distortion during installation and pump-outs • . • Reinforced structural ribbing and fiberglass bulkheads offer additional strength • Can be installed with 6"to 48" of cover The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during • This watertight tank design is offered with infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank, or rainwater(non-potable)tank exceptional strength and watertightness. • No special water filling requirements Inlet Side are necessary • The tank may be backfilled with suitable TANK CUTAWAY Infiltrator • native soil. See installation instructions TW Riser for guidance. System - Partition I °' baffle waif t • ,` ' HEAVY DUTY LID ` CUTAWAY - i ii Reinforced 24"structural - 7( access port • '• ` i f \` '` I Structural I PRO v D r' i bulkheads MAY Q 202 5 i • MID-SEAM Ct1t" pyouN1Y 1 Reinforced water tight mid-searnVIRLN.Y%NTAL HEALTH ,or- i gasketed connection RET i 1 Protectingthe Environment with innovative Wastewater Treatment Solutions INFILTRATOR' I -——— —— -- — — — -- — — —•--— — — __ ———. — —— water technologies / IM-1060 General Specifications and Illustrations STRAP LIFTING LUG RIM COl*rFCT0N (TYPICAL.) (4 TOTAL) inPICAL) The IM-1060 is an injection molded two piece mid-seam -.r -•: iiir, n1 plastic tank. The iM-1060 injection molded plastic design ill 4: ' 1 r Ip ' ! \ +allows for a mid-seam joint that has precise dimensions A 7>!-_� i 1 1 A for accepting an engineered EPDM gasket. Infiltrator's t r;:'-' ° � 6 gasket design utilizes technology from the water industry ,�_11 -- e o �;: �r d °o 111;, 62= ',I ► O O T—.,rr (15s01 to deliver proven means of maintaining a watertight seal. J�!>!-- ,, 1 i 1 1 1. `..Jr k%nRAOS i��� T. !'a a� ��_;_� WnTH The two-piece design is permanently fastened using a �!- j = �� series of non-corrosive plastic alignment dowels and A r` . i i i li locking seam clips.The IM-1060 is assembled and sold J��r through a network of certified Infiltrator distributors. ,27A 12226JFATENOR LENGTH 1 Must be backfilled and installed in accordance with TOP VIEW Infiltrator Water Technologies,Infiltrator IM-Series Septic . OWLET SeriesGeneral Installation Instructions and for shallow ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. AIIIIC SA7 Please visit www.infiltratorwater.com/images/pdf/ =— _-= _ =-�: "FRI 389, _� r FIIF140It ManualsGuides/TANK01.pdf for the latest information. ipi ,Irian SEAM COP �.• iM-1060 LIFTING STRAP _4i Working Capacity 1094 gal(4141 L) (TYPICAL) Total Capacity 1287 gal(4872 L) END VIEW Airspace 16.5% Length 127"(3226 mm) 94lioz1 924(610)ACCESS OP GONGS WITH(OOZING 110S(2) MORASS —0 4 11 0 21 01(0R Width 62.2"(1580 mm) INLET TIE Toz z4o]F1tE1fi0A110 MS Ol2TLETTEC Length-to-Width Ratio 2,3 to 1 In ��i•••lINIMA W. OWLET Height 54.7"(1389 mm) t.I 176 < PFR CODE Liquid Level 44"(1118 rnm) 44.0 _— FIBERGLASS 011114 FIBERGLASS Invert Drop 3"(76 mm) SUPPORT LK100 SUPPORT u DEPTH (rmcuJ WW1 BAFFLE Fiberglass Supports 2 WALL WHERE RECAMED Compartments 1 or 2 ur tr Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mm) CONTINUOUSTANK TOP Weight 320 lbs(145 kg) HALF GASKET TANK ' N,! ` SEAM CLIP INTERIO V APP O LEINTR p ,i. T ,ti DOWEL TANK BOTTOM ,:,,,./, MAY O 2025 HALF 4 Business Perk Road PA,Bob768 Old Saybrook,CT 06475 MASON COUNTY ENVIRONMEN fAL HEALTit INFILTRATOR' 100-221 44i Fax 36 8110-577-7001 RET MID-HEIGHT SEAM SECTION water technologies WWw,inflltratonwateccom U.S.Patella:4,759,861;5,017,041;5,158,488:5.336,017;5,401,116:5,401,459;5,511,803;5,718,163;5,588,778,5,839,844 Canadian Patents 1,329,959;2,004,584 Otter patents pen5ng.Infitrator,Erluafizer, Qulck4,and SIdeWJnder we registered trademarks of Initiator Waler Technologies.infl4alor Is a registered trademark In France.tnflVator Water Techtokagles Is a registered trademark In Medoo. Contour,MicroLeachlea.PolyTLM,GtlamberSpa er,Mulh'ort,Po€JLock,Q11IdICIA,QuldPkry,Snaplodc and StralgMLock as trademarks of M4trator Water Technologies. PolyLok Is a trademark of Pofytok,Inc.TUF-TITE Is a registered trademark of TUF-TITE,INC.Ultra-Rb is a trademark of IPD(Inc. 42 2016 Int I Valor WaterTechrwi0pbs,Llc.NI rights reserved.Printed In U.SA 11.402 1118 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436