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HomeMy WebLinkAboutSWG2024-00378 - SWG Application / Design - 9/6/2024 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 S7 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: SWG2024-00378 APPLICANT MOORE, DAN Phone: 360-801-3644 Address: 75 NE FERN WAY BELFAIR, WA 98528 OWNER MOORE WENDELL D & ROSEMARIE Phone: Address: PO BOX 783 BELFAIR, WA 98528 SEWAGE DESIGNER Russell, Justin Phone: 3609701233 Address: po box 14531 TUMWATER, WA 98511 Site Address: 75 NE FERN WAY Primary Parcel Number: 123292290020 Permit Description: 2BR SFR Repair-Gravity Permit Submitted Date: 09/06/2024 Permit Issued Date: 09/20/2024 Issued By: Jeff Wilmoth Current Permit Fees Paid: $805.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/06/2027 (based on date of inspection) 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 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 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 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/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. a OFFICIAL USE ONLY - — DATERECENED: 09/06/2024 MASON COUNTY o) D ifigit:\%) COMMUNITY SERVICES c 0) AMOUNT RECEIVED: RECEIVED BY: QJ (D d m W-' Public Health(Community Health/Environmental Health) C • �/ 3G0.427.9670,ext.400 a,360-775.4467,'at 400 415 N.6th Street•Shelton,WA 93584 S W G 2024 _ 00378 u' o 0 z cn ON-SITE SEWAGE SYSTEM APPLICATION D m n APP L ICAN I PHONE 1m" Dan Moore 36o -- 70 ( -- 304 if- z MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE g 75 NE Fern Way Belfair WA 98528 cn m SITE ADDRESS-STREET,CITY.ZIP CODE N x' 75 NE Fern Way Belfair WA 98528 4,, CO I NAME OF DESIGNER PHONE I N Justin Russell 360-956-7242 NAME OF INSTALLER PHONE o I CO PERMIT TYPE(select one) DRINKING WATER SOURCE - IV Pi-RESIDENTIAL OSS COMMUNITY OSS In COMMERCIAL OSS ha PRIVATE INDIVIDUAL WELL ff PRIVATE TWO-PARTY WELL Z I co TYPE OF WORK(select one) a PUBLIC WATER SYSTEM _ h q NEW CONSTRUCTION/UPGRADES Ivl REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I N) SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CO DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE nr N I 6WAIVER(S)(IF APPLICABLE) n I 1 I (0 DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) FROM HWY 3 NORTH, TURN LEFT ON HWY 300, LEFT TO STAY ON HWY 300 W, I c) RIGHT ON NE SAND HILL RD, RIGHT ON NE FERN WAY, LEFT ON SHARED DRIVE TO r SITE. o 0 0 IN SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. C OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS 6611 GMS both test holes, no restrictions found SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DAI E LiAfh.� ?‘„ALIIV410-)9-19-24 9-19-27 09/20/2024 T S 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: 1 2 3 2 9 - 2 2 - 9 0 0 2 0 A design will be reviewed when 3 copies 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 form may be scanned and available for public view on the Mason County Web site.,Maximum paper size: I I'X/7" PARCEL IDENTIFICATION Permit Number: SWG 2 02 4-0 0 3 78 Designer's Name: JUSTIN RUSSELL Applicant's Name: DAN MOORS Designer's Phone Number: 360-956-7242 Mailing Address: 75 NE FERN WAY Designer's Address: 4931 68TH AVE NE BELFAIR WA 98528 OLYMPIA WA 98516 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: 0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Drainfield Type CiiGravity 0 Pressure 0 Trench ❑ Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class 40 Daily Flow:Operating Capacity 180 gpd Length 50 ft Daily Flow:Design Flow 240 gpd Diameter 4 in Septic Tank Capacity(working) 1150 gal Number 2 Receiving Soil Type(1-6) 3 Separation 6 ft Receiving Soil Appl.Rate .8 gpd/ft2 Orifices Required Primary Area 300 ft2 Total Number of Orifices Gravity Designed Primary Area 300 ft2 Diameter in Designed Reserve Area ft2 Spacing in Trench/Bed Width 3 ft Manifold Trench/Bed Length 100 ft Schedule/Class 40 Elevation Measurements Length 9 ft Original Drainfield Area Slope 0 % Diameter 4 in New Slope,If Altered % Preferred manifold configuration used? I 'Yes 0 No Depth of Excavation Up-slope 3 0"MAX in Transport Pipe from Original Grade Doh,-slope 3 0"MAX in Schedule/Class 40 Designed Vertical Separation 36"+ in Length 29 ft Gravelless Chambers Required? lS Yes 0 No 0 Optional Diameter 4 in Pump Required? 0 Yes 66 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Gravity Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm ❑Timer ❑Elapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on ,Pump off Comments DESIGN FORM—PAGE TWO Assessor's Parcel Number: 1 2 3 2 9 -- 2 2 -- 9 0 0 2 0 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 0 Test hole locations Drainfield orientation and layout Reference depth from original grade: it Soil logs It Trench/bed dimensions and Et Septic tank Ii Property lines critical distances within layout I21 Drainfield cover It Existing and proposed wells ft D-Box/Valve box locations Reference depth from original grade within 100 ft of property It Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks,and locations I' Laterals,trench/bed,top and surface water and critical areas it Observation port location bottom ❑ Location and orientation of [i21 Clean-out location 0 Curtain drain collector curtain drain and all absorption 111 Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: ❑ Location and dimension of RI Lateral placement with distance 0 Observation ports/clean-outs primary system and reserve area to edge of bed Other Information FZi Buildings 0 Audible/visual alarm referenced Yes No ❑ Direction of slope indicator it Scale of drawing shown on scale It 0 Design staked out • Waterlines bar 0 0 Recorded Notices attached 1 Roads,easements,driveways, 0 0 Waiver(s)attached parking 0 0 Pump curve attached FZi North arrow and scale drawing f;2( ❑ Evaluation of failure shown on scale bar Non-residential justification ❑ 0 Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be notified by install at ime of installation'fYes 0 No gnature of esigner Date The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance with state and local oi t re u tiWivheli, 09/20/2024 En ironmental Health Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health. g_19-2 ✓ 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: 12/7/2015 Q- Q � �o * • U -. • ao x- O a_ O v N W 0 �, U O v 0 I I a_ 17!•.. / i N V.....'71,At'. 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