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HomeMy WebLinkAboutSWG2025-00111 - SWG Application / Design - 4/1/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 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: SWG2025-00111 APPLICANT CHRIS ELSTROTT* Phone: 360-561-5000 Address: 128 NORTH RIVER STREET MONTESANO, WA 98563 OWNER SANDOVAL, BOBBY Phone: Address: 143 W INSELS RD SHELTON, WA 98584 SEPTIC DESIGNER CHRIS ELSTROTT* Phone: 360-561-5000 Address: 128 NORTH RIVER STREET MONTESANO, WA 98563 Site Address: XXXX W Highland Rd Primary Parcel Number: 520241190140 Permit Description: New 3-bedroom pressure system with sand-lined bed Permit Submitted Date: 04/01/2025 Permit Issued Date: 05/29/2025 Issued By: David Anderson Current Permit Fees Paid: $555.00 (additional fees may be required upon Installation of system). Permit Expiration Date: 05/22/2028 (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 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 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. OFFICIAL USE ONLY , ` %..- MASON COUNTY DATE RECEIVED. f / I I [t5 COMMUNITY SERVICES AMOUNT RE RECEIVEOBY: O m Public Health(Colmr unity Realth/Env:rcnmen;alMeahh) Z (I) 750-079670.e.:AN or i<?iTssu),e,tN+ 0) IIS tl fill al.e l-al etc,.T!A Sla£< SING ZOOS- - CO. 1 I 1 o 73 z Co ON-SITE SEWAGE SYSTEM APPLICATION Z A o APPLICANT PHONE m m 1- /SD II .s 4 V1/ 23-3- a -r- oeog 1.tALNIG ADDRESS-$7REEi,CITY.STATE.ZIP CODE 3 /4/3 A/ rwrsriLGs ''. 5a I / ) 98rs'4/ ‘m SITE AnDJWSS-STREET.CITY.ZIP CODE xi. !9 IA' A CZ / Sri eI/r�r,, ar',4 geu-e�/ w I NAME OF DESIGN PHONE C 11j r s /.r,L,0 /f .5'.(rJ— 57/ - re)Do I r NAME OF INSTALLER PHONE O I DRINKING Y/ATER SOURCE � Ir3 PERMIT TYPE(select one) 5 SIDENTIAL OSS h COMMUNITY OSS Fl COMMERCIAL OSS 411TATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z Fe TYPE OF WORK(sekct caw) PUBLIC'NATER SYSTEM_ I '� I Ly-14 CONSTRUCTION I UPGRADES h REPAIR/REPLACEMENT OTHER DETAILS(se:eUalN.uappy) ❑TABLE IX REPAIR k SUBL,IT TALs ❑ SURFACING SEV/AGE ❑EXISTING FAILURE ❑SHORELINE b-larSIGN FORM(REQUIRED) 3EFf�IC DESIGN(REQUIRED) BEDROOMS LOT SIZE I-W IN 'AIVER(S)(IF APPLICABLE) C Li W 3 �! 3z 4, . 0 k, DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.ERsdga;d) /kiss ,r, y 5, 404) / /01,b (1.711 40,1 /ed. ��ivE 44" I 1 o 0 rl /4 AL /ow/. off- /4/2/,..i.o..../ 4.r. _ /c/hi.., /0/.441 /ix?, • r I fi /``o''e 4 I. . I Nc SITE MUST BE FLAGGED FROM MAIN ROAD AND LEST HOLES MUST BE FLAGGED WITH JEST HOLE NUMBERS. ICI -- OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for report-ng purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT 0 HOME SALE ❑COMPLAINT ❑OTHER: _ INSPECTOR SOIL LOOS COMMENTS/CONOITIONS 1'tt10-l?"4c-IKe 5 ( PeV 1 y$z 04 Co4S cry ) Titt.D`zIN vy t ttedS zE I � � t t,Co4S s; al- �Z wi 11 Ttf3.0-D " �,t 5 2y:i�t% F4lo85 fs of y?'r V 1TiI ( MoN . SOIL CODES: RECORD DRAWING AND LNSTALLATION REPORT V=VERY 0=QRAVFLEY S=SAND L=LOAM Si•SILT C=CLAY E=EXTREMELY It'ROOTS REQUIRED FOR FINAL APPROVAL. WISP- R SIGNATURE DALE APPLICATION EXPIRATION DATE APPUCA ION APPROVED/13320ED DY DATE /Z2(?Otc S/Z 7(70I � THIS ORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/Z015 1 DESIGN FORM-PAGE ONE Assessor's Parcel Number:. 2 0,ay -- /1 -- lc a 15'p A design will be reviewed when 3 copies of each of the following are submitted: Completed design form that has been signed and dated. 0 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: 11"A 17" PARCEL IDENTIFICATION Permit Number: SWG 9 ZO2S - 0 01) I Designer's Name: K-i Leis /gd- 2-P4TI' Applicant's Name: ,. 4 .5-4r�4-•q / Designer's Phone Number: ,36-O—S6/-5-666) Mailing Address: A/3 /.t/, s n s e A tid. Designer's Address: /1P' i(/. AP/c"'z S -' Std/D,.,GO/ 9gs- `/ u "7 cl,t t,,4 f6"3-6Z City State Zip City State Zip DESIGN PARAMETERS Treatment Device ❑Glendon Biofilter 0 Sand Filter 0 Mound 111471Lined Drainfield 0 Recirculating Filter,Type: ❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Dt•ainfield Type ❑Gravity ressure 0 Trench DBed 0 Sub Surface Drip Septic'1'anWDrainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 4/0 / Daily Flow:Operating Capacity .e( a gpd Length 36 ' ft Daily Flow:Design Flow .360 gpd Diameter i/y ' in Septic Tank Capacity(working) /per ' gal Number L/ Receiving Soil Type(1-6) / Separation 3'0 ' ft Receiving Soil Appl.Rate /,o . gpd/ft2 Orifices Required Primary Area 347 ft2 Total Number of Orifices JO . Designed Primary Area ,Jbp • 112 Diameter '/iG • in Designed Reserve Area 6, ' ft2 Spacing 3D in Trench/Bed Width /p ' ft Manifold Trench/Be Length 34 ft Schec /Class yO Elevation Measurements Length 7, S " II - Original Drainfield Area Slope Z % Diameter 2. in New Slope,If Altered Z, - % Preferred manifold configuration used? 0 Ycs LYNo Depth of Excavation Up-slope 3g in Transport Pipe from Original Grade town-slope 3l in Sci`to lc/ClassVo Designed Vertical Separation N 211 -i I fr.: tit..in Length sb ft Gravelless Chambers Required? 0 Yes o 0 Optional Diameter .2, in Pump Required? es 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day S/ - Difl:in Elevation Between Pump&Uppermost Orifice ft Dose quantity p gal Drainfield Squirt I leight/Selected Residual(head) * ft Chamber Capacity(flood) /yip • gal Uppermost Orifice['higher 0 Lower than Pump Shutoff Pump ccontrolfs Please cheek those required. Capacity @ Total Pressure Head .r2 gpm Qiiher se Meter eat Counter Cnlcnlnled Total Pressure i-lend f$' ft If Timer: Pump on 78/I.5 c. Pump off Comments AY zi7/.5779(Lilriget/ DESIGN FORM—PAGE TWO Assessor's Parcel Number:g:Z 0 z % -- / / -- 9 o-,L 51.0 Permit Number: SWG DESIGN CHECKLISTS Scale Plot Plan Scaled Layout Sketch Cross-Section Sketch C3�Tje thole locations LrYedllr field(nictitation and layout Reference de lb from original grade: D- Soil logs Trench/b dimensions and ❑ tank 01-11Qerty lines critical distances within layout ❑ rainticld cover rsting and proposed wells _'D-Box/Valve box locations Reference depth from original grade within 100 ft of property Cr'eptic tank/pump chamber and re�st�rict've strata: fc< Measurements to cuts,banks,and locations CYY Laterals,trench/bed,top and surface water and critical areas 12 Observation port location bottom ©— °cation and orientation of lean-out location % Curtain drain collector ci'rtnhrvirain and all absorption 19'Manifold placement id augmentation coin onents ❑ i ice placement Other cross-section detail: LI_ocation and dimension of alplacement with distance 0 Observation ports/clean-outs prin ary system and reserve area to edge of bed g Other Information ui dings , udible visual alarm referenced Yes o /erection of slope indicator 0 e of drawing shown on scale l ❑ Design staked out D c terlines bar 0 IffRe orded Notices attached °ads,easements,driveways, 0 aever(s)attached parking ❑_ Pj�►mp curve attached ❑ th arrow and scale drawing 0 Irtvaluation of failure shown on scale bar .on-r. rdential justification • dil Waste strength • ❑'Flow DESIGN APPROVAL The undersigned designer must be notified installer at time of installation ❑'Yes ❑ No .3 —3/—zs--- Signs ire of Designer Date The undersigned has reviewed this desi n behalf of Mason County Public Healtl i t,t fined it to be in compliance with state and local on-s' re lations: f _" j ' ii p V1"-'n n r. onmental Health Specialist �e�RADate MAY 2 8 2025 CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOIM1Lt'laY( (l( MAt HEALTH ✓ The design is stamped"Approved"by Mason County Public Health. Z�*' ? V The.Onsite Sewage Permit has not expired,the Permit Expiration Date is: 5/ 7/ 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. 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