HomeMy WebLinkAboutSWG2025-00018 - SWG Application / Design - 1/21/2025 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: SWG2025-00018
APPLICANT WATT L SUSAN Phone: 503-201-3977
Address: 7520 N MOHAWK AVE, APT B PORTLAND, OR 97203
OWNER WATT L SUSAN Phone: 503-201-3977
Address: 7520 N MOHAWK AVE, APT B PORTLAND, OR 97203
SEPTIC DESIGNER TOM WEAVER* Phone: 360-620-7054
Address: 3912 STEELHEAD DRIVE NW BREMERTON. WA 98312
Site Address: XXX NE Capstan Rock Rd
Primary Parcel Number: 323157500090
Permit Description: New 2-bedroom gravity system w/Class B waiver
Permit Submitted Date: 01/21/2025
Permit Issued Date: 06/04/2025
Issued By: David Anderson
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/27/2028 (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 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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED:
MASON COUNTY 1 _ a l - D-CD" -, N v
•I I• COMMUNITY SERVICES AMOUNT R�EIVE�� RECEIVED BY: v m
Public Health(Community Health/Environmental Health)
360-427.9670,ext 400 or 360275-467,ext 400
415 N.6th Street-Shelton,WA 98584 S,A,G.4,(3 e` //��/��r
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION 3 13
APPLICANT PHONE m m
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Susan Watt 503-201-3977 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
7520 N Mohawk Ave Apt B Portland OR 97203 m
SITE ADDRESS-STREET.CITY,ZIP CODE •
Capstan Rock Rd Tahuya WA 98588 I w
NAME OF DESIGNER PHONE
Tom Weaver 360-620-7054 N
NAME OF INSTALLER PHONE O I CA)
PERMIT TYPE(select one) � DRINKING WATER SOURCE I -1
ffi RESIDENTIAL OSS 'COMMUNITY OSS II-1 COMMERCIAL OSS IJ_I PRIVATE INDIVIDUAL WELL ff PRIVATE TWO-PARTY WELL Z I
7 PUBLIC WATER SYSTEM Capstan Ridae I
TYPE OF WORK(select one) r+
gfi NEW CONSTRUCTION/UPGRADES h-REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I J
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
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DESIGN FORM(REQUIRED) ffSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE O I U1
14.WAIVER(S)(IF APPLICABLE) 2 5 Acres 8 I
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate) I O
Take the NE Dewatto-Holly Rd to Manke I o
Turn onto Manke Rd and take it to Capstan Rock Rd I o
Turn Right onto Capstan Rock Rd; Go to the top of the ridge and take the left fork °
Parcel is the second right driveway with three blue and pink ribbons at driveway. I
(I used 241 NE Capstan Rock Rd on my phone app to get close to the parcel)
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. o
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for repo-twig purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOlI LOGS COMMENTS/CONDITIONS
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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
INSPECTO SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATI PPROVED/ISSUED BY DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12nr1015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 3 1 5 __7 5 __ 0 0 0 9 0
A design will be reviewed when 3 copies of each of the following are submitted:
'1 Completed design form that has been signed and dated. ''Scaled layout sketch,including all applicable items on checklist
'1 Scaled plot plan, including all applicable items on checklist. '1 Cross-section sketch, including all applicable items on checklist.
This form ma be scanned and available for blic view on the Mason Web site.Maximum r size: 11"X 17"
Permit Number: SWG o?Cr. • QCCS 1.(tS Designer's Name: Tom Weaver
Applicant's Name: Susan Watt Designer's Phone Number: 360-620-7054
Mailing Address: 7520 N Mohawk Ave Apt B Designer's Address: 3912 Steelhead Dr NW
Portland , OR 97203 Bremerton WA 98312
Ci State Zi Ci State Zi
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: Se.?r,e_ /,¢.t.'1\
Drainfield Type
*16 Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 2729
Daily Flow:Operating Capacity 240 gpd Length 45 ft
Daily Flow: Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity 1.000 gal Number 3
Receiving Soil Type(1-6) 4 Separation 5 CC ft
Receiving Soil Appl. Rate .6 gpd/ft2 Orifices
Required Square Footage 400 ft2 Total Number of Orifices NA
Designed Square Footage 400 ft2 Diameter in
Percent Reduction Taken 0 a/o Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 135 ft Schedule/Class NA
Elevation Measurements Length ft
Original Drainfield Area Slope 15 % Diameter in
New Slope, If Altered NA % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation up-slope 12 in Transport Pipe
from Original Grade Doan-slope in Schedule/Class 3034
Designed Vertical Separation 18 in Length 40 ft
Gravelless Chambers Required? 0 Yes 0 No !81 Optional Diameter 4 in
Pump Required? 0 Yes IX No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
4 Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal
Orifice ft
Chamber Capacity 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: s 1 3 1 5 -- b -- O U 'U 9 d
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
N[ Test hole locations QQ Drainfield orientation and layout Reference depth from original grade:
NI Soil logs IX Trench/bed dimensions and 16 Septic tank
p Property lines critical distances within layout 0 Drainfield cover
X Existing and proposed wells Zl D-BoxNalve box locations Reference depth from original grade
within 100 ft of property IX Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations ] Laterals,trench bed, top and
surface water and critical areas IN Observation port location bottom
❑ Location and orientation of tl Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
N Location and dimension of 0 Lateral placement with distance it Observation ports/clean-outs
primary system and reserve area to edge of bed
IX Buildings Other Information
0 Audible/visual alarm referenced Yes No
li Direction of slope indicator
Waterlines MI Scale of drawing shown on scale 0 Design staked out
bar 0 Itg Recorded Notices attached
ci[ Roads,easements,driveways, rit 0 Waiver(s)attached
parking 0 OS Pump curve attached
51 North arrow and scale drawing 0 [ Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified b installer at time of installation ❑ Yes IR No
.�- January 16, 2025
Signature of Designer Rite;
The undersigned has reviewed this design on behalf of Mason County Public Health and de t to be in
compliance with state and local on ' regulations:
d
Environments6((10915
eapecialist Date .
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped "Approved"by Mason County Public Health.✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: I ON
l
✓ 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.
Revision Date: 1/12/2010
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Inlet pipe comes through 2" higher hole
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