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HomeMy WebLinkAboutSWG2024-00370 - SWG Application / Design - 8/29/2024 (2) M A50 N COUNTY 415 N 6TH STREET,SHELTON, ,E,E 400 98584 SHELTON: 42 T 967XT J L 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: SWG2024-00370 Uv APPLICANT WERDALL JESHUA L Phone: 360.801.3633 Address: P 0 BOX 128 BELFAIR, WA 98528 OWNER WERDALL JESHUA L Phone: 360.801.3633 Address: P 0 BOX 128 BELFAIR, WA 98528 SEPTIC DESIGNER ROD LEFT* Phone: 360-698-8488 Address: PO BOX 2954 SILVERDALE, WA 98383 Site Address: 281 E JOHNSON RIDGE DR Primary Parcel Number: 222137700040 Permit Description: New 4bd gravity trench with Class B waiver-REVISION Permit Submitted Date: 08/29/2024 Permit Issued Date: 06/10/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $1,035.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/05/2027 (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. OFFICIAL USE ONLY M .-. MASON COUNTY DATE RECEIVED: 6 ( -�C '� 7 C AMOU T RECEIVED RECEIVE =' Public Health & Human Services �� — v_ m cn Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 < 415 N.6th Street-Shelton,WA 98584 S W G c l.�]U — ��\ 0 s '�.1 1. (� O � Z . ON-SITE SEWAGE SYSTEM APPLICATION m n APPLICANT PHONE m JESHUA WERDALL 360-801-3633 z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g PO BOX 128 BELFAIR WA 98528 co 281 SITE ADDRESS CODE-STREET,CITY,ZIP JOHNSON E RIDGE DR BELFAIR WA 98528 I N NAME OF DESIGNER PHONE I N ROD LEFT 360-698-8488 W NAME OF INSTALLER PHONE 0 I O R- 0 PERMIT TYPE(select one) DRINKING WATER SOURCE N I -P.fif RESIDENTIAL OSS COMMUNITY OSS E COMMERCIAL OSS E PRIVATE INDIVIDUAL WELL 12"PRIVATE TWO-PARTY WELL Z I 111 TYPE OF WORK(select one) PUBLIC WATER SYSTEM Mr NEW CONSTRUCTION/UPGRADES 6 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE co DESIGN FORM(REQUIRED) I SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? r u pn_ O WAIVER(S)(IFAPPLICABLE) 4 219,542 ❑ YES p NO - n I DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) THIS IS A REDESIGN TO MOVE OSS TO WESTERN PART OF PROPERTY. CLASS B I WAIVER FROM ORIGINAL SUBMITTAL TO BE APPLIED. o I I 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 reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE CI COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS i .. o L,,I O,., i '4'I ti-, II 0'-mil 0 Li L'kn S, 01 09"-t—1 ii. - 1 0 -19 (7v k-Si 4tl- fi.11 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. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION D TE APPLICATION APPROVED/ISSUED BY DATE c i (Ali --- al I C— 7 Q.,17\314/00) 46)(ec......_ THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 11111111. DESIGN FORM—PAGE ONE Assessor's Parcel Number: 22213-77-00040- -- A design will be reviewed when 3 conies of each of the following are submitted: Completed design form that has been signed and dated. '1 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 •a•'r size: 11"X 17" Permit Number: SWG �0,; Z6 Designer's Name: ROD LEFT Applicant's Name: JESHUA WERDALL Designer's Phone Number: 360-698-8488 Mailing Address: P.O.BOX 128 Designer's Address: P.O.BOX 2954 BELFAIR WA 98528 City State Zip SILVERDALE WA 98383 Ci State Zi. Designer's Email INFO@ACMESEPTIC.COM Treatment Device 0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Other Treatment Level(check all that apply): ❑A ❑B ❑C ❑BL1 ❑BL2 ❑BL3 OE ❑N Drainfield Type Er 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 4 Schedule/Class 40 Daily Flow:Operating Capacity 360 gpd Length 55 ft Daily Flow:Design Flow 480 gpd Diameter 4 in Septic Tank Capacity(working) 1250 gal Number 5 Receiving Soil Type(1-6) 4 Separation 5 ft Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices Required Primary Area 800 ft2 Total Number of Orifices N/A Designed Primary Area 800 ft2 Diameter in Designed Reserve Area 800 ft2 Spacing in Trench/Bed Width 3 ft Manifold Trench/Bed Length 270 ft Schedule/Class N/A Elevation Measurements Length ft Original Drainfield Area Slope 5 % Diameter in New Slope,If Altered N/A % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope 22 in Transport Pipe from Original Grade Down-slope 20 in Schedule/Class 40 Designed Vertical Separation 18 in Length 300 ft Gravel-based Drainfield Required? 0 Yes 66 No Diameter 4 in Pump Required? 0 Yes Ii4No Dosing and Pump Chamber ', Pump/Siphon Specifications Number of doses/day N/A Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal 1 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 0 Timer 0 Elapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on ,Pump off Comments APPROVED JUN 0 6 2025 MASON COUNTY ENVIRONMEI /2o2s RET ,DESIGN FORM—PAGE TWO Assessor's Parcel Number:22213-77-00040-- -- Permit Number: SWG ',fr*' )✓ apa �^ 'v - t 1��j-" t.G� .+ .25.- 5�� � � a G5. �} 4>i ytd'`.o f '�� y'S '!,'' 'Z `fi " K*�. -F'`" •-,t. .fin.,( l.�r T .I�rj 7!`. f`{AFiE 'a K t \y '�`--. 'S' .t z:; ".,hgn.�X �. SI. E.��'FSrS� �jyJ h! �.1 JX� iGL�L��(7+F���ul..•CI�L.lTVy���itF t7�FY � Y. !K"l�"/~. �� MX' '4 .. Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Test hole locations 62( Drainfield orientation and layout Reference depth from original grade: I Soil logs 64 Trench/bed dimensions and ❑ Septic tank Bl Property lines critical distances within layout L 1' Drainfield cover ❑ Existing and proposed wells lg D-BoxNalve box locations Reference depth from original grade within 100 ft of property 64 Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks,and locations g Laterals,trench/bed,top and surface water and critical areas 62( Observation port location bottom ❑ Location and orientation of g 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: g Location and dimension of 0 Lateral placement with distance 64 Observation ports/clean-outs primary system and reserve area to edge of bed l 1 Buildings g Other Information 0 Audible/visual alarm referenced Yes No 6Q Direction of slope indicator ii Scale of drawing shown on scale 0 0 Design staked out RI Waterlines bar 0 0 Recorded Notices attached RI Roads,easements,driveways, p Elevation benchmark and relative g 0 Waiver(s)attached parking elevations of system components 0 ❑ Pump curve attached RI North arrow and scale drawing 0 0 Evaluation of failure shown on scale bar Non-residential justification ❑ 0 Waste strength ❑ ❑ Flow DESIGN"APPROVAL � .ri � , The undersigned designer must be notified by installer at time ' tallation g Yes 0 No • ature of Designer 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 on-site regulations: (1011 I/ ��� (0 Environmental Health Spec alist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health. at . ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: V ✓ 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. Revised:4/14/2025 . 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