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HomeMy WebLinkAboutSWG2025-00217 - SWG Application / Design - 6/10/2025 eln, ‘: 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: SWG2025-00217 APPLICANT SUTHERBY RUTH L. Phone: Address: 78 W PALMER RD ELMA, WA 98541 OWNER SUTHERBY RUTH L. Phone: Address: 78 W PALMER RD ELMA, WA 98541 SEPTIC DESIGNER CHRIS ELSTROTT* Phone: 360-561-5000 Address: 128 NORTH RIVER STREET MONTESANO, WA 98563 SEPTIC INSTALLER HOUSE BROTHERS Phone: 360-495-4156 Address: PO BOX 1820 MCLEARY, WA 98557 Site Address: 61 W Palmer Rd Primary Parcel Number: 619314090160 Permit Description: New 3BR SFR - Pressure Permit Submitted Date: 06/10/2025 Permit Issued Date: 07/01/2025 Issued By: Jeff Wilmoth Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/20/2028 (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/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: I O . Zo a 0c CDn AMOUNT RECEIVED: ' RECEIVED BY W ((/)�-- Public Health & Human Services J1(,*�. e'L 1/�l4k 0 Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 N 415 N.6th Street -Shelton,WA 98584 S WG 202.6 - 00 2.(1- O xi �/�] z (n ON-SITE SEWAGE SYSTEM APPLICATION APPLICANT PHONE m 17 ITI I- 4 77/ 6-4(77//4"-t?afi ,..?l o - 990 - s2 i,r- MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE % 7 w: ,•9i5k/ham /20. Lm.9 �% ,o s-W w m SITE ADDRESS-STREET,CITY,ZIP CODE 6/ Gri. I4)41-4/ .e-.i iV,o. , �t�.714 , t, /fir// I ss NAME OF DESIGNER PHONE e //R,1 /--GS772017- -eV0 - 17/- 5-coo NAME OF INSTALLER PHONE ` _ PERMIT TYPE(select one) DRINKING WATER SOURCE - I DENTIAL OSS COMMUNITY OSS COMMERCIAL OSS ATE INDIVIDUAL WELL 5-PRIVATE TWO-PARTY WELL Z I\ TYPE OF WORK(select one) Q PUBLIC WATER SYSTEM 1 CONSTRUCTION/UPGRADES ffREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR SUBMITTALS 0 SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE SIGN FORM(REQUIRED) 6.9eric DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4,1/2025' W Ia ]-WAIVER(S)(IF APPLICABLE) f♦ I �3 /6 ❑ YES [}�NO x DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) INO / 1 I‘/ w• Al it. !/V• x -e.� �lur. /�" �"7 c�Ov^ I 0 Ith SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. 1 I OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ['OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS MI 2ES—el, 0— S'i IV/ / V ( ,5 "15 L._ g L lJ// ,i 5, (i,,0 'Io la y 6 * ..._ (.,„.0 E---c„,(5 ,.., cob apfi.......)( • C7i 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. I OR SI NATURE (n DATE APPLICATION EXPIRATION DATE AP C TION APPROVED/ISSUED BY DATE /FF t �i TH • FO BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 ‘/9 3/ - VO - 90/6 d DESIGN FORM-PAGE ONE Assessor's Parcel Number:2 2 2- 2- 2 - 2 2 - ' ' 2 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: 11"X 17" PARCEL IDENTIFICATION Permit Number: SWG )-.0;- - 0O f Designer's Name: C.l1i2'r ,ic.CTi2.oTj Applicant's Name: Rof fA S4 tAe.r 4' Designer's Phone Number: 360- 5-6/- 5-'300 Mailing Address: 78 w. /'A4rnti,z 406 Designer's Address: /2e /t/- A'MF� 577 ��MQ wA MS-9 City State Zip /�O J77- 4AJO) �t/r9 7grg 3 City State Zip Designer's Email e/s/ro ea0/• c.-a DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter 0 Mound ❑ Sand Lined Drainficld ❑ Recirculating Filter 0 ATU LI Other Treatment Level(check all that apply): ❑A U-C U C 0 BLI D2 ❑BL3 El E ❑N DJr infield Type ❑Gravity ressure ['french 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms Schedule/Class yo Daily Flow: Operating Capacity 360 _ gpd Length 5,0 ft Daily Flow:Design Flow 360 gpd Diameter /7i in Septic Tank Capacity(working) /Zc gal Number `r Receiving Soil Type(1-6) '7/ Separation 8 ft Receiving Soil Appl.Rate D-6 gpd/fe Orifices Required Primary Area .QJ ft2 Total Number of Orifices '/O Designed Primary Area bop ft2 Diameter V/6 in Designed Reserve Area Epp ft2 Spacing (Cp in Trench/Bed Width ,� ft Manifold Tren /Bed Length 2 00 ft Schedule/Class 4/0 Elevation Measurements Length 2y ft Original Drainfield Area Slope 0 `io Diameter 2 in New Slope,If Altered d % Preferred manifold configuration used? 0 Yes h'No Depth of Excavation Up-slope 4 in Transport Pipe from Original Grade Down-slope /e9 in Schedule/Class Ye) Designed Vertical Separation �, -)-- ? in Length S-0 ft Gravel-based Drainfield Required? ❑Yes ©moo Diameter Z in Pump Required? l s 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 3 Diff.in Elevation Between Pump&Uppermost Orifice V ft Dose quantity /2 O gal Drainfield Squirt Height/Selected Residual (head) ,2 ft Chamber Capacity(flood) /zv0 gal Uppermost Orifice L igher ❑Lower than Pump Shutoff Pump controls: Please check those required. Capacity @ Total Pressure Head e/3 gptn Gincner 0 se Meter C'YEvent Counter Calculated Total Pressure Head /2,.4' ft if Tim PuFF -` / .— StT Porn. off • 0 I I. ' oil/ Comments E , ' i.',• JUL 0 1 Z-.Ii. toft>SONI,UUNIY ENVIRONMENTAL HEIALT' Revised:4/14/2025 JE IN 6- / 931 — </o - 70/ 6O DESIGN FORM-PAGE TWO Assessor's Parcel Number;-2-2--2 2 2 -- 2 2 2 2 Permit Number: SWG DESIGN CHECKLISTS Scale Plot Plan Scale ayout Sketch Cross-Section Sketch e hole locations Drainfield orientation and layout Reference depth from original grade: S logs C�/re is ed dimensions and o tic tank 3/Property lines c ''cal distances within layout Wield cover xisting and proposed wells lir-l2; ox/Valve box locations Reference depth from original grade within 100 ft of property t Septic tank/pump chamber and restrictive strata: Measurements to cuts,banks,and locations [-Laterals,trench/bed,top and su ace water and critical areas C'Ojservation port location bottom Location and orientation of Ile"-Sean-out location A Curtain drain collector and all absorption ' old placement Sand augmentation coorients Q U ce placement Other cross-section detail: C�Location and dimension of Aral placement with distance ❑ Observation ports/clean-outs �p ary system and reserve area I3,4toe of bed CAB ' dings Other Information udible/visual alarm referenced Yes No rrr ction of slope indicator 0 Scale of drawing shown on scale 0 Comes staked out C��sYW��aterlines bar 0 D rded Notices attached [Roads,easements,driveways, ❑ Elevation benchmark and relative 0 aiver(s)attached 1,king elevations of system components ❑Pp curve attached D. North arrow and scale drawing • }, * { .� " 0 valuation of failure shown on scale bar p p it '.. ;, i Non-residents ' 'cation aste strength IUL 01 2025 ❑F o RaltratJAL 14n (li W00P1 aStflAl w 1 The undersigned designer must be notified by installer at ti M stallation CE'Yes 0 No 6 l€-z-c ignature 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 loca ite regulations: .1 tA t Lift i' I-2_5' E o�=, . Health Specialist Date CAUTION: DESIGN APP OVAL 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: 6 ^16 215 ✓ 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. 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