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HomeMy WebLinkAboutSWG2023-00341 - SWG Application / Design - 8/10/2023 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 at ': BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2023-00341 APPLICANT ROMERO TABITHA Phone: 1.209.480.7013 Address: 324 Watercress Street SHELTON, WA 98584 OWNER ROMERO TABITHA Phone: 1.209.480.7013 Address: 324 Watercress Street SHELTON, WA 98584 SEPTIC DESIGNER Richard Bazzell -Caliber Septic Design Phone: 360-509-7900 Address: 165 NW Tupleo Way POULSBO, WA 98370 Site Address: 3520 W Shelton Valley Rd Primary Parcel Number: 419022100010 Permit Description: New SFR 3-bedroom pump to gravity system: Revised Permit Submitted Date: 08/10/2023 Permit Issued Date: 08/22/2023 Issued By: David Anderson Current Permit Fees Paid: $690.00 (additional fees may be required upon installation of system). Permit Expiration Date: 08/10/2026 (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. 'CC-Sug 'TiL OFFICIAL USE ONLY A.. .. MASON COUNTY DATE RECEIVED: oy-.oy' .5-- C cn AMOUNT RECEIVE RECEIVED BY: --ram Public Health & Human Services ( (Q� o m cn Environmental Health 360-427-9670,ext.400 or 360-275-4-467,ext.400 /'� ^ /� C 415 N.6th Street-Shelton,WA 98584 S W G _ JO / 3 — 0° 3 q I O 0 L� O� Z a, 71 ON-SITE SEWAGE SYSTEM APPLICATION 7, '� APPLICANT ) :�:�) I PHONE m 0 m Tabitha Romero jr ' 209-480-7013 MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE ti� fn g l" I 324 Watercress Street ' Shelton WA 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE jl,-j 0 West Shelton Valley Rd co Shelton WA 98584 I—. • NAME OF DESIGNER r PHONE I _� Richard Bazzell ` 1 360-509-7900 NAME OF INSTALLER r , m PHONE v � To Be Determined N/A PERMIT TYPE(select ono) DRINKING WATER SOURCE0 — RESIDENTIAL OSS FCOMMUNITY OSS I!_L'COMMERCIAL OSS g PRIVATE INDIVIDUAL WELL ff.PRIVATE TWO-PARTY WELL Z I(',_) TYPE OF WORK(select one) a_ PUBLIC WATER SYSTEM g NEW CONSTRUCTION/UPGRADES 5REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W r I❑✓ DESIGN FORM(REQUIRED) ❑r SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 011/202S, O ❑ WAIVER(S)(IF APPLICABLE) 3 6.52 EYES ENO 0 I t X DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked game) See directons on Sheet (SDI) of the attached design. I -1 r In --1 SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. — OFFICIAL USE ONLY BELOW THIS LINE• - UPGRADE/FAILURE SOURCE(for reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS,� �� ��� �� � COMMENTS f CONDITIONS Ttf1- 0-S /Test 14 'Mc 3S 9k VW 0-S6 65c to coot,I r6 f ivi ICI I, 1 Re 1/7 faaff qc ti , lal0 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 FINALAPPROVAL. INSPE R SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE W('/?O7. 3 $ (tOf zo�6 c(fz2jz0z S THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 1 9 0 2 2 1 0 0 0 1 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: 11"X 17" PARCEL IDENTIFICATION . Permit Number: SWG 2023-00341 Designer's Name: Richard Bazzell Applicant's Name: Tabitha Romero Designer's Phone Number: 165 NW Tupelo Way Mailing Address: 324 Watercress Stret Designer's Address: Shelton WA 98584 City State Zip Poulsbo WA 98370 City State Zip Designer's Email richard@calibersepticdesign.com DESIGN PARAMETERS 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 ❑ BLI ❑ BL2 0 BL3 V. E 0 N Drainfield Type Gravity 0 Pressure ❑Trench ❑ Bed ❑ Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 40/3034 Daily Flow: Operating Capacity 24 0 gpd Length 40 ft Daily Flow:Design Flow 360 gpd Diameter 4 in Septic Tank Capacity(working) 1250 gal Number 5 Receiving Soil Type(1-6) 4 Separation 10 on center ft Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices Required Primary Area 600 ft2 Total Number of Orifices n/a Designed Primary Area 600 ft2 Diameter n/a in Designed Reserve Area 600 ft2 Spacing n/a in Trench/Bed Width 3 ft Manifold Trench/Bed Length 40 ft Schedule/Class n/a Elevation Measurements Length n/a ft Original Drainfield Area Slope 5-7 % Diameter n/a in New Slope,If Altered n/a % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope 17.2-19.2 in Transport Pipe from Original Grade Down-slope 15-19 in Schedule/Class 40/3034 Designed Vertical Separation 36 in Length 50 ft Gravel-based Drainfield Required? 0 Yes I4 No Diameter 2 in Pump Required? g Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 8 Diff. in Elevation Between Pump&Uppermost Orifice n/a ft Dose quantity 33 gal Drainfield Squirt Height/Selected Residual (head) n/a ft Chamber Capacity(flood) 'fZ 115 O ill'gal ' Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. °ul`c� Capacity @ Total Pressure Head 50 gpm If Timer 0 Elapse Meter 0 Event Counter Calculated Total Pressure Head 15.3 ft If Timer: Pump on 1.11 min ,Pump off 2.98 hrs Comments This is a redesign to add a pump chamber with time dosing Revised: 6/11/2025 1 Assessor's Parcel Number:, 411 1 9 0 2 2 1 �0 0 0 1 0 DESIGN FORM—PAGE TWO Permit Number: SWG 2023-00341 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Ef Test hole locations lit Drainfield orientation and layout Reference depth from original grade: Er Soil logs of Trench/bed dimensions and Er Septic tank if Property lines critical distances within layout le Drainfield cover le Existing and proposed wells Er D-Box/Valve box locations Reference depth from original grade within 100 ft of property le Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks, and locations 0 Laterals,trench/bed,top and surface water and critical areas he Observation port location bottom ❑ Location and orientation of Er 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: Er Location and dimension of 0 Lateral placement with distance Er Observation ports/clean-outs primary system and reserve area to edge of bed Other Information El Buildings 0 Audible/visual alarm referenced Yes No fig Direction of slope indicator Er Scale of drawing shown on scale EC ❑ Design staked out Er Waterlines bar 0 if Recorded Notices attached ElRoads,easements,driveways, V Elevation benchmark and relative 0 ErWaiver(s)attached parking elevations of system components ❑ WI Pump curve attached Ll North arrow and scale drawing 0 WI'Evaluation of failure shown on scale bar Non-residential justification ❑ ErWaste strength ❑ [9 Flow ath - DESIGN APPROVAL C y The undersigned designer must be notified by installer at time of installation IgYes 0 No 08/20/2025 RFC-.at& Signature of Designer Date A Cm The undersigned has reviewed this design on behalf of Mason County Public Health and determined°itt i�compliance with state and local on-site regu r s: AUG 2 u r77? 00Z�Uate V°NoorlNn'fir 2 2025 r Environmental Health Specialist R00 0,41 CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: H ION: EAL rH ✓ The design is stamped"Approved"by Mason County Public Health. ���� ���� ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ✓ Drainfield site conditions have not been altered to adversely affect conditions of desi approval. 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