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HomeMy WebLinkAboutSWG2026-00069 - SWG Application / Design - 3/12/2026 , (PtMASON COUNTY 415 N 6TH STREET,SHELTON, 98584 SHELTON:360 427-967967 0,,EXT 400 BELFAIR:360-275-4467,EXT 400 I1 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2026-00069 OWNER DAMER BENJAMIN E &NICOLE M Phone: Address: 1028 LAKEVIEW BLVD E#8 SEATTLE, WA 98102 APPLICANT DAMER BENJAMIN E & NICOLE M Phone: Address: 1028 LAKEVIEW BLVD E#8 SEATTLE, WA 98102 SEPTIC INSTALLER THAD BAMFORD* Phone: 360-790-2364 Address: 301 WALLACE KNEELAND BLVD STE 224-332 SHELTON, WA 98584 Site Address: 130 SE SELLS DR Primary Parcel Number: 319024390030 Permit Description: Replace pump tank Permit Submitted Date: 03/12/2026 Permit Issued Date: 03/12/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/12/2027 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Pump Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 4 Drinking Water Source: Private Well/Spring Additional Details: IM-1250 Permit Conditions: 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained • 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 4 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/OR 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 DM RECEIVED: ,,,,, 7:4-- -,,,,, MASON COUNTY 3/to/6(a AMO T R RECEIVED B C Cl) t , " COMMUNITY SERVICES c �, Public Health(Community Health/Environmental Health) Eh — av� .- 4158.6th e -400 n WA 985847,eM.400 SWG ��hh\\` j `ter 415 N.6th Street-Shelton,WA 98584 V �Jat�\J\/I/v^ z tp ON-SITE SEWAGE TANK ONLY APPLICATION 7P5NT --) (....H_O_NE m MAILING ADDRES STREET,CITY,STATE,ZIP CODE E 1043 ,e/v terA-1 OLVDi XI SIT RESS-STREET,CITY,Zy.CODE 1111: MI6 q8/6Z I NAME OF DESIGNER �� �^ J PHONE I-- 1O;i/INSTAL IR ' ' /i _/ ,..i-Th_ P Fy' _)77 L�._2 OW / v 5 TYPE OF WORK(select one) DRINKI G WATER SOURCE o NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL 2 IN COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM I ❑ SEPTIC TANK UMP TANK 0 RV HOLDING TANK BEDROOW A LOT SIZE ❑ OTHER 773?L► �`-7 9 W OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST P PA v t ❑ SURFACING SEWAGE tEXISTING FAILURE -SHORELINE le100FT+PUBLIC/COMMUNITY WELLS , o ^ SUBMITTALS �Kry 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS A. Ik PLOT PLAN(REQUIRED) /x-TANK CROSS SECTION(REQUIRED) 10FT+DRINKING WATER SUPPLY LINES I/) ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) '�5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS l� PLOT PLAN CHECKLIST f"' Ico4 APROPERTY LINES AND EASEMENTS EXISTING/PROPOSED STRUCTURES EXISTING/PROPOSED OSS COMPONENTS AND LINES I ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES LJ'DRIVEWAYS!PARKING�/ 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I V� ❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ELLNORTH ARROW 0 SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY'✓✓�MAINTENANCE/PUMPING 0 BUILDING PERMIT ElHOME SALE ❑COMPLAINT 0 OTHER: COMMENTS/CONDITIONS \WO (Y1W j 14n IA 62/ f tiVr\•p -) a ft _K.__ 'P-1,43 0O1_ Caput SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS".TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EQUIPPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 3iflifl vti-T\24,1014 34fac , THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 T.b . 117 , 011 Drainfield& manifold orientation ,,,• 1 l? , r &layout r .H Trench/bed /. ' dimensions and >t.44 3Xysr critical distances s i 0/within layout i e Septic/pump tank { 6 `t f 5��.: placement �-k 6 11 Location of • buildings �'" g(Observation port& , ,?" �r.,rsRr7 !`'1PROV /clean-out location 1 Location ofwells& MAR 1 2 2q2 /oads ! MASON COUNTY ENVIRON Undisturbed native AFT EV'ALHEALTH soil between es � '1re)North arrow ; i / 1`) j ak 4/r VAj- ,,o Se,f,e • y 1 . IS r r,�k . CAUTION:Minor adjustments to septic tank and drainfteld orientation made in theteld by thanstali am acceptable m both the deportme n and the deravtaa provalfrent either ce tain arses the via'bility of the*stem, h is the' Aer's rowan:Mi ky the s ilitty Aobtabt prior written O- ns f om the appmed dm heakh�nmsr be shown D"e'"""" anydeviationsfraam design that off act Install"(Check a box from Row"A"and"B",sign end date the certification A. 0 I certify that I installed the system without any CI I certify that all deviations from the design stamped deviation from the design stamped"APPROVED"by "APPROVED"by MCPB are shown above. MCPH B. CI I certify that I contacted the designer and left the (VI did not contact the designer prior to final cover because the system open for inspection up to 48 hrs prior to cover. designer waived the notification requirement. I fluffier unify that all information contained on this form is accurate. I understand that if the"on o herein is not accurate,there will be just cause for immediate suspension of my installer certification. to//7 // tore of t r ate The undersigned approves this installation on behalf of Mason County Public Health. eLA-Li i 4 10 l • `m� .--4 , li,,x € ,,, t l 1 "'° 11 , ;€ Sitr_Lse of Date i tit .4:K.0° t^ 'toe is s t 4 ,.,: a 'u r 4A LA x ti 6 m:.r t L" ,,,4 Printed from 4 s n Couri1y DrviS IIIIIIINIMONIN .iji-illik 4 ASBUILT FORM Masuiu:County Public Health • PARCEL IDENTIFICATION ! Permit Number SWO 2011 _o0.13/ Assessor's Parcel 3/ o(Tweve-DiigitN ) c Applicant's Name 1:9D ©rMe..- Subdivision ``-''�� (Name/Divisioa//Blocid.ot) Applicant Address 13O. .S _5e//_5"D< Installer's Name 3—o/,n G%//,/,,,,.,/- AL . City,State.TIP 3Y-2,144-1—.A-1.4‘a2 Designer's Name .T ) '-Zyn ,11144spn INSTALLER CHECKLIST N/A Yes Prior to Completion L SEPTIC TANK >5 ft Fz+nm faarndation?...............................................�........- ® a >50 ftfrom wells?.......................................................»......... ❑ Pc a >50 ft surfac a water?...................................................�........ ❑ Zr ❑ Building stubotit to septic tank:cleanout if not 1-2%? O PC,,,. ❑ Ba lee intact and cleane ❑ ❑ - Dividing wall intact?.... .........................................._ O JOG O Risersinstalled for .••-..'► .............................._...... ❑ e ❑ Screen basket r.effluent filter install,-, •(circle one)..-....-.—....-.- a Ec 0 • Tank size: 1-1 del gal.; , r , i -: I., /r]4i51[e 71..n K IL D-BOX PA„,_ ,. . . -t OF Leveled with water? O O Speed leveler used? ❑ a III. Drd >10 ft from foundation' ...... O O >5 ft from property lines and easement lines? .. O or ❑ >100 ft from wells? ❑ O >100 ft from surface water? O O >10 ft from potable water lines? O O Laterals level to±1 inch&end carps present if not looped? O El O Gravelless chambers utilized? k ,l� ❑ . Gravel clean,properly sized,and proper depth? ❑ ❑ PRESSURE SYSTEMS Sand quality ASTM C-33?........................................._.. je a a Head height uniform ≥24 inches? Actual head height )2 ❑ a , Clean-outs and observation ports present? ❑ a Mound: Side Slope 3:1? a i:/ ❑ Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I?............_ O RI O C�—�) IV. PUMP/PUMP CHAMBER I Pump make: iy�i3Ort14.�1� ; Pump model Sh,1 1/ ❑ ❑ c chamber size 1d 0D_ gal; Manufacture ?REiYI i ER a Er a b - Height of pump off bottom of pump chamber CI" inches .— Pump chamber draw-down /12.1 t gallons per inch per minute 0 L--.3 Pump capacity gallons per minute Pump controls:Timer,Elapsed Time Meter,Counted(Chick all that a re a E�- pp apply). If timer:Pump On ,2 m`» Pump Off 217 1rr Riser installed for access?......................................................... ❑ ❑ Alarminstalled?........................................................:............. ® V ❑ Printed F o y r as 'n GoL � DIMS Printed from Mason County DM 6• lM 1250 General Specifications and Illustrations • The IM-1250 is an injection molded two-piece rid-seam polypropylene tank. The injection molded design of thelM-1250 allows for a mid-seam joint-that has precise LIFTING STRAP(TYP.) LIFTING LUG(TYP.) :RISER CONNECTION(TYP.) dimensions for accepting an engineered EPDM gasket. The engineered mid-seam joint accepts a continuous ,Y- t1 fIyIr II 111II Ir'P I i"irl I i' t;;4 - loop EPDM gasket. Infiltrator's EPDM;gasket design G �':O�L-t- r :1 �, i l�L�l1 �`-' . : ��' .f 'iii ° ilil I yll 61.7 utilizes technology and materials from the,sanitary. ji p d 1.! 0)fill. i l e[ .. .I [1,567] sewer pipe industry to deliver a reliable watertight seal. f c 7^,, -' it it l Ji Ujj Li, li�lli .,,,.;-,.:.,.t-if! DT EXTERIOR The two-piece"'design'is permanently fastened using � `xf f,j i :,Iciil!Ill•i,a!�,,L%a'I Iiiiii!�f! _ 7" I :ra system of molded-in alignment dowels and locking , 152.3[3,868] seam clips. The IM-1250 is assembled and sold.throwg h EXTERIOR LENGTH a network of.certified infiltrator distributors. , •0\ TOP VIEW Must be backfilled and installed in :-•V. accordance with the Infiltrator IM-and_ 9 °°d re,.R° � CM-Series Septic Tank General OUTLET PIPE °o r,:g - Installation Instructions.For shallow i-' rr• ''''';,r- - =- '/ ..1,E ground water conditions reference Ili i l i p pp7p INF(i, ,,°° .i.::. the Infiltrator IM-and CM-Series Tank iii i !i I -° °°irs e®-°.: II,L.d i i,d dill lul 1.Ll.lL [1,387] 1-o° -MI ... Buoyancy Control Guidance. Ixxsn 9K:r.-n-tn ;.—. G0 um.°: tl SEAM( CLIP) :VI(t,i✓p' III ' .Iflv�ilri.v EXTERIOR -°g-u- ° ° I i HEIGHT Please visit www.infiltratorwater.com R a' I 1. j I /11 r l or scan OR code for the latest \'' '' i 1 ` LIFTING STRAP' r. I - A M E information. (TYP.) It.. , (1480'` 1 •, A ` r - . . END.VIEW Working Capacity 1,278 GAL(4,839 L) ' PVC OR ;0 24.0[610]ACCESS PORT Total Capacity 1,480 GAL(5,602 L) I INLET TEE i WITH LOCKING LID(2) 10.0[254]FREEBOARD /PVC[OR ABS Airspace 16.30% i OUTLET TEE - INL�. I 16.3% I 1- i Length 154" (3,911 mm) ? 3.0( %AIR SPACE [76] I 0.2[5]WALL Width 61.7" (1,567 mm) 1. THICKNESS o- PER CODE 44.0 i ' 2 51 C 7 [1,118 r PER CODE r-, Length-to-Width Ratio 2.8:1 rr )) [51 LIQUIu 1 FISUPPORSS DEPTH SUPPORT Height 54.6" (1,387 mm) i I TYP.) • i z :.. ♦ 1.. .,.... Liquid Level 44"(1,118 mm) ] I Invert Drop 3"(76 mm) .SIDE-VIEW I Fiberglass Supports 4 rr// APP. K OPE 6..d/ j , CONTINUOUS Compartments 1 or 2 �TdN 11 d// / ELASTOMERIC HALF j 1 / GASKET Maximum Burial Depth 48"(1,219 mm) MAR 12 2026 ',,"v ///I • Minimum Burial Depth 6"(152 mm) MASON COUNTY EN I� '4 _ENVIRONMENTAL HEALTKi '0 ;;�s!— vSZ CLIP i Maximum Pipe Diameter 4"(102 mm) I Weight 405 lbs(184 kg) INTEGRAL ALIGNMENT I 4,DOWEL I / TANK BOTTOM fl HALF 4 Business Park Road P.O.Box 768 old Saybrook,CT 06475 MID-HEIGHT SEAM SECTION 860-577-7000•Fax 860-577-7001 N 1-800-221-4436 i F 9 LT RAT O R www.infiltratorwater.com w<to technologies info@infiltratorwater.com For U.S.Patents information visit www.infiltratorwater.com/patents.Other patents pending.Infiltrator,Quick4 and EZflow are registered trademarks of Infiltrator Water Technologies.Infiltrator Water Technologies is a wholly-owned subsidiary of Advanced Drainage Systems,Inc.(ADS). ©2024 Infiltrator Water Technologies,LLC. Not responsible for any typographic errors.Printed in U.S.A. IM125 0124 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436 ,