HomeMy WebLinkAboutSWG2023-00002 - SWG Application / Design - 1/5/2023 DATE RECEIVED: r ^ ^/
MASON COUNTY Q I !I T",'LJ DAL 3 � � ,
COMMUNITY SERVICES AMOUNT RECEIVED: 'r) RECEIVED BY: CO Cn
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Public Health(Community Health/Environmental Health)0
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See-a27-%70,ext.400 or 3ti0-275-a467,ex;.400 oO,\ ,` /� O O
415 Y.6M Street•Shelron,WA 98584 SWG i 3 UUOC71r '�w
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ON-SITE SEWAGE TANK ONLY APPLICATION DxJ
m n APPLICANT PHONE mr
MICHAEL & KIMBERLY JOHNSONI z
MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE g
52 E OLD WINERY ROAD, SHELTON, WA 98584 coco
SITE ADDRESS-STREET,CITY,ZIP CODE
50 E OLD WINERY ROAD, SHELTON, WA 98584 I N
NAME OF DESIGNER PHONE I N
ROBERT H. PAYSSE 360-426-1803
NAME OF INSTALLER PHONE o
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TBD <
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TYPE OF WORK(select one) DRINKING WATER SOURCE O
0 NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z CD
e❑ PUBLIC WATER SYSTEM UNKNOWN
COMPONENT(S)TO BE REPLACED/INSTALLED I
❑O SEPTIC TANK ® PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I --1
❑ OTHER THREE 1.2 ACRES CO
OTHER DETA:_S(select al,that apply) TANK(S)SETBACK CHECKLIST 5 I N
❑ SURFACING SEWAGE 0 EXISTING FAILURE IN SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS n t
7 I CO
SUBMITTALS IID SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
0 PLOT PLAN(REQUIRED) RI TANK CROSS SECTION(REQUIRED) ® 10FT+DRINKING WATER SUPPLY LINES I O
RI PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) I 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS
PLOT PLAN CHECKLIST O I 0.
O PROPERTY LINES AND EASEMENTS I1 EXISTING/PROPOSED STRUCTURES ® EXISTING!PROPOSED OSS COMPONENTS AND LINES
O WELLS WITHIN 100FT I3 WATER SUPPLY LINES 111 DRIVEWAYS/PARKING ® SURFACE WATERS,STREAMS,RIVERS,ETC... I --1
DIRECTION OF SLOPE/CONTOURS III PERIMETER!CURTAIN DRAINS ® NORTH ARROW III SCALE BAR
N
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
N. HWY 3 TO RIGHT ON PICKERING ROAD. CONTINUE ON PICKERING 4.2 MILES TO (
LEFT ON OLD WINERY ROAD. SEE SITE PLAN.
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7'
UPGRADE/FAILURE SOURCE(for reporting purposes) y
❑VOLUNTARY ❑MAINTENANCE/PUMPING CIBUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: II ,--.1=1 CO
COMMENTS/CONDITIONS
4
6A "C\\4 -5 - — ug W\(
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SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED waiiiSER
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. n
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INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY 11-1U1 DAZE
--_-- \ \q 12(6 r � M a
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217/! m
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MASONCOUNTY 415 N 6TH STREET, 98584
•
SHELTON: EXT 400
BELFAIR: 360-275-4467,EXT 400
r P Public Health & Human Services SHELTON,360-427-9670,ELMA:360482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00002
APPLICANT JOHNSON MICHAEL ZANE & Phone: 503.444.0270
KIMBERLY OPP
Address: 52 E OLD WINERY RD SHELTON, WA 98584
OWNER JOHNSON MICHAEL ZANE & Phone: 503.444.0270
KIMBERLY OPP
Address: 52 E OLD WINERY RD SHELTON, WA 98584
SEPTIC DESIGNER Bob Paysse - Pioneer Digging Inc Phone: 360-426-1803
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
Site Address: 50 E OLD WINERY RD
Primary Parcel Number: 220091290012
Permit Description: Add Nuwater and pump tank to existing community DF
Permit Submitted Date: 01/05/2023
Permit Issued Date: 01/09/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/09/2026 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: Septic and Pump Tanks
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: Nuwater and pump tank
Permit Conditions:
4 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 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
•
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 0 0 9 — 1 2 — 9 0 0 1 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 sager size: 11"X 17"
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Permit Number: SWG a.V2.5- oOQ) Designer's Name: ROBERT H. PAYSSE
MICHAEL JOHNSON 360-426-1803
Applicant's Name: Designer's Phone Number:
Mailing Address: 52 E OLD WINERY ROAD Designer's Address: 3083 E MASON BENSON RD
SHELTON WA 98584 GRAPEVIEW WA 98546
Ci State Zi. Cit State Zi.
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
'Aerobic Unit Make/Model NUWTER BNR500 ❑ Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 ScheduleiClass -
Daily Flow: Operating Capacity 270 gpd Length - ft
Daily Flow:Design Flow 360 gpd Diameter - in
Septic Tank Capacity(woika:g) BNR5C0 gal Number -
Receiving Soil Type(1-6) - Separation - ft
Receiving Soil Appl.Rate - gpd/ft2 Orifices
Required Primary Area - ft2 Total Number of Orifices -
Designed Primary Area - ft2 I Diameter - in
Designed Reserve Area - ft2 Spacing - in
Trench/Bed Width - ft Manifold
Trench/Bed Length - ft Schedule/Class -
Elevation Measurements Length - ft
Original Drainfield Area Slope - % Diameter - in
New Slope,If Altered - % Preferred manifold configuration used? gYes 0 No
Depth of Excavation Up-slope - in Transport Pipe
from Original Grade Doran-slope - in Schedule/Class SCH. 40
Designed Vertical Separa:ion - in Length 120 ft
Gravelless Chambers Required? 0 Yes ❑No 0 Optional Diameter 2 in
Pump Required? El Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications ; Number of doses/day 6
Diff.in Elevation Between Pump&Uppermost Orifice - ft ! Dose quantity 60 gal
Drainfield Squirt Height/Selected Residua! (head) - ft x Chamber Capacity(flood) 1500 gal
Uppermost Orifice 0 Higher 0 Lowe:than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head - gpm 'Timer 'Elapse Meter M'Event Counter
Calculated Total Pressure Head ______ _ ft !f Timer: Pump on 1.5 MIN ,Pump off 4 HRS
Comments
TANK ONLY, CONNECTION TO EXISTING DRAINFIELD. USE 1/2 HP PUMP
- SEE OSS RECORDS FOR COMMUNITY SYSTEM FROM 1987
Ilk
DESIGN FORM-PAGE TWO Assessor's Parcel Number:2 2 0 0 9 -- 1 2 -- 9 0 0 1 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
1 Test hole locations GZ1 Drainfield orientation and layout Reference depth from original grade:
g Soil logs g Trench:bed dimensions and LZi Septic tank
I Property lines critical distances within layout 121 Drainfield cover
g Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property ; lig Septic tank/pump chamber and restrictive strata:
Pi Measurements to cuts,banks,and locations G2( Laterals.trench/bed,top and
surface water and critical areas , I Observation port location bottom
g Location and orientation of ' l Clean-out location u Curtain drain collector
curtain drain and al: absorption g Manifold placement ❑ Sand augmentation
components
G2f Orifice placement Other cross-section detail:
g Location and dimension of i
g Lateral placement with distance rZ Observation ports/clean-outs
primary system and reserve area to edge of bed f
g i Other Information
g Buildings � Audible/visuai alarm referenced Yes No
Eg Direction of slope indicator Ci Scale of drawing shown on scale 0 w Design staked out
Waterlines bar 0 g Recorded Notices attached
• Roads, easements,driveways, 0 g Waiver(s)attached
parking I' ❑ Pump curve attached
g North arrow and scale drawing 0 121 Evaluation of failure
shown on scale bar Non-residential justification
❑ g Waste strength
❑ g Flow
DESIGN APPROVAL
The undersigned designer must be notifie by in aller at time of installation f Yes ❑ No
VICAI I 23
Signature of esigTr-t 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:
h:S
Environmental Health Spec list Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. (0(• The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ` f ,,Ca
✓ 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.
Updated Date: 12/7/2015
1
PICKERING ROAD —__^'
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1 i I - OLD WINERY RD
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COMMUNITY \\ 1 I COMMUNITY
WELL —\t \\ DRAINFIELD I
I I LOCATION I
Itr �1001 h I 1 EXISTING
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1 1 1 PUMP TANK
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—� 4114., EXISTING CONNECTION POINT FOR
—_ `� � _ FORCEMAIN.
APPROX. EXISTING , \ *CAUTION OTHER UTILITIES NEARBY
WATERLINE. SLEEVE
TRANSPORT LINE .\. I I PROPOSED SHOP/RESIDENCE
IF W/IN 10FT I I — -r
r� I PROPOSED TANKS W/ NEW
CONNECTION TO I SEPTIC TRANSPORT LINE
CUN
DRAINO ELnD LOICATED TY L L—I I APPROVED
ON PARCEL {u I "' 1 BAN 09 2023
22009-12-90180 & !st 8 MASON COUNTY HEALTH22009-12-90190 RETENVIRONMENTAL ,/t
APPROX. SHORELINE 1 `/ d '�"
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EXPiRES
PICKERING PASSAGE AN ASBUILT!INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, INC. PARCEL##CUSTOMER:ICH J HNSON NO TEST HOLES NEEDED/TANK ONLY
SEPTIC DESIGNS ADDRESS: 50 E OLD WINERY RD
3083 E MASON BEN>O;\RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE DucwMER THE u NOT A SURVEY.REFERENCES INCLUDE APPUCANTICOUNTY PROVIDED
100' PUTS OR SURVEYS.FIELD MEASUREMENTS AND COUNTY GIS DESIGN INTENDED FOR SEPTIC
SHEET: SITE PLAN SCALE: I„= PURPOSES ONLY PROPOSED DER NOT RESPNTONSIBLE
MAY OR SUBJECT TO TO
OFFICE•360-426-1803 FAX-360-427-2353TICCOI DEPARTMENT/AGENCY REV EW DES GNER NOT RESPONSIBLE FOR SETBACKSBJECUNRELATEDOTHER
TO
SEPTIC COMPONENTS.
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// 1 AN ASBUI Sol WILL
/ I \ BE CHARGEDILT AT TIINSTALLME OF IG INSTALLATION
EXISTING STUB OUT/ I
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CONNECTION POINT \\\ I
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APPROX.EXIST.SEWERLINE /
___----
/ OLD WINERY RD
--- APPROX.-XIST.WATERLINE
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/ / EXISTING STUBOUTAND CONNECTION
� ) c 1 TO EXISTING FORCE.MAIN. INSTALL
I t 1 I SERVICEABLE 2" BALL & CHECK VALVE
I ' / AT POINT OF CONNECTION, 1
• 4 ,-...„.--'" IF NONE ALREADY EXISTS.
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1CONNECTION EXAMPLE:r•
1
CHECK VALVE
FORCEMAIN �,
; 1 �' ■ ® IIII=IIllII
1
PROPOSED 1
BALL VALVE
1 \ RESIDENCE/SHOP 1 VALVE BOX TO GRAPE
1 1 IJNtON
APPROVED
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--= JAN 09 2023 `+`.
/ M4ON COUNTY ENV1RONME RE ►f, ` 4
, / [1—•
EXPIRES
1\I MI • O I. I
PROPOSED 2" SCH. 40 SEPTIC LINE
1 \._ PROPOSED NUWATER BNR500 .
1 & 1500 GAL. PUMP TANK
I 1 1
I-. ,
NO TEST HOLES NEEDED/TANK ONLY
PIONEER DIGGING, INC. CUSTOMER.
O 0 2 ooiOHNSON
SEPTIC DESIGNS ADDRFSS: 50 E OLD WINERY RD f
FLATSTHISR.D. OR SURVEYS.FIELD I SURVEY.
ENTS AND COUNTY GIN.DESIGN INTENDED FOR SEPTIC
OFFICE-360426-1803 FAX-J60-427"2353 /y PURPOSES ONLY PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTIER
SHEET: DF DETAIL SCALE r=2L DEPARTMENT/AGENCY REVIEW CESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTC COL9CnENTS
I&
DVAL PORT AERATOR
LID VENT 1 OPTIONAL IN GROVN D BLOWER LOCATION
4•CLEANOI,'T 3:T• 24•CAST iN RISER W/ \
FRON iOVNJA"OAS ,-WATERTIGHT LID hND SCREWS
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2•-35- - 1.PVC MP1-\ LB 1/2'PVC AIRLINESANITARY-.- I } 3 4 tee
,�, y Y ; 1 MASTIC ,
\`�•� 2'COVDIING
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J I ' 1• f 1 OUTLET TO PUMP TANK
' •h�TER'Chr---r `1-PVC SLVCCP r� WATERTIGHT
-EC.=E:IT'INC $ :::
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INSTALL
TANKS MUST BE NVWATER .`
ON STATE DOH
APPROVED LIST I BN R500 .o . i
OF SEWAGE I •
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J17!fUSERMR$Q) 1-1.,11. USE RUBBER
! TANKS • IL •
�?ARALI€ TANK WALL , : GROMETS FOR
// o SLUDGE RETURN-, •
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0 ! TRANSPORT LINE
«� , AND ELECTRICAL
l' fl
;; srfi: ?��s ! r 4 ON RISERS. MAKE
. SURE ALL HOLES
PUMP TANKS r A . . •- v--
{ OVER.1000 GAL. ARE WATER-TIGHT
REQUIRES TWO APPROVED
ACCESS RISERS
TO GRADE ONTROLPAN, ` :: 5 ED RISERS
JAN 0 9 2 3` - 1'r• 2�V\ ' \ATER TIGHT LIDS
MASON COUNTY ENVIRONMENTAL HEALTH ! !
T i
----� FINISHED GRADE
ELEC-RI AL WORK DONE --~~-�
BY LICENSED ELECTRICIAN
=LECTR.CA.CC. 7,.,T TRANSPORT LINE
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E I-- Fa UNION BALL VALVE
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WATER-TIGHT —/ 500 GALLON WATERT/GHT Ift
JOINTS CONCRETE PUMP TANK I a
At
CHECK VALVE
4-•� HIGH WATER FLOAT II,
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�1 : VSE TANKS FITTED .
�� ON/OFF FLOAT W/CASTIN WATER
�1, .,. . TIGHT FITTINGS FOR
PUMP BUCKET INLET/OVTLESAND
�;��, �' , = CAST IN RISER
�.- 1•, = ADAPTERS TO
Srry ::r >>. .,,:. _ w `,,.,.._1.- y;p.41l. sµ ni 's _- .4!'9=a ENSURE WATER
!' • . , ;. . TIGHTNESS
EXPIRES
f. CUSTOMER: MICHAEL JOHNSON SCALE:V';
PIONEEf L1IGGll`��IC. INC PARCEL s:2200912 90012 INSTALL TANKS ON ORIGINAL OR
SEP [IC DESIGNS ADDRESS: 50 E OLD WINERY RD COMPACTED LEVEL SOILS. RVN CROSS
3083 E MASON BENSON RD. CRAPEVIEw,wA 98546 DESIGNER: ROBERT FL PAYSSE CONNECTIONS INTO ORIGINAL SOILS TO
OFFICE-360-426-1803 FAX-360-427-2353 DESIGN PAGE TANKS DETAIL AVOID SE 1 !LING.
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APPROVED
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JAN 09 2023 $ •••
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MASON COUNTY ENVIRONMENTAL HEALTH
.
PIONEER DIGGINIG1 2009-12-90012
INC CUSTOMER: M1CF.AEL JOHNSON
• PARCEL:-•-.2 '''.,..* — --",... , ro•—.4. ge
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SEPTIC DESI(..,-NS .NDDRESS: 50 E OLD WINE.RY RD
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3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE EXP•-':
OFFICE-360-426-1803 FAX-360-427-2353 , SHEET: CALCS SCALE NA
mr—JeW SI.,
Installation & System Notes
1.Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks,lids,
transport line,drainfield,and water lines must be open for inspection. A$300.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2.This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state,county, and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department prior to attempting installation.
3. Designer is r.o..a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder,lot
developer,or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities (ex.water,gas,electric) prior to
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6.All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
i maintenance. Component manufacturers(ex.ATU,Glendons,) may have other requirements not listed within this design.
7.All electrical wiring shall be done by a licensed electrician or homeowner(if allowed)and must be permitted through Labor
and Industries.
8.The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain 10ft to waterlines with all septic components. If less than 10ft is required,sleeving in sch.40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18" above sewage line with one of the lines sleeved in sch. I
40 pvc 10ft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11.Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and 10ft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or
= may not meet other requirements.
1 13.All onsite septic systems require regular maintenance to verify satisfactory operation. The system owner/operator is
responsible for the continuous operation and maintenance of the system per WAC 246-272A. For operation and maintenance I
information, refer to Mason County Public Health Homeowner's Manual,which should be received after installation approval.
14.System owner should be cautious of landscaping around septic components. Root intrusion
can cause premature failure of the drainfield area. d' 'o u s rttbs should be kept
away from lids and other septic maintenance poin. �
JAN 0 9 2023 �4
MASON COUNTY ENVIRONMENTAL HEALTH �•
CUSTOMER: MI JOHNSON
PIONEER DIGGING INC. =
PARCEL#:22009-12-90012 �; ROBE&T "AiYSs!
SEPTIC DESIGNS • " �,°�:
ADDRFSS: 50 E OLD WINERY RD 1��i.J+'
3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER ROBERT H.PAYSSE EXPIRES
OFFICE-36(}426-I803 FAX-360-427-2353 SHEET: NOTES SCALE NA