HomeMy WebLinkAboutSWG2023-00254 - SWG Application / Design - 6/20/2023 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
Yz d :' ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00254
APPLICANT Timothy Earl Phone:
Address: 101 E Main St ELMA, WA 98541
SEPTIC DESIGNER CHRIS ELSTROTT-Advanced Phone: 360-561-5000
Engineering
Address: 128 NORTH RIVER STREET MONTESANO, WA 98563
Site Address: 420 W Haven Dr
Primary Parcel Number: 619305100062
Permit Description: New SFR-2BR sand lined bed
Permit Submitted Date: 06/20/2023
Permit Issued Date: 07/26/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/25/2026 (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 Drainfield 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/healthlenvironmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
DATE RECEIVED: / ^ O /� / C N
MASON COUNTY Ot/C / l-Jl-b
. h'ii4rii ., COMMUNITY SERVICES AMOUNT CENED. IREC[NEDSY
. 0 m
t Public Health(Community Health/Environmental Health) r\`2 /� 1t�,
a360 ISN 6th Street
-a00wn,WA 5.N67,ert.400 SWG �V v 3 — CXj / \ Z 2
41 S N.6lh SlreA-Shelton,WA 98584 -C.
ON-SITE SEWAGE SYSTEM APPLICATION m 73
APPLICANT
PHONE rn
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7>'rooTA a.• / 30� — yGo — 876s Z
VVV 3�
MAILING ADDRESS-STREET, ITY,STATE,ZIP CODE 1 g
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/0/ E. /f9.9/N ST , /Z6 4/4 4,/9 9erY/ Q
73
SITE ADDRESS-STREET,CITY,ZIP CODE It I.
,Of 4i20 w. /�i¢vo'.v ,v/e. ,[U G A' )' , w/ 78 `//
NAME OF DESIGNER _ O S=DB V IC'HON�`o - T.,G / - ,J-a o 0 1 I`
G/,1�,s �LSi !Zo TiT �L - I�0
NAME OF INSTALLER ��`1 r) O 1O^^ �,�F'IONE �
PERMIT TYPE(select one)ES BY —DRINKING WATER SOURCE
IJ
ralfl IDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS }HATE INDIVIDUAL WELL 0 PRIVATE 3/2 `a/ ?SELL Z I Q
UBLIC WATER SYSTEM y ,se 2g t
TYPE OF WORK(select ale) I
fl NEW CONSTRUCTION I UPGRADES fl REPAIR/REPLACEMENT OTHER DETAILS(sake aft that apply) 0 TABLE IX REPAIR
SUBMITTALS
0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
LOT SIZE e r I�
SIGN FORM(REQUIRED) PTIC DESIGN(REQUIRED) BEDROOMS n r
7 WAWER(S)(IFAPPLICABLE) 2' /�yx /Pe o ID
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate) I (O
rO IO
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. N IN
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT El HOME SALE ❑COMPLAINT 0 OTHER:
COMMENTS/CONDITIONS
INSPECTOR SOIL LOGS / ` /
a -z� L5
11/2 "-yii. r
0i2 ,co
`
- o �/ I RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: REQUIRED FOR FINAL APPROVAL.
V=VERY G=GSA S=SAND L=LO Si=SILT C=CLAY E=EXTREMELY R=ROOTS DATE
PLIC)ATION APPROVED!ISSUED BY
IN TOR SIGNATURE DATE APPLICATION EXPIRATION DATE I 7- 6
2-3
0,(11.1-2.0 .-1 _ -,-)_ 6- .2.t .9,66 WI, likeq.\
TH AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
REVISED 12l7/2015
'DESIGN FORM-PAGE ONE Assessor's Parcel Number: G / f 3 0 -- 5 / -- as a L 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"
PARCEL11 IDENTIFICATION
Permit Number: SWG ai 543- ,,
�K Designer's Name: mc-AL/2/..5 /2-4s7-- ?T
Applicant's Name: T//h a ply EARL Designer's 'p rF C . �}�I V . - 5-6/- 5-BL
Mailing Address: /v/ 6- M/ai/i/ 577 Designer's .!; eJUN Z O 2023 4,1, /t
46-4,14/4 1,4,,it f6'ry/ , I e,VTL$l4/0, wr9 I'd Sg3
,,��,,yy City State Zip 'j/�'�7'j� [' h,i . Ci State Zi.
rYY''Y f+ #t yk, F„*4+G �.Otnit Y�'. }`t S prJ`�J'V.3'yew t * ESION'r'AIl�l��L�I.Jr4. 1 ,... n ,. r , .. ..
Treatment Device
❑ Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑ Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: "-My re -%2r 41.
Dr field Type
❑ Gravity ressure rench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms Z- Schedule/Class !lo
Daily Flow: Operating Capacity Zyo gpd Length 2S ft
Daily Flow:Design Flow -.i a gpd Diameter /// in
Septic Tank Capacity(working) iz. a gal Number V
Receiving Soil Type(1-6) / Separation 2- " ft
Receiving Soil Appl. Rate /•a gpd/ft2 Orifices
Required Primary Area -VO ft2 �1 Number of Orifices 90
Designed Primary Area z Va ft2 iat�eR 3//6 n in
Designed Reserve Area /o t ft2 swing O .3o in
S JV�
Trench/Bed Width /0 ft 0/y C0oN 2 6 20?3Wanifold
Trench/ ,�,d Length z y ft Sc s VO
L�c�i9�i1 �fNTgC H ' � ft
Elevation Measurements W Eglrti 7
Original Drainfield Area Slope Q % Diameter Z• in
New Slope,If Altered D % Preferred manifold configuration used? ❑Yes t
Depth of Excavation Up-slope 51) Z /„ci/so„,in Transport Pipe
from Original Grade Down-slopeo.�o'„^ / s,,„I in Sche Class y4
Designed Vertical Separation 7 2/ in Length ea ft
Gravelless Chambers Required? ❑Yes D-210❑Optional Diameter Z in
Pump Required? es 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 5/
Diff.in Elevation Between Pump&Uppermost Orifice S ft Dose quantity 4rD gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) /G?,d gal
Pum
Uppermost Orifice 13"Higher 0 Lower than Pump Shutoff p controls:Please check those required.
Capacity @ Total Pressure Head `// gpm imer apse Meter vent Counter
Calculated Total Pressure Head /V ' ft If Timer: Pump on 70 4f 3-cr. ,Pump off
iqr , s�vs�'rcno�v
Comments eAl ch �u� U
DESIGN FORM—PAGE TWO
Assessor's Parcel Number: 6 / 9 3 0 -- S/ -- 40 .06. Z.
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan
Scaled yout Sketch Cross-Section Sketch
p---1 hole locations grainfield orientation and layout Reference depth from original grade:
Soil logs CY 1 rench/bed imensions and CLAgtic tank
E2VPcritical distances within layout rainfield cover
roperty lines
At D-BoxNalve box locations Reference depth from original grade
Existing and proposed wells tic tank/pump chamber and restricts -e strata:
within 100 ft of property
Measurements to cuts,banks, and
locations Laterals,trench/befi,top and
su a water and critical areas Observation port location bottom
}ean-out location C dain drain collector
Location and orientation of Sand augmentation
� ici and all absorption [��nifold placement
components rife e placement Other croj,psection detail:
cation and dimension of bservation ports/clean-outs
CY Lo ateral placement with distance
primary system and reserve area to ed a of bed Other Information
f3-4uildings 0 udibl visual alarm referenced Yes No
Direction of 1.ope indicator, le ra shown on scale ❑ ❑ esign staked out
Gs?T Si r'� bar " 'o1 0 C3- rded Notices attached
p�iaterlines s" 0 ■ aiver(s)attached
1:3-40.;- easements,driveways, f" e ❑Pump curve attached
parking flit ?8 . 44 ;�"� p aluation of failure
[/North arrow and scale drawing �p�N1),A.A 20 on-residenti justification
shown on scale bar Je kGNM il -eNT�I la ❑ Wa - strength
DESIGN APPROVAL
gn
The undersigned designer must be notified by installer at time of installation es 0 No
Signature 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 o ' e regulations: 7-2C2 2_7
En r ntal Health Specialist
Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. Z ,��
/ The Onsite Sewage Permit has not been alteredpired,the Permit Expiration Date is: I—o adversely affect conditions of design approval.
✓ Drainfield site conditions have not
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 re uired.
This form may be scanned and available for public view on the Mason County Web site.dated Date: 12/7/2015
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