J06 Thurston Co Septic permit.pdf

Building Development Center 2000 Lakeridge Dr. SW, Olympia, WA 98502 y, 360) 786- 5490 / ( 360) 754- 2939( Fax)

TDD Line( 360) 754- 2933

1- 6 Email: permit@co. thurston. wa. us

THURSTON COUNTY

www. thurstoncountybdc. com

Creating Solutions for Our Future

SINCE 1952

MASTER APPLICATION

This application must accompany a project specific supplemental application.

STAFF USE ONLY_

J

DATE STAMP

THUR 0UNTY

2019102541 19- 106618 HD Area: 1 11 LL, 1, c I V L D

Site: 10427 MULLEN RD SE OLYMPIA

NOT 21831111300 MAY 29 2019

IN Bl Sub Type: On Site Sewage System

DE/ EL Pi" ENT SERVICES

Gopher Soils YES NO Prairie Soils YES NO Intake By:

PROJECT DESCRIPTION

New septic to serve existing 3 and 1 bedroom residences

PROPERTY INFORMATION

1. Tax Parcel Number( s) 21831111300

2. Subdivision Name Lot#

3. Property Address 10427 Mullen Road SE

City Olympia

Zip Code 98513

4.Directions to Property( from nearest major road)

Mullen Road SE to address

PROPERTY ACCESS

S. Property Access R Existing Proposed

6. Access Type ® Private Driveway Shared Driveway Private Road Public Road

7. Property Access Issues ( locked gate, gate code, dogs or other animals) R No Yes

Property owner is responsible for providing gate code and securing animals prior to site visit.

WATER/ SEPTIC

8. Water Supply R Existing Proposed

9. Water Supply Type I7Single Family Two Party Well Group A Group B

WATER SYSTEM NAME City Water

10. Waste Water Sewage Disposal Existing R Proposed

11. Sewage Disposal System Type IRIndividual Septic System Community System Sewer

NAME OF PUBLIC SYSTEM

Building Development Center Master Application s. r 3 i•' a r

BILLING OF INVOICES

The fee charged at the time of application covers base hours listed on the fee schedule. When base hours by a Department are used, a monthly billing invoice is generated at the hourly rate listed on the fee schedule. ShoulNeview of the project exceed the base hours allotted, billing invoices shall be mailed to: Owner ® Applicant_ U Point of Contact

PROPERTY OWNER additional property owner sheet can be obtained online at www.thurstoncountybdc. com)

Property Owner Name Danae Pierce

Mailing Address 10427 Mullen Road SE

City Olympia

State

WA

Zip Code 98513

Phone( Cell Fax

EMAIL

Communication from staff provided by Email? AYES 8 NO

Property Owner Signature* Date

APPLICANT

Applicant Name Indian Health Services

Mailing Address 4060 Wheaton Way, Suite E

City Bremerton

State

WA

Zip Code 98310

Phone 3( 60 ) 792- 1235

Cell Fax(

EMAIL

Eva- Marie. East@ihs. gov

Communication from staff provided by Email? 8 YES NO

Signature* Date

POINT OF CONTACT (Person receiving all County correspondence)

Name Environmental Design- Becky Rieger

Mailing Address 901 L Street

City Centralia

State

WA

Zip Code 98531

Phone 3( 60 ) 219- 3343

Cell Fax

EMAIL

office@environmentaldesignllc. com

Communication from staff provided by Email? ® YES NO

Signature* D

Date 2

DISCLAIMER

Application is hereby made for a permit( s) to authorize the activities described herein. I certify that I am familiar with the information contained in the application package and that to the best of my knowledge and belief, such information is true, complete, and accurate.

I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agencies to which this application is made or forwarded, the right to enter the above- described location to inspect the proposed, in- progress or completed work. I agree to start work only after all necessary permits/ approvals have been received.

Revised 05/ 31/ 18 sTAFTWUKU, N COUNTY

SUPPLEMENTAL APPLICATION

N9AY 2 9 2019

ON-SITE I CIET OES

SEWAGE 2019102541 19- 106618 HD Area: 1

SYSTEM

Site: 10427 MULLEN RD SE OLYMPIA 21831111300

Sub Type: On Site Sewage System

PLEASE NOTE: ALL APPLICATIONS AND SITE PLANS MUST BE COMPLETED IN BLACK OR BLUE INK ONLY

This application cannot be submitted alone. In addition to this form, a complete application includes:

Master Application

For on- site sewage system projects within an urban growth area or city jurisdiction, this application must be taken to the city for review and comment prior to submittal.

For new on- site sewage systems requiring a design: Five ( 5) site plans and three ( 3) on- site sewage system designs.

For replacement of existing on-site sewage systems requiring a design: Three (3) on-site sewage system designs.

For submittals not requiring a design ( i.e. septic tank or pump chamber placement): Three ( 3) site plans.

Applicable processing fees ( refer to current fee schedules; additional fees may apply if base hours/ fees at intake are exhausted).

PERMIT TYPE: On- Site Sewage with Residential Site Plan Review ® On- site Sewage System Only Tank Only Drainfield Only Community Drainfield Sand Filter or Mound Rebuild or Replace

WORK TYPE: New ® Repair Modification

PROJECT TYPE: ® Residential Single Family: Number of Bedrooms 4 Residential Multifamily: Number of Units

Number of Bedrooms in Units

Non- Residential Description:

TAX PARCEL NUMBER: 21831111300 Parcel Size ( acres):

0. 4

Property Address: 10427 Mullen Road SE City.

Olympia Zip:

98513

JURISDICTION: A Thurston County Urban Growth Area of City of

CITY JURISDICTION REVIEW AND COMMENT: APPROVED DENIED

Comments:

Signature: Tide:

Date:

Resource Stewardship I Permit Assistance Center 2000 Lakeridge Drive SW, Olympia, WA 98502

360) 754- 3355/( 360) 754- 2939( Pax)/ TDD Line( 360) 754- 2933

THURSTON COUNTY permitaco thurston wa us/ www co thurston wa us/ permittine Page 1 of 2

SEPTIC DESIGNER: Becky Rieger

Company:

Environmental Design

Email: Office@environmentaidesignllc. com

Cell Phone: ( 360 ) 219 3343 Office Phone:

Mailing A ss:

901 L Street

City:

Centralia State: WA zip/:G98531 Signature: Date:

ADDITIONAL REQUIREMENTS & INFORMATION

PROJECT SITE:

The project site must be identified in the field by posting an identification sign visible from the access road and by flagging the property corners and the center of the driveway/ road access location.

The following test pit requirements must be met:

Test pits must be six ( 6) feet deep, although excavation may stop at a depth where the water table or restrictive layer is encountered;

Test pits must be large enough and ramped for easy and safe access. The applicant is responsible for constructing and maintaining test pits in a manner so as to prevent injury to people;

A cleared and marked path through any brush, fences or obstacles to all test pits must be provided;

Each test pit must be numbered by a painted or flagged stake;

Test pit construction shall be consistent with Washington State Department of Health' s Guidelines for Test Pit Construction for On-site Selvage Systems, which can be found at htti2:// www.doh.wa.gov/ Portals/ 1/ Documents/ Pubs/ 337- 110.]2df

RIGHT TO APPEAL:

Any person aggrieved by a decision, an inspection, or notice made by the Health Office shall have the right to appeal the matter as specified in Article I of the Thurston County Sanitary Code.

EXPIRATION:

On- site Sewage System applications expire one year after the date of application per Thurston County Sanitary Code, Article IV, Section 8. 3. 3. 1. This period may be extended for a single one year period without charge, if specifically requested in writing by the applicant prior to the expiration date.

Resource Stewardship I Permit Assistance Center 2000 Lakeridge Drive SW, Olympia, WA 98502

360) 754-3355/( 360) 754-2939( Fax)/ TDD Line( 360) 754- 2933

THURSIO® Y permit( t o thurgon wa us/ Nyw%v. co. thurston. wi.us/ permiULng Page 2 of 2

ON- SITE RECORD OF ACTION

RELATED PROJECTS:

2019102541 19-106618 HD Area: 1

Site: 10427 MULLEN RD SE OLYMPIA Route To: ON- SITE PPR TANK PLMT LANDUSE EHSS

21831111300 Sub Type: On Site Sewage System Imaged Parcel File Attached to Amanda

Hard Copy Attached

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PROJECT# PAGE

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Thurston County Environmental Health Department

Environmental Health Division

A 2000 Lakeridge Drive Olympia, WA 98502

Phone ( 360) 867- 2628 Fax

THURSTON COUNTY

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SINCE 1852

On Site Sewage Systems Permit # 19106618

Property Tax#: 21831111300

Site Address: 10427 MULLEN RD SE Plans Approved By:

City: OLYMPIA Issued Date: 08/ 13/ 2019

Subdivision: Lot#: Issued By: Susan Lord

Sub Type: On Site Sewage System Expire Date: 05/ 29/ 2020

Work Proposed: Repair

Permit Description: new 4 bedroom septic system to serve existing 3 and 1 bedroom residences.

replacing existing.

Applicant: Indian Health Services Phone: ( 360) 792- 1235111

Address. 4060 WHEATON WAY SUITE E BREMERTON WA 98310

Owner: CHERRI A CRAIN Phone:

Address: 3824 DANDELION DR SE OLYMPIA, WA 98501

Owner: DANAE C PEIRCE Phone:

Address: 10427 MULLEN RD SE OLYMPIA, WA 98513

OSS Designer: Becky Rieger/ Enviornmental Design, LLC Phone: ( 360) 219- 3343

Address: 901 L Street Centralia , WA 98531

Point of Contact: Becky Rieger/ Enviornmental Design, LLC Phone: ( 360) 219- 3343

Address. 901 L Street Centralia , WA 98531

Info of compartments: 2 Pump chamber size: 1250 Proposed Sewage System Use: Residential, Singl

Water Supply Type: Group A Assign Sanitadan: sangstb Number of Bedrooms: 4

Tank: Concrete Pre/ treatment: None Disinfection: None

Transport: Pressure distribution Disposal: Bed: sand lined( C33) Programmable timer needed?-Yes

An Operation& Maint Cert is required: No Special OPC conditions needed?: No OPC type: Single Family

Structure type: Single Family Is bacti sampling required?: No TSS/ BOD/ OG required?: No

OSS serves a food establishment.: No Does system have a grease trap?: No This OSS system is experimental: No

GSA area:MCALLISTER SPRINGS

Project Conditions

All fees associated with this project reflect the current fee schedule in effect at the time the charges were assessed. All unpaid fees are subject to change without notice, upon the adoption of a new fee schedule by the Thurston County Board of County Commissioners.

On April 8, 2014, the U. S. Fish and Wildlife Service listed the Mazama Pocket Gopher under the Endangered Species Act. The subject parcel contains potential pocket gopher habitat. It is the responsibility of the landowner to comply with applicable federal regulations.

Approval of this and other County permits may be superseded by federal law. Endangered species cannot be harmed at any time, even after permit issuance. If any are found during construction, the applicant should contact the U. S. Fish and Wildlife Service( USFWS).

This design is approved for repair to serve an existing 3 bedroom residence and an existing 1 bedroom residence only. 600 gallons/ day max.

Prior to Final, a Septic System record drawing must be submitted and accepted by Environmental Health.

Access Issues: none

Directions: Marvin Rd, Lt on Pacific Ave, Rt on Mullen rd, PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE LOCATIONS AND

RELATED EASEMENTS.

For FINAL INSPECTION, call 360- 786- 5489

Installation must be in conformance with the stamped, approved design for this permit number This permit may be revoked if the site conditions have changed since the design was approved.

The on- site sewage system may be installed only by an installer certified in Thurston County.

This system may not be used until the final Record Drawing is accepted by this department. It is the responsibility of the property owner or permit applicant to assure that the Record Drawing is submitted to this department

For FINAL INSPECTION, call 360- 786- 5489

From: Susan Lord To: Schatz, Sierra (IHS/POR) Subject: one year extension Date: Thursday, April 02, 2020 11:20:18 AM

Hello Sierra, Please know that per your phone call and the provisions provided in Thurston County Article IV, I have extended the expiration date on our permit numberr19-106618.

This permit is for a new 4 bedroom septic design replacing an existing system at 10427 Mullen Road SE, Olympia, WA 98513; parcel number 21831111300.

The new expires date is 5/29/2021. The system must be installed in the ground, the installation inspected and the record drawing accepted by that date. If not, the applicant must start all over with all the new fees required.

This extension is a one time provision. It can not be extended any further.

Thank you

Sue Lord Program Assistant 2 Thurston County, Environmental Health 360-867-2628 lords@co.thurston.wa.us

PHSS MISSION STATEMENT

“Working together to achieve the highest level of health and well-being for everyone.”

mailto:lords@co.thurston.wa.us mailto:Sierra.Schatz@ihs.gov mailto:lords@co.thurston.wa.us

Structural Adequacy of Home verified.pdf