HomeMy WebLinkAboutSWG2024-00360 - SWG Application / Design - 8/23/2024 SHEL
MASON COUNTY 415N6TH LFAIR. 60-27 ON, ,EXT 404
SHELTON:360427-9670,EXT 400
4 BELFAIR:380.275-048],E%T 400
Public Health & Human Services ELM W0482-5269,EXT 400
FAX 380427-7787
On-Site Sewage System Permit: SWG2024-00360
APPLICANT GREEN BARBARA E Phone: 206-794-5525
Address: 1920 208th PI SW LYNNWOOD,WA 98036
OWNER GREEN BARBARA E Phone: 206-794-5525
Address: 1920 208th PI SW LYNNWOOD,WA 98036
SEPTIC DESIGNER MICAH HALVERSON* Phone: 360490-6365
Address: PO BOX 1519 SHELTON,WA 98584
SEPTIC INSTALLER THAD BAMFORD* Phone: 360-790-2364
Address: 301 WALLACE KNEELAND BLVD STE 224-332 SHELTON, WA 98584
Site Address: 4532 E Grapeview Loop Rd
Primary Parcel Number: 121053400060
Permit Description: 2-bedroom pressure system: REPAIR
Permit Submitted Date: 08/23/2024
Permit Issued Date: 08128/2024
Issued By: David Anderson
Current Permit Fees Paid: $805.00 (addilanal fees may M reymred uFon.nmialw�of ayeaml.
Permit Expiration Date: 08/2712025 (unsad on dare 0 inspeonon)
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 Dreinfield installation not to exceed designed upsiope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to bacldlll of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
bacAfill 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.govlhealthienvironmental/onsiteloss4nspection-request.php or call:
360427-9670,extension 400.
OFFICIAL USE ONLY
WTEfECFMU . f
MASON COUNTY
COMMUNITY SERVICES "` ° m
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ON-SITE SEWAGE SYSTEM APPLICATION n a
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APPLICANT PHONE r
Barbara Green / Debbie Bennet 206-794-5525 c
MMLIHG ADORESS-STREET CRY.STATE.ZIP CODE 3
1920 208th PI SW Lynnwood W 98036 TO
SITEADDRESS ETCPNZIPCODE
4532 E BE GRAPEVIEW LOOP RD GRAPEVIEW
NAME OF DESIGNER PHONE
MICAH HALVERSON 360-490-636 qnGG
i NAME OF INSTALLER PHONE (—
THAD BAMFORD ll CY H IO
PER.NPE(tde.Y ux) C WINKING NMTER SOURCE
WRESIDENTALOSS f]COMLTDNRYOSS LJCOMMERCYILOSS 1W PRIVATE INDIVIDUAL WELL tJPRPATE1DW0-P I2 I�
TYPE OFNORK(eWNde) CrPUBLIC N ETER SYSTEM 11'
ENEW CONSTRUCTIONIUPGRADES WREPAIRIREPLACEMENT OTHERDETAhS(MW.fm'WBWAPPY) OTABLE IX REPAIR
[3 SURFACING SE E Id EXISTING FAILURE Id SHOREUNE
SUBMITTALS m
p C LOT sN>: /� r
ID.DESIGN FORM(REQUIRED) C SEPTIC DESIGN(REQUIRED) BEDROOMS 2 1 J7 0
GNAP/ER(S)(IFAPPLICABLE) I O
DIRECTIONS TO SITE MD SITE CONORIONS(sc KKhNLW)
From Shelton take Hwy3 toward Belfair. Turn right onto 1st grapeview loop rd intersection.
travel to stop sign in grapeview turn left at stop sign. driveway is on the right, shared c 10
driveway has a wood address sign 4534 and another sign 4532. I� Its,
BRE MST BET OGIED FROM MAN ROM AM TF4TXWES YUSTBERAOBEG MIFM TFBTNWFM.BMFRY.
OFFICIAL USE ONLY BELOW THIS LINE _
UPGRME/FMWRE SORRCE W�MLO pAN®I
[]VOLUNTARY OMIINTENNCEWUMPING ❑BUILDINGPERMIT [31HOMEMLE OCOMPLAINT DITHER:
NSPECTDRSOILLODS CCMMENIS ICWDRIONB
71tt:d -38' tist
AUG 3 2024 37
BY
a+ 3$1 wig
RECORD DRANINGMOINSTPLIATION REPORT
SOIL WOPM:
V=VERY G=GRM£LLY S-SNBI L=LW S=SLT C•CIAY E-EXTREMELY R•RCOT9 REQUIRED FOR FR OVENALPPPROVAL.
PPPLI N PEP I59VED BY GATE
INSPECTORSIGNATURRGEE DATE MPL(CA�TION IXPNATION GATE �j
THW FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED I2/TA15
DESIGN FORM-PAGE ONE Assessor's Parcel Number. I Z OS -- 3 y -- 0 Oro
A design will he reviewed when 3 copies of each of the following are submitted:
•Completed design form that has been signed and dated. Y Scaled layout sketch,including all applicable items on checklist
♦Scaled plot plan,including all applicable items on checklist. v Cross-section sketch,including all applicable items on checklist.
This fears may be scanned and available for public vlaso on the Mason Cou Web alas.Maximum a er size: 11"X IT'
Permit Number: SWG Za]y `� O3L''Jn Designer's Name: Micah Halverson
Applicant's Name: Barbara Green/Debbie Bennett Designer's Phone Number: 360-490.6365
Mailing Address: 1920 208th PI SW Designer's Address: PO Box 1519
Lynnwood WA 98036 Shelton WA SB584
city State Zi city State Zi
_ DESIGNPA <'
Treatment Device
❑Glendon Biofiller ❑ Send Filter ❑Mound ❑ Sand Lined Drainfield ❑ Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other: Septic Tank
Drainfleld Type
❑Crravity IN Pressure I111Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfleld Specifications Laterals
Number of Bedrooms 2 Schedule/Class 40
Daily Flow:Operating Capacity 180 - gpd Length 36 _ ft
Daily Flow:Design Flow 240 gpd Diameter 1 1/4 in
Septic Tank Capacity(working) 1278 gal Number 4
Receiving Soil Type(1-6) 4 - Separation 5+ ft
Receiving Soil Appl.Rate .6 gpd/ft' Orifices
Required Primary Area 400 fir Total Number of Orifices 36 '
Designed Primary Area 407.52 fi Diameter 3116 in
Designed Reserve Area 1500sgft ftt Spacing 48 in
Treuch/Bed Width 3 - ft Manifold
Trench/Bed Length 144 - ft Schedule/Class 40
Elevation Measurements Length Preferred ft
Original Drainfield Area Slope 8 % Dinmcter 2 in
New Slope,If Altered same je Preferred manifold configuration used? g Yes O No
Depth of Excavation U"iWe 12 in Transport Pipe
from Original Grade Dma_ac 9.12 in Schedule/Class 40
Designed Vertical Separation 24+ in Length 445 ft
Gravelless Chambers Required? O Yes O No V Optional Diameter 2 in
Pump Required? If Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day 4
Diff.in Elevation Between Pump&Uppermost Orifice 40 ft Dose quantity 45 gal
Drainfield Squat Height/Selected Residual(head) 2+ It Chamber Capacity(flood) 1287 gal
Uppermost Orifice re s=H ❑Lower than 3 Pump Shutoff
Pump controls:Please check those required.
Capacity @Total Pressure Head 30.3 gears Ef£hner elapse Meter fB'Evmt Counter
Calculated Total Pressure Head 52.9 it if Timer: Pump on TBD ,Pump off 6hrs
Comments
Edge of Drainfield area has been staked for clearing. After site has been cleared contact designer to
assist with staking trench's. Installer to notify designer 24 hours before install.
DESIGN FORM—PAGE TWO Assessor's Parcel Number:
Permit Number: SWG
DESIGN CHECKLI5Ts
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
16 Test hole locations lZ Drainfield orientation and layout Reference depth from original grade:
Id Soil logs 19 Trench/bed dimensions and 9 Septic tank
0 Property lines critical distances within layout ii Drainfield cover
0 Existing and proposed wells I9 D-BoxNalve box locations Reference depth from original grade
within 100 ft of property 19 Septic tank/pump chamber and restrictive strata:
H Measurements to cuts,banks, and locations Iff Laterals,trench/bed,top and
surface water and critical areas B Observation port location bottom
0 Location and orientation of B Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 11 Manifold placement ❑ Sand augmentation
components ® Orifice placement Other cross-section detail:
0 Location and dimension of 19 Lateral placement with distance 9 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
H Buildings 19 Audible/visual alarm referenced Yes No
0 Direction of slope indicator pj Scale of drawing shown on scale ❑ m Design staked out
10 Waterlines bar ❑ 15 Recorded Notices attached
15 Roads, easements,driveways, ❑ 19 Waiver(s)attached
parking 9 ❑ Pump curve attached
11 North arrow and scale drawing ❑ 9 Evaluation of failure
shown on scale bar Non-realdential justification
❑ ❑Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be&ffedby installer at time of installation EI Yes ❑ No
�zZ��zy
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 on-site lations:
Auk 1 L ��
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING COStDI7yffipFA/I/;
✓ The design is stamped"Approved"by Mason County Public Health. „I/�U
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: EIV—
✓ 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 torn may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
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CASE INLET s e of s
Abbreviated Description:TRACT 6 OF GOVT LOT 4 8 TAX 167J
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M.Halverson Design LLC Barbara Green I Debbie Bennett
PO Box 1519 Shelton We 98584 1920208th PI SW,Lynnwood,WA98036 4532 E GRAPEVIEW LOOP RD
Halversondesi nllc outlook.com