HomeMy WebLinkAboutSWG2023-00257 - SWG Application / Design - 6/20/2023 M . MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00257
APPLICANT GOULD DOUGLAS LEE & ROBIN LEE Phone:
Address: 841 EAST CAMDEN WAY SHELTON, WA 98584
OWNER GOULD DOUGLAS LEE & ROBIN LEE Phone:
Address: 841 EAST CAMDEN WAY SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON-M. Halverson Phone: 360-490-6365
Design LLC
Address: PO BOX 1519 SHELTON, WA 98584
Site Address: 843 E Camden Way
Primary Parcel Number: 120311290050
Permit Description: New SFR -3BR Gravity
Permit Submitted Date: 06/20/2023
Permit Issued Date: 07/05/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/05/2026 (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 Drain field 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/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: -
-
1
Inf., COMMUNITY SERVICES AMOUNTItt. RECEIVE, All CO
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Public Health (Community Health/Environmental Health)
415 N.6th Street
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415 N.6th Street�Shelton.WA 98584 pS)-/`'J� /`�( "Jl
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m
Doug & Robin Gould 360-463-6540 1A Z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 0 3
841 E Camden Way Shelton Wa 98584 :
SITE ADDRESS-STREET,CITY,ZIP CODE -�
843 E Camden Way Shelton Wa 98584 o I—
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NAME OF DESIGNER PHONE �. - IN
Micah Halverson 360-490-6365 'v
NAME OF INSTALLER PHONE v I G.
Logan Spear 360-239-1541 <
PERMIT TYPE(select one) DRINKING WATER SOURCE
Or RESIDENTIAL OSS F COMMUNITY OSS Ifl COMMERCIAL OSS U PRIVATE INDIVIDUAL WELL e PRIVATE T!VO-PARTY WELL Z I—
TYPE OF WORK(select one) 0 PUBLIC WATER SYSTEM 1
11 NEW CONSTRUCTION/UPGRADES rl REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
DESIGN FORM(REQUIRED) iii SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE Q IN
i-1 WAIVER(S)(IF APPLICABLE) 3 1 .26Ac 6 11
�/
DIRECTIONS TO SITE AND SITE CONDITIONS:(en.locked gale) -
After Harstine Island Bridge turn right (south), at stop sign turn right again continuing south, Ip
turn left on E Camden Way. Contact Designer or Applicant for Gate code to enter Camden
Way. Perk holes are marked with pink ribbon drainfield is staked out o IO
16)
P.
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. IL)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
qi-6 to m 3 --i-,,,,,s__
sr.„‘„), ,45,i______
y ,/,1 / 3 nit, 6
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
TOR SIGNATURE DATE APPLICATION EXPIRATION DATE LIGATION APPROVED!ISSUED BY DATE
10 d,\,,,,ri__
T IS F M MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 1 2 0 .S 1 -- / 2- -- 1 0 OS Q
A design will be reviewed when 3 copies of each of the following are submitted:
''Completed design form that has been signed and dated. '1 Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. '1 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.Maximumjaper size. I1"X 17"
PARCEL IDENTIFICATION
n 0 3 — 64o S? er's Name: Micah Halverson
Permit Number: SWG � s- 0?- . Desi�
Doug&Robin Gould Desi ner's Phone Number: 360-490-6365
Applicant's Name: g
Mailing Address:
841 E Camden Way Designer's Address: PO Box 1519
Shelton Wa 98584 Shelton Wa 98584
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑ Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
0 Disinfection Unit Make/Model Other: Septic Tank ,
❑ Aerobic Unit Make/Model ' 1
Drainfield Type
l 'Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class ASTM 2729
Daily Flow:Operating Capacity 360 gpd Length
50 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 9 ft
Receiving Soil Appl.Rate 0.8 gpdift2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices Perf.
�,�
Designed Primary Area 450 ft2 Diameter 1 in
Designed Reserve Area 450 ft2 Spacing in
I
Trench/Bed Width 3 ft Manifold I
Trench/Bed Length 150 ft Schedule/Class D-Box
j
Elevation Measurements Length ft
Original Drainfield Area Slope 4-5 % Diameter in
New Slope,If Altered same % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade Down-slope 12.2 in Schedule/Class ASTM 3034
Designed Vertical Separation 36+ in Length 5 ft
Gravelless Chambers Required? 0 Yes EC No 0 Optional Diameter
4 in
Pump Required? 0 Yes Er No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
Diff. in Elevation Between Pump&Uppermost Orifice N/A ft Dose quantity N/A gal
Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) N/A gal
Pump controls: Please check those required.
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff • la se Meter ❑ Event Counter
Capacity @ Total Pressure Head N/A gpm ❑Timer
Calculated Total Pressure Head
N/A ft If Timer: Pump on s ' , P /A
Comments JUL 0 5 2023
MASON COUNTY ENVIRONMENTAL HF4�N
JEW
DESIGN FORM—PAGE TWO Assessor's Parcel Number: I L O 3 1 -- i 2 -- I c' O 5 O
Permit Number: SWG
DESIGN CHECKLISTS
Y
Scaled Plot Plan
Scaled Layout Sketch Cross-Section Sketch
P1 Test hole locations 51 Drainfield orientation and layout Reference depth from original grade:
O Soil logs E1 Trench/bed dimensions and Ili Septic tank
O Property lines critical distances within layout 0 Drainfield cover
0 Existing and proposed wells RI D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Lot Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks, and locations ®' Laterals,trench/bed, top and
surface water and critical areas 0 Observation port location bottom
0 Location and orientation of 0 Clean-out location 0 Curtain ollector
placement 0 Sand aty ion
curtain drain and all absorption � Manifold
components 0 Orifice placement Other cross-section detail:
le Location and dimension of 0 Lateral placement with distance E1 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
0 Buildings ❑ Audible/visual 3; r referenced Yes No
EJ Direction of slope indicator 0 Scale of drawing shown on scale Er 0 Design staked out
0 Waterlines bar 0 0 Recorded Notices attached
PJ Roads, easements, driveways, AP p R ® V E 0
Ig Waiver(s) attached
El ET Pump curve attached
parking CI ;: Evaluation of failure
0 North arrow and scale drawing JUL 0 5 2023
shown on scale bar Non-residential justification
IASON COUNTY ENVIRONMENTAL HEALTH ❑ GI Waste strength
JBW 0 lEr Flow
LwAGN APPROVAL
The undersigned designer must be Y tified by installer at time of installation lg Yes 0 No
/
05-/ZQ L3
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 ite regulations:
E vircipsen 1 Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.✓ The Onsite Sewage Permit has not expired, the Permit Expiration Date is: (//c° — 2_6 y
✓ Drainfield site conditions have not been altered to adversely feet conditions of design approval.
Please Note: The system must be insta led 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 pdated Date: 12/7/2015
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M.Halverson Design LLC ownPr'Ap""anf Douq & Robin Gould Site Info- Parcel#12031-12-90050 SHEET NUNBER
PO Box 1519 Shelton Wa 9858484
1 BAST CAMDEN WAY 843 E CAMDEN WAY 3
Halversondesignllc(a�outlook.com SHELTON, WA 98584
REVISION 4