HomeMy WebLinkAboutSWG2022-00190 - SWG Application / Design - 4/8/2022 Ili , . .. OFFICIAL USE ONLY
MASON COUNTY —III . t
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I. COMMUNITY SERVICES AMOUNT NED: . RECE v y
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Public Health(Community Health/Environmental Health) C cn
arst 7-hstr er-40h It e.3 WA
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475 N.6th Street-Shekon,WA 98584 0
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ON-SITE SEWAGE SYSTEM APPLICATION 3 73
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APPLICANT PHONE ill
CHEERVA, ALEXANDRA 502-558-7633 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E
5008 WOLFPEN WOODS DR PROSPECT KY 40059 co
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SITE ADDRESS-STREET,CITY,ZIP CODE
26474 N HWY 101 Hoodsport Wa 98548 I CA
NAME OF DESIGNER PHONE
Micah Halverson 360-490-6365
NAME OF INSTALLER PHONE 0 I CA
Glendon Installer <_y I
PERMIT TYPE(select one) C i DRINKING WATER SOURCE
Of RESIDENTIAL OSS I COMMUNITY OSS �1 COMMERCIAL OSS f PRIVATE INDIVIDUAL WELL ii PRIVATE TWO-PARTY WELL Z I
PUBLIC WATER SYSTEM Holiday view Estates
TYPE OF WORK(select ono) t
l NEW CONSTRUCTION/UPGRADES Of REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I W
SUBMITTALS 0 SURFACING SEWAGE Ef EXISTING FAILURE ®SHORELINE W (
DESIGN FORM(REQUIRED) iPl SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE , I (A)WAIVER(S)(IF APPLICABLE) 5 .3AC 0
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Travel North on Hwy 101 past Hoodsport, Nellie Way is on left just after Holiday Beach, ID
drive up Nellie Way, Test Holes are marked along Nellie Way. Call Designer if you would
like to meet onsite o I
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I V
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
OLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ['OTHER:
/INS�PEC�TOR SOIL LOGS , (� COMMENTSk I CONDITIONS
CID/ U —?- S 1 L �D C� O� tse.�t� ((s '. �`�/ C,✓ �, �� <`„"•♦t1
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SOIL CODES: , 3 V+ 5; ,5 (or ..)„,t-\-- RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY =EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL,
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLI ON APPROVED/ISSUED BY DATE
'A ItIlloey'v ("1 //y 422 6/ 7/5/26,7)
IS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: . Z 3 3 I -- -3 3 — 7 0 `t 7
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"
PARCEL IDENTIFICATION ' -
Permit Number: SWG Designer's Name: Micah Halverson
- Applicant's Name: CHEERVA,ALEXANDRA Designer's Phone Number: 360 490-6365
Mailing Address: 5008 WOLFPEN WOODS DR Designer's Address: PO Box 1519
PROSPECT KY 40059 Shelton Wa 98584
City State Zip City State Zip
DESIGN PARAMETERS
•
Treatment Device
Er 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:
Drainfleld Type
❑ Gravity 0 Pressure 0 Trench ❑ Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
-Number of Bedrooms 5 (/ Schedule/Class Glendon
l
Daily Flow: Operating Capacity 450 gpd Length " ft
Daily Flow:Design Flow 600 gpd/ Diameter " in
II
Septic Tank Capacity(working) Existing1000+200 gal Number
Receiving Soil Type(1-6) 5 / Separation si ft
Receiving Soil Appl.Rate .4 gpd/ft/2 Orifices
Required Primary Area 1500 ft2 ✓� Total Number of Orifices
Designed Primary Area 1710 ft2 /// Diameter " in
Designed Reserve Area 1920 ft2 Spacing in
Trench/Bed Width See Design ft Manifold
Trench/Bed Length See Design ft Schedule/Class 40
Elevation Measurements Length Glendon ft
Original Drainfield Area Slope 1-3% % Diameter 1 in
New Slope,If Altered same % Preferred manifold configuration used? 0 Ycs FigNo
Depth of Excavation up-slope Glendon in Transport Pipe
from Original Grade Down-slope Glendon in Schedule/Class 40
Designed Vertical Separation 16" in Length 700 ft
Gravelless Chambers Required? 0 Yes of No 0 Optional Diameter 1 1/4 in
Pump Required? 'Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Glendon
Diff.in Elevation Between Pump&Uppermost Orifice 150 ft Dose quantity Glendon gal
Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) 1800 gal
Uppermost Orifice'Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 4.9 . 'Timer (l lapse Meter (B'Event Counter
207.9 , '* ' r on Glendon ,pump off Glendon
Calculated Total Pressure Head �� P
Comments
See Also: Geotechnical Report and Biologist Mappk.ig. _
DESIGN FORM-PAGE TWO Assessor's Parcel Number: 3 2 3 3 ( -- 3 3 -- 7 0 9 7L
I Permit Number: SWG
DESIGN CHECILIST5
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Or Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
or Soil logs [,3i' Trench/bed dimensions and 0 Septic tank-Is)4's�tk,./J
critical distances within layoutDrainfield cover
j$°' Property lines �
"Existin and proposed wells D-Box/Valve box locations
g p p Reference depth from original grade
within 100 ft of property .' Septic tank/pump chamber and restrictive strata:
Jlir-Measurements to cuts, banks,and locations ❑
surface water and critical areas II Observation port location 13ettent-- C4rn c.�
rir Location and orientation of 0 Fx 15 1,hc.) 0 r
curtain drain and all absorption Manifold placement 0 Strrci-augmentatioa`
components ❑ Dri es-placetrre —C-Ic. 6,ti Other cross-section detail:
Location and dimension of 0 0
primary system and reserve area
�$ Buildings Other Information
Audible/vis larm referenced Yes No
(Sr Direction of slope indicator kr Scale of i hown on scale 0 Pi.Design staked out
il Waterlines bar tic + 0 Recorded Notices attached
0 Roads, easements,driveways, , rl . 0 Waiver(s) attached
parking To be Re�e Aftiooskt..-41, ta, ❑Pump curve attached
lir North arrow and scale drawing 3 4, ,_ '�� ❑ Evaluation of failure
shown on scale bar 5j Non-residential justification
uivaw THWEL HA-'•'r�+s`x1 0 0�h
LICENSED OE.��C t4ER ) 0 El Firm--
-
DE ' PI'tOVAL
The undersigned designer must notified by installer at time of installation I ..Yes 0 No
VCO°1Z-
Signature of Designer Date A )
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it"tTIGV
compliance with state and local on-si egulations: 7
sEP 0�s Z423
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MAsoN�OJN�
Environmental Health Specialist Date Ro M
pJq � ENTq�HEALTH
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
V The design is stamped"Approved"by Mason County Public Health. 1` �/ / /���L�
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ` (/ �`/[/
4 V 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
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Parcel#32331-33-90970 Abbreviated Description:TR 97 OF GOVT LOT 4 LOT 3 OF SP #1522
Parcel#32331-33-00021
Abbreviated Description:PTN OF PCL 2 OF BLA#0135 AF #1733904 LYING NWLY OF HWY 101 PTN OF GOVT LOT 1
M.Halverson Design LLC Applicant/Owner. Site Address' SHEET NUMBER
CHEERVA,ALEXANDRA 26474 N HWY 101
PO Box 1519 Shelton Wa 98584 5008 WOLFPEN WOODS DR1
Halversondesignllc(a�outlook.com PROSPECT KY 40059 HOODSPORT 98548
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M.Halverson Design LLC Applicant/Owner Site Address. SHEETNUM(1ER
CHEERVA,ALEXANDRA 26474 N HWY 101 3
PO Box 1519 Shelton Wa 98584 5008 WOLFPEN WOODS DR
HalversondesignlIc(c�outlook.com PROSPECT KY 40059 HOODSPORT 98548 REVISION St:
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Applicant/Owner. Sae SHEET NUMBER
M.Halverson Design LLC
CHEERVA,ALEXANDRA 26474 N HWY 101
PO Box 1519 Shelton Wa 98584 5008 WOLFPEN WOODS DR 5
HalversondesignllcCc�outlook.com PROSPECT KY 40059 HOODSPORT 98548
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