HomeMy WebLinkAboutSWG2023-00426 - SWG Application / Design - 10/4/2023 eMASON COUNTY 415NfiTH STREET,SHELTON,WA 98584 SHELTON: SHELTON,
-9670,EXT 98584
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: SWG2023-00426
APPLICANT CASE JACQUELINE Phone: 1.541.206.4463
Address: 1519 PUGET ST SHELTON, WA 98584
OWNER CASE JACQUELINE Phone: 1.541.206.4463
Address: 1519 PUGET ST SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON-M. Halverson Phone: 360-490-6365
Design LLC
Address: PO BOX 1519 SHELTON, WA 98584
Site Address: 11 E Webb Hill Rd
Primary Parcel Number: 421244390013
Permit Description: 3-bedroom pressure system
Permit Submitted Date: 10/04/2023
Permit Issued Date: 11/13/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional ees may be required upon installation of system).
Permit Expiration Date: 10/19/2026 (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 pnor 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/environmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY --
MASON COUNTY DArIeELf D 16 - Li - 13
1,1 - COMMUNITY SERVICES AMOUNT RECEIVE!) RECEIVED/ o N
' PublicHealth lc iy Health/Environmental Health) - {Co < y
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a•,nFt+sceIRannnWA°meta .w SWG a0 �.3 — Op 4iC o 2.
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ON-SITE SEWAGE SYSTEM APPLICATION n z
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APPLICANT PHONE m �
Jacualine Case 541-206-4463 c
MAILING ADDRESS-STREET 1519 Puget StCITY.GTATE IP CODE Shelton Wa 98584 A
P CODE
11 ADDRESSSITE I E Webb HillRd Union Wa 98592 Is-
NAME OF DESIGNER PHONF I_ ,
Micah Halverson 360-490-6365 IN
ME OF INSTALLER PHONE O
Unknown _ IN
PERMIT TYPE(select one) DRINKING WATER SOURCE y
O
icl RESIDENTIAL CSS n COMMUNITY CSS nCOMMERCIAL OSS IN PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
I r"
❑ PUBLIC WATER SYSTEM __,,.__
TYPE OF WORK(select ace)
in NEW CONSTRUCTION I UPGRADES ❑ REPAIR I REPLACEMENT OTHERDETAILS(.elntrml dial a001y) 0 TABLE IX REPAIR
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE CO I
"Pr DESIGN FORM(REQUIRED) PI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE f4
W WAIVER(S)(IF APPLICABLE) 3 2.25Ac x
DIRECTIONS TO SITE AND SITE CONDITIONS.(ev.Imckedgate)
Lot is on the corner of Webb hill rd and Mcreavy. Drainfield is staked and test holes are I a
marked with pink ribbon
0 10
I'--1
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. ILA
OFTICIAL USE ONLY BELOW THIS LINE -- -- --
UPGRADE I FAILURE SOURCE Pot rep,ing purposes)
❑VOLUNTARY D MAINTENANCE/PUMPING D BUILDING PERMIT ['HOME SALE ['COMPLAINT DOTHER.
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
VI: o-31 V(,SL
AO al ?it !--/ 1• it
lit 0 j5„
O S+ at 35 'W/1+ft
, TH3'.0-EEL Vc,5f, ll
)11 ikSf oil- 2i: � �/
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES.
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=
ETREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. I//�7p
INSPE OR SIFT GNATURE 101/7/m EXPIRATIONAPPLICATION DATE Z6 AP PLICAT�BI�APPROVEDI ISSUED
B'/� /i.S/ I3
THISFFFOORRMM//MAY BE SCANNEDAND AVAILABLE3FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE I�rw'//w/� REVISED I2/712015
DESIGN FORM-PAGE ONE Assessor's Parcel Number: H Z I 2- I _- N 3 -- q 0 0 13
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: II"X 17"
PARCELdDENTIPTCATfoN
Permit Number: SWG �, �l �yl t( Designer's er's Name: Micah Halverson
n' 'W
Applicant's Name: Jacqueline Case Designer's Phone Number: 360A90E365
Mailing Address: 1519 Puget St Designer's Address: PO Box 1519
Shelton Wa 98584 Shelton Wa 98584
City State Zip City State Zip
. DI ON PARAMBTZRS:
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Mndel ❑Disinfection Unit Make/Model other: Attenuation Zone
Drainfield Type
❑Gravity S Pressure S Trench ❑Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 40
Daily Flow: Operating Capacity 270 gpd / Length 54 ft/
Daily Flow: Design Flow 360 gpd Diameter 1 1/4 in
Septic Tank Capacity(working) 1200 gal ' Number 4 -
Receiving Soil Type(1-6) 4 Separation 9'+ ft -
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices 52
Designed Primary Area 601.44 ft2 Diameter 3/16 in
Designed Reserve Area 600 ft' Spacing 48 in
Trench/Bed Width 3 ft / / Manifold
Trench/Bed Length 216 ft Schedule/Class 40
Elevation Measurements Length Preferred ft
Original Drainfield Area Slope 4 /c Diameter 2 in
New Slope,If Altered same %u Preferred manifold configuration used? Rif Yes 0 No
Depth of Excavation Up-slope 9 in Transport Pipe
from Original Grade Down-slope 7.56 in ' Schedule/Class 40
Designed Vertical Separation 12"+ in - Length <100 ft
Graveness Chambers Required? PI Yes 0 No 0 Optional Diameter 2 in
Pump Required? le Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 6
Diff.in Elevation Between Pump&Uppermost Orifice <10 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2'+ ft Chamber Capacity(flood) 1200 gal i-
L�Lower than PumpShutoff Pump controls:Please check those required.
Uppermost Orifice 0 Higher
Capacity g Total Pressure Head 42.8 gpm E(Timer BTElapse Meter IB Event Counter
Calculated Total Pressure Head 20 ft IfAT'igiq u5p on TBD ,Pump off 4hrs
,, Comments -„—
NOV 1 3 2fl2
DESIGN FORM—PAGE TWO Assessor's Parcel Number: I:1Z 1 e- q -- 4(3 -- L O 0 / 3
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations id Drainfield orientation and layout Reference depth from original grade:
El Soil logs E( Trench/bed dimensions and E( Septic tank
H Property lines critical distances within layout fa7 Drainfield cover
El Existingand proposed wells H D-Box'Valve box locations
P P Reference depth from original grade
within 100 ft of property Id Septic tank/pump chamber and restrictive strata:
e Measurements to cuts,banks, and locations Ef Laterals,trench bed, top and
surface water and critical areas 0 Observation port location bottom
H Location and orientation of a Clean-out location 0 Curtain drain collector
curtain drain and all absorption a Manifold placement 0 Sand augmentation
components H Orifice placement Other cross-section detail:
El Location and dimension of g Lateral placement with distance Ig Observation ports/clean-outs
primary system and reserve\ area to edge of bed
Ei Buildings CI'roPc`+� ) Other Information
PJ Audible/vise; alarm referenced Yes No
8 Direction of slope indicator s Scale of 1 tit shown on scale Ig 0 Design staked out
H Waterlines bar ii 0 g Recorded Notices attached
kfit El Roads,easements,driveways, ti g ❑ Waiver(s)attached
parking ' t iH ❑ Pump curve attached
I3 North arrow and scale drawing v�gg }�/%tit 0 0 Evaluation of failure
shown on scale bar = 5100100 °fit Non-residential justification
• � No
i ti ❑ 0 Waste strength
.. . . i. 0 0 Flow
e
D ak ,:.- , ,.r VAL
The undersigned designer must be otifiedp by installer at time of installation El Yes 0 No
e, 434 Acre3
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and de ne %Lf,^ 'o r
compliance with state and local on-s' gulations: • s .0'
111 /5/?CZ] NOV 13 2923
Environmental Health Specialist Datd' ° ;OL:y/
ni,xR,:A h'
� _S� E..CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIO!'4
✓ The design is stamped"Approved"by Mason County Public Health. /
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 10 /I q/G 016
/ 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.
t. 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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