HomeMy WebLinkAboutSWG2023-00517 - SWG Application / Design - 12/11/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, 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: SWG2023-00517
APPLICANT Gloria Wilson Phone: 360-550-4409
Address: 5650 NW Marks RD BREMERTON, WA 98312
OWNER HALVERSON MICAH T Phone: 360-490-6365
Address: P 0 BOX 1519 SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON- M. Halverson Phone: 360-490-6365
Design LLC
Address: PO BOX 1519 SHELTON, WA 98584
Site Address: XXXX E North Island Dr
Primary Parcel Number: 221347590121
Permit Description: 2-bedroom NuWater BNR500 system
Permit Submitted Date: 12/11/2023
Permit Issued Date: 12/18/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/11/2026 (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
ill of .
6 backfill Mason Countysystem Asbuilt Formcomponents, 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
MASONCOUNTY DATE RECEIVED: ` ,� — �-�
COMMUNITYSERVICES AMODNT E D: 1E .. RECEIVED
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415 N.6th Street Shelton.WA 98581 —
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z ON-SITE SEWAGE SYSTEM APPLICATION > 14
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APPLICANT PHONE m m
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Gloria J Wilson 360-550-4409 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
5650 NW Marks Rd Bremerton WA 98312 m
SITE ADDRESS-STREET.CITY.ZIP CODE
Undeveloped - Land IN
NAME OF DESIGNER PHONE I N
Micah Halverson 360-490-6365
NAME OF INSTALLER PHONE a I'—
Unknown z ,�`
PERMIT TYPE(select one) DRINKING WATER SOURCE ( I W
5
* RESIDENTIAL OSS El COMMUNITY OSS f COMMERCIAL OSSL_l PRIVATE INDIVIDUAL WELL 6d PRIVATE TWO-PARTY WELL Z _
0 PUBLIC WATER SYSTEM
TYPE OF WORK(select one) t
Pi NEW CONSTRUCTION/UPGRADES El REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I J
SUBMITTALS 0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE
4 DESIGN FORM(REQUIRED) 171 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 I CJ"f
1 WAIVER(S)(IF APPLICABLE) 2 2.5Ac 5 I t
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate)
Meet with Dave Anderson 11/30/2023 P
O r I—
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. 1.---
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: ii_ - G�
INSPECTOR SOIL LOGS TY
I r O'(11, t COMMENTS/CONDITIONS J�%
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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
INSPECTO SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE
1//310 7o2j, IZ( ) 1/zdz6 l Zia( 7r3 p -
THIS 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 2- 1 3 K -- 7 S -- cq 0 I Z 1
A design will be 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. Y 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 IOU —CO
TT Designer's Name: Micah Halverson
360-490-6365
Applicant's Name: Gloria J Wilson Designer's Phone Number:
5650 NW Marks Rd PO Box 1519
Mailing Address: Designer's Address:
Bremerton Wa 98312
Shelton Wa 98584
City State Zp
City State Zip
DESIGN PARAMETERS
Treatment Device
0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
'Aerobic Unit Make/Model
NuWater BNR-500 0 Disinfection Unit Make/Model Other:
Drainfield Type
Cl Gravity
F3'Pressure STrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms
2 i Schedule/Class 40
Daily Flow: Operating Capacity 180 i gpd Length 35 — ft
Daily Flow: Design Flow gpd d Diameter 1 1/4 in
r 4b Number Septic Tank Capacity(working) 500+ BNR-500 rgal ,
+ ft
Receiving Soil Type(1-6) 4 f Separation 5
Receiving Soil Appl.Rate .6 „---gpd/ft2 Orifices28
Required Primary Area 400 ft2 otal Number of Orifices
Designed Primary Area 420 ft2 Diameter 3/16 in
Designed Reserve Area
420 / ft2 Spacing 60 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length
140 / ft Schedule/Class 40
Elevation Measurements
Length Preferred ft
Original Drainfield Area Slope
g / % Diameter 2 in
New Slope,If Altered same % Preferred manifold configuration used? IP'Yes 0 No
Up-slope 16 in Transport Pipe
Depth of Excavation 40 �
from Original Grade Down-slope 12.76 in/ Schedule/Class
Designed Vertical Separation
12+ in----- Length 125 ft
Gravelless Chambers Required? 0 Yes 0 No lErOptional Diameter
2 in
Pump Required? ES Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
4
Diff.in Elevation Between Pump&Uppe
rmost Orifice "5 ft Dose quantity 45 gal
2'+ ft Chamber Capacity(flood) 1223 gale
Drainfield Squirt Height/Selected Residual(head) Pump controls:Please check those required.
Uppermost Orifice 0 Higher Er Lower than Pump Shutoff
Capacity @ Total Pressure Head 20.15 gpm I 'Timer 1BI✓lapse Meter 8a'Event Counter
�fj�; on TBD �pip off 6hrs -1
Calculated Total Pressure Head 2.41 p 0 VIE BP
Comments
DEC 1 8 2023
MASOP1 CO4-€1444;4I-IEALT44
DJA
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 Z 1 `/-- 7 S — ci 0 / Z- (
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
P1 Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
A Soil logs B Trench/bed dimensions and l Septic tank
B Property lines critical distances within layout ®' Drainfield cover
0 Existing and proposed wells B 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 drain collector
curtain drain and all absorption B Manifold placement 0 Sand augmentation
components 17 Orifice placement Other cross-section detail:
Pi Location and dimension of g Lateral placement with distance B Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
0 Buildings l?roOe i Art`, B Audible/visual alarm referenced Yes No
Ef Direction of slope indicator B Scale of drawing shown on scale Ef 0 Design staked out
A Waterlines bar 0 Lo1 Recorded Notices attached
E1 Roads, easements, driveways, 0 LK Waiver(s)attached
parking EC 0 Pump curve attached
121 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be no ' ed by installer at time of installation Lot Yes 0 No
Z/i/2�Z3
Signature of Designer Date P P R®V
ED
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"A/
regulations: / q DEC 1 8 2023
17/T` M 73 ��MM ON COUNTY ENVIRONMENTAL HEALTH
Environmental Health Specialist Date DJA
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. (1(/7i 6/✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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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M.Halverson Design LLC Applicant- Gloria J Wilson Site Info. Parcel #22134-75-90121 SHEET NJW6ER
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M.Halverson Design LLC ��'��nr Gloria J Wilson Site into Parcel #22134-75-90121 SHEET MASER
PO Box 1519 Shelton Wa 98584 "ailing: 5650 NW Marks Rd
Bremerton Wa 98312 Undeveloped - Land 5
Haiversondesignlic�a�outlook.com r e:9s1'Dr,