HomeMy WebLinkAboutSWG2024-00094 - SWG Application / Design - 3/11/2024 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
r.m.
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: SWG2024-00094 1 bvil' \
APPLICANT CHISHOLM WILLIAM G JR & SHERRY L Phone:
Address: P 0 BOX 3235 SHELTON, WA 98584
OWNER CHISHOLM WILLIAM G JR & SHERRY L Phone:
Address: P 0 BOX 3235 SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON* Phone: 360-490-6365
Address: PO BOX 1519 SHELTON, WA 98584
Site Address: 851 E Camden Way
Primary Parcel Number: 120311200020
Permit Description: New SFR -4BR Gravity
Permit Submitted Date: 03/11/2024
Permit Issued Date: 03/25/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $540.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 03/11/2027 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: �1I —
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COMMUNITY SERVICES A10Ut� E� _ RECEIV r: W
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Public Health(Community Health/Environmental Health)360 ' C
415 N.6th ,not. or 3 WA 5 4467,ext.400 S W G ` �1 - O/�O Cl) co
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415 N.6th Street Shelton,- WA 985t14 U L T` U
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPI(CANT PHONE m
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William G Chisholm, Jr 509-554-1953 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
91 E Tamarack Ln Shelton Wa 98584 co
SITE ADDRESS-STREET,CITY,ZIP CODE
851 E Camden Way Shelton Wa 98584 I—
NAME OF DESIGNER PHONE
Micah Halverson 360-490-6365 IN
NAME OF INSTALLER PHONE D
Logan Spear 360-239-1541 o
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PERMIT TYPE(select one) DRINKING WATER SOURCE
4 RESIDENTIAL OSS I.' COMMUNITY OSS I COMMERCIAL OSS I I PRIVATE INDIVIDUAL WELL ID PRIVATE TWO-PARTY WELL Z H.
TYPE OF WORK(select one) (:1 PUBLIC WATER SYSTEM t
4 NEW CONSTRUCTION/UPGRADES i-REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR (—
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) its SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE CD
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HI WAIVER(S)(IF APPLICABLE) 4 7.81Ac 0 .
DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate)
After Harstine Island Bridge turn right (south), at stop sign turn right again continuing south, Ia
turn left on E Camden Way. Contact Designer or Applicant for Gate code to enter Camden
Way. Perk holes are marked with pink ribbon drainfiel is staked out o to
q(9, ct3 5 (Nr IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE—
UPGRADE I FAILURE SOURCE(tor reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS!CONDITIONS
.72 4.- 44.5'
/I„ I ^ ) 5 MAR 1 X 2024
1Bv . )t. ../ ________
_. ______
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
I P TOR SIGNATURE DATE APPLICATION EXPIRATION DATE AP IC TION APPROVED/ISSUED BY DATE
\,NO") 3--/Y—2(f /q .--)-7)
(Ai ILAN* .2,C--'2 C(1
T S F MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
t '
DESIGN FORM-PAGE ONE Assessor's Parcel Number: I Z 0 3 J -- i Z -- 0 O O F b
A design will be reviewed when 3 conies of each of the following are submitted:
Completed design form that has been signed and dated. 0 Scaled layout sketch,including all applicable items on checklist
0 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 2.0›- 44 — K Designer's Name: Micah Halverson
Applicant's Name: William G Chishol,Jr Designer's Phone Number: 360-490-6365
Mailing Address: 91 E Tamarack Ln Designer's Address: PO Box 1519
Shelton Wa 98584 Shelton Wa 98584
City State Zip City State Zt s
DESIGN PARAMETERS' : t_
Treatment Device
❑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: Septic Tank
Drainfield Type
l'Gravity 0 Pressure I'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 2729
Daily Flow:Operating Capacity 480 gpd Length 67 ft
Daily Flow: Design Flow 480 gpd Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 4
Receiving Soil Type(1-6) 4 Separation 9'+ ft
Receiving Soil Appl. Rate .6 gpd/ft2 Orifices
Required Primary Area 800 ft2 Total Number of Orifices Perf
Designed Primary Area 804 ft2 Diameter in
Designed Reserve Area 828 ft2 Spacing .1 in
Trench/Bed Width 2 ft Manifold
Trench/Bed Length 268 ft Schedule/Class D-Box
Length ft
Elevation Measurements Len g
Original Drainfield Area Slope 12-15 % Diameter in
11 New Slope, If Altered same % Preferred manifold configuration used? 0 Yes li 'No
Depth of Excavation Up-slope 32 in Transport Pipe
1 from Original Grade Down-slope 26.6 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 20 +/- ft
Gravelless Chambers Required? 0 Yes 66 No 0 Optional Diameter 4 in
Pump Required? 0 Yes 'No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal
PUppermost Orifice 0 Higher 0 Lower than Pump Shutoff c o s h s �e�uired.
❑ m r er ❑Event Counter
Capacity @ Total Pressure Head gpm Calculated Total Pressure Head ftIqer: �up�p op l $4.
mpoffMAK LI ..
Comments MASON COUNTY ENVIRONMENTAL HEALTH
JBW
DESIGN FORM—PAGE TWO Assessor's Parcel Number: I Z 0 3 / -- / 2 -- 0 0 0 Z 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ed Test hole locations 64 Drainfield orientation and layout Reference depth from original grade:
6i Soil logs It Trench/bed dimensions and RI Septic tank
6/1 Property lines critical distances within layout 62J Drainfield cover
621 Existing and proposed wells Ri D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 64 Septic tank/pump chamber and restrictive strata:
621 Measurements to cuts,banks,and locations [if Laterals,trench/bed,top and
surface water and critical areas lif Observation port location bottom
121 Location and orientation of la Clean-out location 0 Curtain drain collector
curtain drain and all absorption it Manifold placement 0 Sand augmentation
components 64 Orifice placement Other cross-section detail:
Efi Location and dimension of Lateral placement with distance li4 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
Itil Buildings Ft Audible/visual alarm referenced Yes No
21 Direction of slope indicator Ig Scale of drawing shown on scale it ❑ Design staked out
Eli Waterlines bar 0 g Recorded Notices attached
Ei Roads, easements,driveways, 0 1r Waiver(s)attached
parking 0 I'Pump curve attached
Pi North arrow and scale drawing 0 [ii Evaluation of failure
shown on scale bar Non-residential justification
❑ El Waste strength
❑ lL Flow
DESIGN APPROVAL
The undersigned designer must be n ied by installer at time of installation It Yes 0 No
4--______ r7/./40 e. y
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 o ite regulations:
Li.L% -'25-2 `f
E ' ental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
I The design is stamped"Approved"by Mason County Public Health.
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 3—/'(— 27
I 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 fro froltift° is Health.
An Installation Fee is required. MAR 2 5 2024
This form may be scanned and available for public view on t 111 iniy 11 dT ALTH
J B W Updated Date: 12/7/2015
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SItP. Info' SHEET NUMBER
M.Halverson Design LLC Appiicant/Owner' Parcel# 12031-12-00020
William G Chrisholm, Jr 1
PO Box 1519 Shelton Wa 98584 Mailing. 91 E Tamarack Ln 851 E CAMDEN WAY, SHELTON 98584 ]I,''
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M.Halverson Design LLC Site Info* SHEET NUMBER
Applicanuo is Parcel# 12031-12-00020
William G Chrisholm, Jr 2
PO Box 1519 Shelton Wa 98584 Mailing' 91 E Tamarack Ln 851 E CAMDEN WAY, SHELTON 98584 FF'Icl`
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Applicant/owner Site info Parcel# 12031-12-00020
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PO Box 1519 Shelton Wa 98584 91 E Tamarack Ln 851 E CAMDEN WAY, SHELTON 9 kEvisioNn.
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App1icantIOwner site Info. Parcel# 12031-12-00020
M.Halverson Design LLC William G Chrisholm, Jr 4
PO Box 1519 Shelton Wa 98584 Mailing' Shelton Wa 98584 851 E CAMDEN WAY, SHELTON 98584 ',EJISI,',.
Halversondesignllc@outlook.com