HomeMy WebLinkAboutSWG2024-00115 - SWG Application / Design - 3/25/2024 584
MASON COUNTY 415N6THELTON:STREET,SHELTO70.EXT 400
SHELTON:360<2]-96]0.EXT 400
BELFAIR:360-2154467,EXT 400
Public Health & Human Services 1360-182-5269,EXT 400
FAX:360a27a]8]
On-Site Sewage System Permit: SWG2024-00115
APPLICANT MCGOVERN ET LIX DENNIS Phone:
Address: 424 N C St. TACOMA, WA 98403
OWNER MCGOVERN ET LIX DENNIS Phone:
Address: 424 N C St. TACOMA, WA 98403
SEPTIC DESIGNER MICAH HALVERSON* Phone: 360-490-6365
Address: PO BOX 1519 SHELTON, WA 98584
SEPTIC INSTALLER SCOTTJOHNSONa Phone: 360-490-5408
Address: 8639 Salty DR NW OLYMPIA, WA 98502
Site Address: 1181 E POINT WILSON RD
Primary Parcel Number: 120191300010
Permit Description: New 4bd gravity trench
Permit Submitted Date: 03/25/2024
Permit Issued Date: 03/28/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (additional leas may as required upon installation of spend
Permit Expiration Date: 03/27/2027 leased on dale of aspeni
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 Drainfield 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 UARRKfN D:E)1l - 25 Z
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ON-SITE SEWAGE SYSTEM APPLICATION 3 A
APPLICANT PHONE IT, m
MCGOVERN, DENNIS 253-797-6159 z
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NAIUNGAOIX W-STREET,CITY,STATE,3p COM: 3
424 N C ST TACOMA WA 98403 m
SREAODREM-STREET,G ,ZIP CODE •.{1
Undeveloped - Land IIb1 C?p( i4—u ; Id6rl kJ I�
NMEC£DESIGNER FIpRE
MICAH HALVERSON 360490-6365
WME OF INSTALLER PHONE
SCOTT JOHNSON 360-490-5408 faPERMRTYPEIwk .) DRINKINGMMERSOURCE
WKRESIDENTIALOSS 6COMMUNITYOSS EjCOMMERCIALOSS IT PRIVATE INDNIDUALWELL EJ PRNATETW04ARTYWELL z
TYPEOFWORNNaAe y gf PUBLIC WATERSYSTEM I 1
JC NEWCONSTRUCTIONIUPCdiADES ITREPAIR/REPIACEMENT OTHER UETNLS(u 001hsle ) 13TABLEIXREFAIR
sUM SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE -�
SRTALS pJ IU3
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L DESIGN FORM(REQUIRED) p SEPTIC DESIGN(REQUIRED) BEDROOMS Loi S¢E r
ffWANER(S)(IFAPPUCMLE) 4 7.28 AC 1
DIRECTICNSTOS(TEANDSITECONCITM&(ea FSIW 1 I IO
FROM HWY3 TURN ONTO E PICKERING RD, AFTER HARSTINE ISLAND BRIDGE 13
TURN RIGHT, TRAVEL SOUTHERLY TO STOP SIGN, TURN RIGHT ONTO E
HARSTINE ISLAND RD SOUTH, TURN LEFT ONTO E POINT WILSON RD, TURN LEFT 0-
ONTO E SMITH COVE WAY, TAKE FIRST LEFT ONTO E CASE VIEW PLACE, I I_
DRAINFIELD IS STAKED AND TEST HOLES ARE MARKED WITH PINK RIBBON.
YIIEYUYIBE FIAOOEDFFgI NAM ROADAND 1FYi HOIFd MNYTYE R.AGOEO KRMTEYTIKILENWHERY. IV '
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FMURE SOURCE(W, gWmosN)
[]VOLUNTARY OMNNTENMCEYPUMPING CIBUILDINGPERMIT 0HOMESME OCOMPLAINT DOTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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80L CODES: RECORDDM NWNGNIDINST TOIREPORT
V=VERY G-GRAVELLY S-SAND L=LOM1 &=SILT C=CLAY E=EMREMELY R=BOOB REQUIRED FOR FNN.AP%tO
INSPECTCRSIGNATIRE DATE APRICATIONE%PIRATCNOAME AFPLICATIONPPNROVER'ISSUEDSY GATE
31T 2- -► 3
THIS FORMMAY BE SCMNIDAIIDAMAIABLE FOR PU VIEW ON THE MINIM COUNTYWEBSITE RENSE01N2016
DESIGN FORM—PAGE ONE Assessor's Parcel Number: L 2 O 9 — 1 3 -• d OL
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
e Scaled plot plan,including all applicable items on checklist. a Cross-section sketch,including all applicable items on checklist.
This loon m be swnrrod and available for gbk view on the Mason County Web slte.Maximum ¢r size: 11"X IT'
Permit Number: SWG Z.l) Zs•{— UOIL� Designer's Name: MICAH HALVERSON
Applicant's Name: DENNIS MCGOVERN Designer's Phone Number: 360-490-6365
Mailing Address: 424 N C ST Designer's Address: PO BOX 1519
TACOMA WA 98403 SHELTON WA 98584
Ci State Zi Ci State Zi
Treatment Device
❑Giendon Biofilter ❑ Sand Filter ❑Mound ❑ Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit MA./Model ❑Disinfection Unit Meke/Madel Other: SEPTIC TANK
Drainfield Type
flrGmvity ❑Pressure Laf Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 2729
Daily Flow:Operating Capacity 460 Slid Length 54 It
Daily Flow:Design Flow 460 Slid Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 5
Receiving Soil Type(1-6) 4 Separation 6 DC ft
Receiving Soil Appl.Rate 0.6 gpd/ft' Orifices
Required Primary Area 600 11 Total Number of Orifices PERF
Designed Primary Area 610 ft' Diameter in
Designed Reserve Area 1200 ftr Spacing in
Trenched Width 3 ft Manifold
Trench/Bed Length 270 ft Schedule/Class D-BOX
Elevation Measurements Length It
Original Drainfield Area Slope 10 % Diameter in
New Slope,If Altered SAME % Preferred manifold configuration used? 0 Yes If No
Depth of Excavation Up lwe 31 in Transport Pipe
from Original Grade � dwe 27.4 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length VARIES ft
Gravelless Chambers Required? ❑Yes Pf No 0 Optional Diameter 4 in
Pump Required? ❑Yes Ef No Dosing and Pump Chamber
Pump/Siphon Speciflcations Number ofdosea/day GRAVITY
Diff.in Flevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) _ft Chamber Capacity(flood) gal
Uppermost Orifice O Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head gpm OTimer OElapse Meter ❑Event Counter
Calculated Total Pressure Head 1 'J VI'E—Da Pump off
Comments
MAR 2 8 2024
4 KA , COUNTY EWRONYBTAL HEALTH
DESIGN FORM—PAGE TWO _ Assessor's Parcel Number: Z b 5 _ f 3 -- OCEO / Q
Permit Number: SWG
DESIGN CIIECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
9 Test hole locations B Drainfield orientation and layout Reference depth from original grade:
0 Soil logs B Trench/bed dimensions and 16 Septic tank
H Property lines critical distances within layout B Draintield cover
0 Existingand proposed wells IH D-BoxNalve box locations
P� Reference depth from original grade
within 100It of property II Septic tank/pump chamber and restrictive strata:
la Measurements to cuts,banks,and locations IH Laterals,trench/bed,top and
surface water and critical areas B Observation port location bottom
® Location and orientation of ® Clean-out location IB Curtain drain collector
curtain drain and all absorption 19 Manifold placement M Sand augmentation
components ® Orifice placement Other cross-section detail:
19 Location and dimension of IJ Lateral placement with distance 19 Observation ports/clean-outs
primary system and reserve area to edge of bed
® Buildings Other Information
El Audible/visual alarm referenced Yes No
9 Direction of slope indicator B Scale of drawing shown on scale Design
L7 ❑ staked out
B Waterlines bar ❑ If Recorded Notices attached
11 Roads,easements,driveways, ❑ Ig Waiver(s)attached
parking ❑ Iff Pump curve attached
P1 North arrow and scale drawing ❑ I(Evaluation of failure
shown on scale bar Non-residential Justification
❑ If Waste strength
❑ If Flow
DESIGN APPROVAL
The undersigned designer must be o ed by installer at time of installation 15 Yes ❑ No
3 e tsz
Siguature of Designer I 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 on-site regulations:
�� 31V6hj
Environmental Health Specialilst Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
IThe design is stamped"Approved"by Mason County Public Health. 3 /Z''Z-7
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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