HomeMy WebLinkAboutSWG2024-00149 - SWG Application / Design - 4/12/2024 MASON COUNTY 415N6TH 0427-97 .EXT 40
SHELTON.STREE ,SHELTON,
WA EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX 360427-7787
On-Site Sewage System Permit: SWG2024-00149
APPLICANT GREENOVATION LLC Phone: 206-423-9650
Address: 8312 SIERRA DR EDMONDS,WA 98206
OWNER GREENOVATION LLC Phone: 206-423-9650
Address: 8312 SIERRA DR EDMONDS,WA 98206
SEPTIC DESIGNER MICAH HALVERSOW Phone: 360490-6365
Address: PO BOX 1519 SHELTON,WA 98584
SEPTIC INSTALLER JAMIE WORKMAN' Phone: 360463-9573
Address: 120 E TIMBERLAKE DR SHELTON, WA 98584
Site Address: XXX E Armes Way
Primary Parcel Number: 220175000097
Permit Description: 2-bedroom Glendon Biofilter
Permit Submitted Date: 04/12/2024
Permit Issued Date: 0 4/2 412 0 24
Issued By: David Anderson
Current Permit Fees Paid: $540.00 (addidonal roes may tea required upon instenadon or system).
Permit Expiration Date: 04/18/2027 Ibasad on dale of nsp ioo)
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/environmentallonsiteloss-inspection-request.php or call:
360427.9670,extension 400.
OFFICIAL USE ONLY
Opf RFQINER l- I /Y - •`
MASON COUNTY !R
COMMUNITY SERVICES
PUMN NpI1X(CwnmumityahNFmmm�memal HeaXM SWG aOILA -c�o� �l 0 s N A
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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PHONE m
Shawn Green 206-423-9650 ` z
MNLINGAOOREES-STREET,CITY.STATE,ZW CCOE 3
8312 SIERRA DR. EDMONDS WA 98026 m
sITEADOREss-STREET CRKZIPCODE � p
151 E ANNAS WAY SHELTON WA 98584 n
NANE OF DESIGNER PHONE
MICAH HALVERSON 360-490-6365
NAME OF WVlALER PHONE G I V
JAMIE WORKMAN 360-463-9573 I�
PFApMDTYyE(<ylrvy) c C DRINKING WADER SDURCE C
L•I RESIDENTL1L 055 l.I COMMUNRY OSS II COMMERCIAL OS5 E�F PRIVATE INDIVIDUAL WELL LI PRNATE TWO�PARTY WELL Z I�
T9E OFlWMN(wlsRor,X) Is PUBLIC WATER SYSTEM TMBERW(ES
WNEWCONSTRUCTIONIUPGRADES F] REPAIRIREPLACEMENT OTHERDETAILS( Wmeta *) OTABLE IX REPAIR
SUBLHDTALS O SURFACING SEWAGE O EXISTING FAILURE O SHORELINE I O
IJ DESIGN FORM(REWIRED) ASEPTIC DESIGN(REQUIRED) BEOflOCA15 LOT S.
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f.WAIVER(S)(IFAPPLICABLE) 2 .16 AC ICA
DIRECTK NSTO 6NIEAND SITE CONDITIONS:I—ba SAO
FROM E AGATE RD TURN INTO TIMBERLAKES COMMUNITY ON E TIMBERLAKES DR
TURN RIGHT ONTO E LAKESHORE DR W TURN RIGHT ONTO E TIMBER PRKWY
TURN RIGHT ONTO E LAKESHORE DR E TURN LEFT ONTO E ANNAS WAY. o
ADDRESS IS ON LEFT DRAINFIELD AREA STAKED WITH PINK RIBBON. 14)
yTE M1I6T BE FIAOOEO FFOM MIIM ROAD AHP TEBTNOES MUSTBEF AGED WITH IESTXOIENumommu,
OFFICIAL USE ONLY BELOW THI5 LINE
UPGMDEIFPLURE SOIREE(fo reP•Gp W,Wa>)
OVOLUNTARY OMAINTENANCENPIIMPING OBUILOINGPERMIT OHOMESALE OCOMPLAINT OOTHER:
INSPELTORSOILLOGS COMMENTS I CONDITIONS
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V=VEFY=VERY G=GMYELLY 6•W1D L•LOMI Si=BLT C=OAY E+E%TRETELY R=RWTB REQUIRED FOR FINALAP'flOVPL
INSPECTOR SIGNATURE DATE ISSUED APPLICATION E%PRTTpN WTE iPPL VED/ ED BY OATS
Y�lBlm. vfl 262 APPRO 2 zoa
THIS FORM MAY BE SCANNEO AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVRSEDIY@016
DESIGN FORM-PAGE ONE Assessor's Parcel Number: Z ZO f '7 _ S _ 0 O Q 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. I 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 farm 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 70Z'4-00 to Designer's Name: MICAH HALVERSON
Applicant's Name: SHAWN GREEN Designer's Phone Number: 360-490-6365
Mailing Address: 6312 SIERRA DR Designer's Address: PO BOX 1519
EDMONDS WA gem SHELTON WA 98584
city State Zi C4X State Zi
TEES
Treatment Device
BYGlendan Biwilter ❑ Sand Filter ❑ Mound ❑ Sand Lined Drainfield 0 Recirculating Filta,Type:
❑Aerobic Unit Make/Modd ❑Disinfection Unit Make/Modd Other:
Drainfleld Type
❑Gravity ❑Pressure ❑Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number ofBedmoms 2 Schedule/Class glendon
Daily Flow: Operating Capacity 180 ' gpd Length ft
Daily Flow:Design Flow 240 ' gpd Diameter in
Septic Tank Capacity(working) 1200 / gal Number
Receiving Soil Type(1-6) 4 - Separation f[
Receiving Soil Appl.Rate .6 gpd/ftt Orifices
Required Primary Area 400 ' ftt Total Number of Orifices
Designed Primary Area 416 fe Diameter in
Designed Reserve Area 420 ft' Spacing in
Trench/Bed Width glendon - ft Manifold
Trcnch/Bed Length " ft Schedule/Class 40
Elevation Measurements Length per glendon It
Original Drainfield Area Slope 2-4 % Diameter 1 1/4 in
New Slope,If Altered Same % Preferred manifold configuration used? O Yes I TNo
Depth of Excavation Upalnpe 0 in Transport Pipe
from original Grade D.-sla,e 0 in Sebedule/Class 40
Designed Vertical Separation 18+ in Length 20 - 100 ft
Gravelless Chambers Required? ❑Yes 0 No 0 Optional Diameter 1 1/4" in
Pump Required? ElYes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoscs/day Per Glendon
Diff.in Elevation Between Pump&Uppermost Orifice_ft Dose quantity " gal
Drainfield Squirt Height/Selected Residual(head) _it Chamber Capacity(flood) gal
Uppermost Orifice 0 higher 0 Lower than Pump Shutoff Pump controls:Please check those rationed.
Capacity Q Total Pressure Head glendon gpm OThuer OElapse Meta ❑Event Counter
Calculated Total Pressure Head 11 if Timer: Pump on .Pump off
Comments
' DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 Z
Permit Number: SWG
DESIGN:CHECI£LIS`I'S
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
9 Test hole locations Q Drainfield orientation and layout Reference depth from original grade:
9 Soil logs 9 Trenchlbed dimensions and Id Septic tank
10 Property lines critical distances within layout Q Drainfield cover
9 Existing and proposed wells 9 D-BoxNalve box locations Reference depth from original grade
within 100 R of property 9 Septic tank/pump chamber and restrictive strata:
9 Measurements to cuts,banks, and locations ❑ Laterals,trenchlbed,top and
surface water and critical areas 9 Observation port location bottom
la Location and orientation of B Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 9 Manifold placement ❑ Sand augmentation
components 9 Orifice placement Other cross-section detail:
9 Location and dimension of Ef Lateral placement with distance ❑ Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
9 Buildings 9 Audible/visual alarm referenced Yes No
9 Direction of slope indicator pJ Scale of drawing shown on scale Ef ❑ Design staked out
9 Waterlines but ❑ 9 Recorded Notices attached
9 Roads,easements,driveways, ❑ IY Waiver(s)attached
parking - 9 ❑ Pump curve attached
9 North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar Non-residential Justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL,
The undersigned designer must milled by installer at time of installation 9 Yes ❑ No
/Z ZOZ.c/
Signature of Designer D r-
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to"
compliance with state and local on-s gulations: APR 2 4 2024
COUNrvENVIROFyr
n,a
Environmental Health Specialist YDate ''1_'+'4t HEALTH,
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. G
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ Drainfield site conditions have not been altered to adversely affect conditions o 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 PP ICANT/OW.NFR Shawn Gfeen Parcel# 22017-50-00097
PO Box 1519 Shelton Wa 98584 6312 Sier a Drive
Edmontls,WA98026 151 E ANNAS WAY, SHELTON
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