HomeMy WebLinkAboutSWG2024-00028 - SWG Application / Design - 1/26/2024 MASON COUNTY 41fiN 6SHELTON: 60427-O7o,EXT 400
SHSTREE ,SO ELTON,0,EXT 5M
4 BELFAIR:360-2754487,EXT 400
Public Health&Human Services ELMA:360-4825269,EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2024-00028
APPLICANT Thomas James-Incline Timber LLC Phone: 307-2313795
Address: 228 N Eldon Ln LILLIWAUP,WA 98555
OWNER Thomas James-Incline Timber LLC Phone: 307-231.3795
Address: 228 N Eldon Ln LILLIWAUP,WA 98555
SEPTIC DESIGNER MICAH HALVERSON` Phone: 360-490-6365
Address: PO BOX 1519 SHELTON,WA 98584
Site Address: UNKNOWN
Primary Parcel Number: 324237500060
Permit Description: 3-bedroom pressure system
Permit Submitted Date: 01/2 612 0 2 4
Permit Issued Date: 05/17/2024
Issued By: David Anderson
Current Permit Fees Paid: $540.00 (adebmnauoo .1ba reamrm U,111sunaton&sIW-).
Permit Expiration Date: 02/08/2027 (b dondateoina dlon)
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 Dreinfield 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 SUE 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.govlheahhlenvironmental/onsite/oss-inspection-request.php or call:
360-427-9670,extension 400.
OFFICIAL USE ONLY
pARXECEVFR //a /_ /
® MASON COUNTY (/ Y — C a m
COMMUNITY SERVICES MONND� RRNmBEc o
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ON-SITE SEWAGE SYSTEM APPLICATION 3 A
m TO
PHONE TO
APPLICANT r
Thomas James O 307-231-3795 z
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I. Ij AOORESS-STREET,Cm.STATEZIPQOOE 3
228 N Eldon Ln r Lilliwaup We 98555 z
snenooasss-sTREET cm,zPcoDE
Undeveloped - Land �6 �J Lilliwaup We �W
HMIE OF DESMNER PHONE
IN
Micah Halverson 360-490-6365
NNAE OF MSTMMR PHONE
TBD y IN
PEflMRIVPE(m --) C DRINKING YMTER SOURCE 5
9RESIDENTIALOSS Cl COMMUNITYOW t7COMMERCIALOSS If PRIVATEINDIVIDUALWELL EPRIVATETM00 MT WELL 2
TYPEOF NORK(mb .f IS PUBLIC WATER SYSTEM I I
If NEWCONSTRUCIONIUPGRADES 6REPMR/REP1.ACEMENT OTHEFDETNLS(FN Mlhete ) OTABLE IX REPAIR I'v
sUBMITTALB El SURFACING SENMGE O EIUSTING FAILURE 0 SHORELINE W
O B� r
krDESIGN FORM(REQUIRED) V SEPTIC DESIGN(REOUIRED) BEDROOMS 3 7,2 AC x ^'
6MMIVER(S)(IF APPLICABLE) IV'
DIRECTIONS TO SMMI SNE OOXURIONs:(v.A 1A ) I IO
From Hwy 101 turn onto N Hamma Hamma Rd (FS25) take first dirt road on left. follow
road uphill until you see new driveway on right. test holes are marked with pink ribbon. r
GPS Cord: 47.56487,- 123.01992 S
4RE W/ST N:FLMOPO IAOB W N RMB AXO TEBT XOLEB MAY N:-----TEET MOIE_.
OFFICIAL USE ONLY BELOW THIS LINE
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URE 8 W RGE Qa rN V IYp PR�NN)ARY ❑MAINTEMTNCE/PUMNNG OBUILDINGPERMIT OHOMESALE OCOMPLAINT OOTHER:L LOGB Lf4 vr)sc fo tv*m v/ C^PR; t4d" k6a to d##Owl N/ ccmpodk hyh361W., <7SL 10 ''IVOM38" SSG+ q+ 38` �/ Nto� Q MII ? Can94" 45 40 4itlFdmkf P f1 pecMF1
RECORD ORAWNG AND INBTu1LAT10N REPORT
=LCO0E8: REOUIREDFORFINKAPPRWM.
V=VERY G-GRAVELLY S=SNID L=LORN 51=SR.T C=CIAY E.F%TRFAELY R=RWTB
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GATE MPLM/SION F%PMUTXN WIE MPLICATKINAPPROWD/SSUEO BY WlE
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THIS FORM MAY BE SCANNED AND AVMLABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISEDI2OW5
/
r DESIGN FORM-PAGE ONE Assessor's s Parcel Number: Z Z 3 - �.5 - 6 O O (oO
A design will be reviewed when 3 copies of each of the following are submitted:
v Completed design form that has been signed and dated. O Scaled layout sketch,including all applicable items on checklist
•Scaled plot plan,including all applicable items on checklist. I Cross-section sketch,including all applicable items on checklist.
This form may be sunned and available for public A"on the Mason County Web site.M"imum a er size: 11"X 17"
PARCELIDEN ICATION '"
I Permit Number. SWG Designer's Name: Micah Halverson
�a 4_'Q � _ - 360-090�365
Applicant's Name: Thomas James D igner's Isbmw No er:
228 N Eklon Ln Desi a's AdiJress: PO Box 1519
Mailing Acidness: ' Shelton We 985M
Llllavaup we 9855.5 �_�
cityState Zi n Cit, State Zi
DESIGN PA
Treatment Nxlce
❑Glendon Biofilter ❑Saud Filter ❑Mound ❑Sand Lined Drain eld ❑Recbculaung Filter,Type:
❑Aerobic Unit Make/Model
❑Disinfection Unit Make Model Other: Septic Tank
Drainfreld Type
O Gravity ifPressure ffTrench ❑Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 f Schedule/Class 40
Daily Flow: Operating Capacity 270 gpd Length 66.67 - it
Daily Flow:Design Flow 360 gpd Diameter 1 1/4 Y in
Septic Tank Capacity(working) 1200�- gal Number 5
Receiving Soil Type 0-6) 4 r Separation 1.5 - ft
Receiving Soil Appl.tale .6 i gpd/ft
Orifices
Required Primary Area 600 ft,/ ' Total Number of Orifices 1/
8 in
Designed Primary Area 602 / fe Diameter
4
Designed Reserve Area 602 ft2 Spacing 8 in
Trench/Bed Width 2 it Manifold
TrcuchBed Length 334 i ft Schedule/Class 40
Elevation Measurements Length
Preferred fl
Original Drainfield Area Slope
12-14 % Diameter 2 in
New Slope,If Altered same % Preferred manifold configuration used? NrYes ONO
Depth of Excavation
up,bpe 10 in Transport Pipe
from Original Grade 40
n°.w+lope 6.64 in Schedule/Class
Designed Vertical Separation 24+ � N Length
150 ft
i;rtavelless Chambers Required? ❑Yes ONO plOptionel Diameter
2 in
Pump Required? 9 Yes ONO Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
6
Diff.in Elevation Between Pump&Uppermost Orifice 15 ft Dose quantity 45 gal
5 ft Chamber Capacity(flood) 1500 gal
Drainfield Squirt Height/Selected Residual(heed) a
Pump controls:Please check those required.
Uppermost Orifice lrHigher ❑Lower than Pump Shumff eimer 8it):lapse Meter 9if Event Counter
Capacity Q Total Pressure Head gPm
Calculated Total Pressure Head 26A It If Timer: Pump on TBD ,Pump off 4hrs
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number: rZ 75 - 60060
Permit Number: SWG _
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Id Test hole locations Q Drainfield orientation and layout Reference depth from original grade:
9 Soil logs 9 Trench/bed dimensions and 11 Septic tank
16 Property lines critical distances within layout Q Grainfield cover
Lf D-Box/Valve box locations Referenced th from on 1 grade
M Existing and proposed wells Septic tank/ chamber
within 100 it of property ep pump and restrictive strata:
17 Measurements to cuts,banks,and locations 9 Laterals,trench bed,top and
surface water and critical areas 0 Observation port location bottom
H Location and orientation of M Clesoout location ❑ Curtain drain collector
❑ Sand augmentation
curtain drain and all absorption g Manifold placement
components ® Orifice placement Other cross-section detail:
0 Location and dimension of wJ Lateral placement with distance 9 Observation Ports/clean-outs
primary system and reserve area to edge of bed Other Information
H Buildings Ig Audible/visual alarm referenced Yes No
Ira Direction of slope indicator pJ Scale of drawing shown on scale ❑ if Design staked out
hJ Waterlines bar ❑ ❑Recorded Notices attached
❑ ❑Waiver(s)attached
Ej Roads,easements,driveways,
Iff ❑ pump curve attached
parldng ❑ ❑Evaluation of failure
9 North arrow and scale drawing
shown on scale bar Non-residential justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL.
The undersign7reviewed
ufied by installer at time of installation Ef Yes ❑ No
� /Lh
gaature of Designer h Da A ^ ,
The undersign design on behalf of Mason County Public Health and deter ineTYt ,pye �compliance wi -si Iations: ���., ®'�
f - ergs '1' o yAY ��ZOZy
Enviro ental Health Specialist Date Wry
FNUIRpNMt47
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDIITI�Mq qt
✓ The design is stamped"Approved"by Mason County Public Health. ^7 ! $/ZaC��
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: C
✓ Grainfield 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 re uired.
unty Web site.
Thls form may be scanned and available for public view on the Mason Co
t,pdatca D.rr. 11,7 1011
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