HomeMy WebLinkAboutSWG2024-00384 - SWG Application / Design - 9/13/2024 SHELTON,WA
MASONCOUNTY 415N 6THELTON , 0427-97 ,EXT 400
584
SHELTON 360-27544]0,E%T 400
BELFAIR'.360-2]5-0467,ENT 400
Public Health SL Human Services ELMA:360482-5269,ExT 400
FAA:360-427-7787
On-Site Sewage System Permit: SWG2024-00384
APPLICANT MACIEL ELISEO &SOILA A Phone:
Address: 260 E KARI SCOTT LN SHELTON, WA 98584
OWNER MACIEL ELISEO&SOILA A Phone:
Address: 260 E KARI SCOTT LN SHELTON, WA 98584
SEWAGE DESIGNER MICAH HALVERSON* Phone: 360-490-6365
Address: PO BOX 1519 SHELTON, WA 98584
SEWAGE INSTALLER JAMIE WORKMAN' Phone: 360-463-9573
Address: 120 E TIMBERLAKE DR SHELTON, WA 98584
Site Address: 260 E KARI SCOTT LN
Primary Parcel Number: 120182350110
Permit Description: New 3bd gravity bed
Permit Submitted Date: 09/13/2024
Permit Issued Date: 0911812024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (additional fees may be required upon ioemuaron or systeml.
Permit Expiration Date: 09/16/2027 (based on dam of Inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staffper 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 back ill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
5 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 JSE ONLY --
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ON-SITE SEWAGE SYSTEM APPLICATION 3 A
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APPLICANT PHONE m
MACIEL, SOILA A 362-999-8860 c
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MAILING ADDRESS-STREET CITY,STATE XUA CODE W
260 E KARI SCOTT LN SHELTON WA 9858nP
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SITE ADDRESS-GTREET,OILY,ZIP OOOE
SAME AS MAILING " �—
NAME OF DESIGNER PRONE ^ I r,`
MICAH HALVERSON 360-490-6365 FNI
NAME OF INSTALLER PHONE Q I n
JAMIE WORKMAN 360-463-9573 y
PER PE UhNC ooe) PRINKING WATER SOURCE
m RESIDENTIAL OSS Fl COMMUNITY OSS IT COMMERCIAL OSS Wr PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL $
] PUBLIC WATER SYSTEM
TYPE OF WORK UXU,U onel
H NEW CONSTRUCTION I UPGRADES rf REPAIR)REPLACEMENT OTHER DETAILS(Phlel au Thal eGON) ❑ TABLE IX REPAIR
❑ SURFACING SEWAGE ❑EXISTING FAILURE O SHORELINE
s°ewnALs
0
Rr DESIGN FORM(REQUIRED) b SEPTIC DESIGN(REQUIRED) BEOROOMe LOT srzE hL
❑ WAIVER(S7(IF APPLICABLE) 3 5.2AC
OI PROTONS TO SITE AND SITE CONDI TICKS (01 "G LAW
From HWY3 turn onto E Pickering Rd, travel to Harstine Island, after crossing harstine
bridge turn right (south), Take E South Island Drive to stop sign, turn right (south) on E
Harstine Island Rd South, turn left E Island Shores Rd, turn left on E Plantation Way, o
continue onto E Walter Scott dr, turn left onto E Kari Scott Ln, address is on right with Red
Gate. Test holes are marked with pink ribbon
SITE MUSTBERPIGGEO FROM MAIN ROADAND IESTNOLE5 NWT S FLAGGED WITH TESTNDLENOVERS.
OFFICIAL LEE ONLY BELOW THIS LINE ---
UPGRADE I FAILURE SCTRre Jor raPannyo.m
❑VOLUNTARY ❑MAINTENANOEIPUMPING O BUILDING PERMIT ❑HOMESALE OCOMPLAINT OOTHER:
NSPECTOR 601Lt0G5
COMMENTD I CONDITIONS
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RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES'.
V=VERY GRAVELLY S=SAND L=LOAM SI=51 Li C=CLAY E=EXTREMELY R-ROOTS REOUIREO FOR FINPI APPROVAL
.
INSPECTOR SIGNATURE DATE APPLICAT ION EXPIRATION DATE APPLICATION APPROVEDIID By I � � DATE
`9:1' � � C',kilA R lI�Iv7 a i
THIS FORM MAY BE SCA NEO AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WESSITE REVISED 12RQ015
15
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DESIGN FORM—PAGE ONE Assessor's Parcel Number:1 z E`
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
a Scaled plot plan, including all applicable items on checklist. Crass-section sketch,including all applicable items on checklist.
This form in be scanned aml available for public view on the Mason Coumy Web site.Maximum a er size: I"X 17"
p. L:fD ATCD
Permit Number: SWC,��LL (33 Designer's Name: MICAH HALVERSON
Applicant's Name: MACIEL, SOILA A Designer's Phone Number: 360490-6365
Mailing Address: 460 E KARI SCOTT LN Designer's Address: PO BOX 1519
SHELTON WA 985a4 SHELTON WA 98584
City State Zip City State Zi
`.. DE9I FARALNETfsR$;
Treatment Device
❑ Glendon BloFilter ❑ Sand Filter ❑ Mound ❑ Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make,Mlodel ❑ Disinfectian Unit MakeWodel Other: SEPTIC TANK
Drainfield Type
IIKGravity ❑ Pressure ❑Trench ffBed ❑ Sub Surface Drip
Septic Tank/Dralnfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class ASTM 2729
Daily Flow: Operating Capacity 270 gpd Length 50 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 2.66 ft
Receiving Soil Appl.Rate .8 gpd/ftz Orifices
Required Primary Area 450 ftr Total Number of Orifices PERF
Designed Primary Area 450 ft, Diameter � In
Designed Reserve Area 450 ft' Spacings in
Trench/Bed Width 9 ft Manifold
Trench/Bed Length 50 ft Schedule/Class D-BOX
Elevation Measurements Length it
Original Drainfield Area Slope <1 % Diameter in
New Slope,If Altered SAME % Preferred manifold configuration used? ❑Yes I9No
Depth of Excavation OP-.love 28 in Transport Pipe
from Original Grade Down-slope 15-28 in Schedule/Class ASTM3034
Designed Vertical Separation 36+ in Length 25 ft
Gravelless Chambers Required? ❑Yes E1 No ❑ Optional Diameter 4 in
Pump Required? ❑Yes If No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day GRAVITY
Diff.in Elevation Between Pump&Uppermost Orifice_fl Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal
Uppermostote❑Higher O Lower than Pump Shutoff
Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm 13Timff OElapse Meter ❑ Event Counter
Calculated Total Pressure Head ft If Timer: Pump on Pu off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number: I `'
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ih Test hole locations ® Drainfield orientation and layout Reference depth from original grade:
0 Soil logs 0 Trench/bed dimensions and Ef Septic tank
0 Property lines critical distances within layout 0 Drainfield cover
0 Existing and proposed wells 0 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks, and locations IS Laterals, trench/bed,top and
surface water and critical areas 0 Observation port location bottom
0 Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption tvf Manifold placement ❑ Sand augmentation
components 0 Orifice placement Other cross-section detail:
0 Location and dimension of 9 Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
0 Buildings el Audible/visual alarm referenced Yes No
0 Direction of slope indicator 19 Scale of drawing shown on scale 0 ❑ Design staked out
0 Waterlines bar ❑ LEI Recorded Notices attached
0 Roads, easements,driveways, ❑ 0 Waiver(s) attached
parking ❑ 0 Pump curve attached
0 North arrow and scale drawing ❑ 0 Evaluation of failure
shown on scale bar Non-residendal justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be tified by installer at time of installation 15 Yes ❑ No
7 -- yl7l2n?.,/
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 on-site regulations:
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. 'b _Z_ —
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date
✓ 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 re uired.
This form may be scanned and available for public view on the Mason County Web site.
dated Dace: 12/7n015
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Halversondesi nllc outlook.com SHELTON WA 98584 260 E KARI SCOTT LN o p