HomeMy WebLinkAboutSWG2024-00438 - SWG Application / Design - 11/8/2024 MASON COUNTY 416 N BTH STREET, 0427-9 7 ,E 98584
SHELTON:360-2754467,EXT 400
BELFAIR:360-27544fi7,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2024-00438 CDV
APPLICANT DAMMANN DAVID&VERITY Phone: 907-321-4445
Address: PO BOX 3155 SHELTON, WA 98584
OWNER DAMMANN DAVID &VERITY Phone: 907-321-4445
Address: PO BOX 3155 SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON• Phone: 360-490-6365
Address: PO BOX 1519 SHELTON,WA 98584
SEPTIC INSTALLER JAMIE WORKMAN' Phone: 360-463-9573
Address: 120 E TIMBERLAKE DR SHELTON, WA 98584
Site Address: 480 W SIMPSON RD
Primary Parcel Number: 520017700020
Permit Description: New 3bd ATU to pressure bed
Permit Submitted Date: 1110812024
Permit Issued Date: 01/1 012 0 2 5
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (addiwool Nes may ba required anon lnslalmon of sotem)
-
PermitExpirationDate: 11/1812027 (based on dale or inavectionl
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 DURI NO 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.
OFFICIALLL USE ONLY
®
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ON-SITE SEWAGE SYSTEM APPLICATION R
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APPLICANT PHp1E r
DAMMANN, DAVID & VERITY 907-321-4445 �n c
"LING ADDRESS-STREET,CBK STATE.ZIP CODE Z
PO BOX 3155 Shelton We 98584 A
SITE ADDRESS-STREET CITY,ZIP COCE
480 W SIMPSON RD .: - Shelton We 98584 s
NAME OF DESIGNER NQy Q g 2ogl N
Micah Halverson t 360-490-6365
NAMEGF INSTALLER PHONE I Q
Jamie Workman by -. _ - 360-463-9573 <
DRINKWO WATER SOURCE w I G
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FfRNRNFE(WeCaref cc cc _
1_n.RESIDENTIAL ff0S5 COMMUNRYOSS LT.COMMERCIALOSS PRIVATE INONIDUALWELL 6 PRIVATE TWO-PARTY WELL Z I_
TWEOF WORK(roblt a,e) Cr PUBUC WATER SYSTEM I ,
9NEWCONSTRUCTIONIUPGRADES 6REPAIR(REPLACEMENT OTHER DETAILS(,N,M M E SNOW 13TABLE IX REPAIR IJ
SUBMRTALS CC O SURFACING SEWAGE [3 EXISTING FAILURE OSHORELINE w
W MSIGNFORM(REQUIRED) iISEPTICDESIGN(REOUIRED) BEDROOMS LOTSQE r0 1,1
l]WAIVER(S)(IFAIRPLICABLE) 3 5.06Ac x lO
OIRECTIgISTOSITEANDSRECONDTIgNS'.(u.b'le )
From W shelton Matlock Rd turn onto W Hanks Lake Rd, turn right on W Martin Rd, I 10
continue on W simpson Rd. Site will be on the right. test holes are marked with ink ribbon o IO
EIFEW/ET BE RAOOEO FlMYYMI ROAD AXD 1EBT NOI.ESWIBI BE FlI00E0 WTM 19T NOTE AY06fE.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE IF.NLGRE SOURCE rynr,.Po,me wnb•®)
OVOLUNTARY OMAINTENANCEPUMPING E3WILDINGPERMIT OHOMESALE 13COMPIAINT DOTHER:
INSPECTOR SOIL LOGE CIXA.1.CIX"'T'ONS
RECORDg ING AND NSTM_XPON REPORT
V=WW G•GMWUY S=MD L=LOAM M=SLT C=CIW F=E%IREMELY R=ROOTS RGCUNEDFORFR APPROWA
MSPECTOR SIGNATURE GATE CN E%P WTE APM1IGTICN IPPROVEW ISBl1ED BY DATE
THIS FORM MIIY BE NED AND AVAlAJIIE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSRE REVISED M]RIMIS
" DESIGN FORM—PAGE ONE Assessor's Parcel Number: $ 2 -d! — � -- D O D Z O
A design will be reviewed when 3 copies of each of the followingS are caled layout ssubtketch,including all applicable items on checklist
v Completed design form that lies been signed and dated. Y
r Scaled plot plan,including all applicable items on checklist Cross-section sketch,including all applicable items on checklist.
This form may he scanned end evellable for public view on the Mason Cou Web alto•Maxrmum er srze 71"X 17"
- _ •• ,- ,,�•���qp Micah Halverson
Permit Number: �,- SWG Gv2�'W"7.JlL Designer's Name:
Applicant's Name: DAMMANN,DAVID&VERITY Designer's Phone Number.
360�190-8365
PO BOX 3155 Designer's Address:
PO Box 1519
Mailing Address: Shanon Wo 98584
snwron we sesea g� zi
Ci
State zi Cr .... .
Treatment Device
❑Glendon Biefilter ❑Send Filter ❑Mound ❑ Sand Lined D d field ❑Rechwlating Filter,Type:
gK Aerobic Unit Make/Madel
NUWater BNR-500 0 Disinfection Unit Meke/Model Other:
d Dralnfleld Type ❑ Sub Surface Drip
❑Gravity wr Pressure (3 Trench P1Bed
Laterals
Septic Tank/Dninfleld Specifications �� 40
Number of Bedrooms 3 Schedule/ -
270 gpd Length 37 ft
Daily Flow:Operating Capacity -y
1/4 in
d N
Daily Flow:Design Flow 360 SP Diameere� m 3
Septic Tank Capacity(working) 500+NuWater gal Number 0 3 ft
Receiving Soil Type(1-6) 1 Separation n >
l J z O flees
Receiving Soil Appl.Rate 1'0 ��� Total Num 63
�"
Required Primary Area 380 ft m 1/8 in
Designed Primacy Area 360
Diameter
360 W Spacing 22 in
Designed Reserve Area Manifold
TmnchBed Width 9 ft
Tmuch/Bed Length
40 ft Schedule/Class 40
Elevation Measurements Lend — 2 in� ft
—
Original Dminfield Area Slope Level % Diameter
New Slope,If Altered % Preferred manifold configuration used? ❑Yes �No
up�tope 38Max in Transport Pipe
Depth of Excavation 40
from Original Grade Down dwt in Schedule/Class
Designed Vertical Separation 36+ in Length
150 ft
2 in
Graveness Chambers Required? ❑Yes Iff No 0 Optional Diameter _-_---
Pump Required? ig Yes 0 No Dosing and Pump Chamber
6
Pump/Stphon Specifications Number of doses/daY
45 gal
Diff.in Elevation Between Pump @.Uppermost Orifice 25 ft Dose quantity 1223�-- gal
Height/U Selected Residual(head) 5+ ft Chamber Capacity(flood)
Dminfield Squirt glr pomp controls:Please check those required.
Uppermost Orifice dktigher 0 Lower them Pump Shutoff 9'ITmer 11111apse Meter BEvom Counter
Capacity @ Total Pressure Head 28.5 Spot TBD 41rs
Calculated Total Pressure Head 27.84 ft if Timer: Pornp
c° °ens JAN 10 2025
EWROWENTAL HEALTH
RET
DESIGN FORM—PAGE TWO Assessor's Parcel Numbers5 Z �% — 7 -- UOrJ Z 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
0 Test hole locations 0 Dminfield orientation and layout Reference depth from original grade:
0 Soil logs 0 Tnuch/bed dimensions and P1 Septic tank
0 Property lines
19
critical distances within layout Ad Drandiield cover
D-Box/Valve box locations Reference depth from original grade
0 Existing and proposed wells Septic tank/pump chamber and restrictive strata:
within 100 ft of property locations
0 Measurements no
to cuts,banks,and 0 Laterals,trench/bed,top and
surface water and critical areas ® Observation port location ❑ (}rrtaimn drain collector
0 Location and orientation of 10 Cleanout location
curtain drain and all absorption 0 Manifold placement
❑ Sand augmentation
components 0 Orifice placement Other cross-section detaiC
0 Location and dimension of 0 Observation ports/cleanouts
E1 Lateral placement with distance
primary system and reserve area to edge of bed other Information
0 Buildings 0 Audible/visual alarm referenced Yes No
0 Direction of slope indicator 0 Scale of drawing shown on scale Tf ❑ Design staked out
0 Waterlines bar ❑ O Recorded Notices attached
❑ E1 Waiver(s)attached
0 Roads,easements,driveways, 0 ❑Pump curve attached
parking ❑ 0 Evaluation of failure
0 North arrow and scale drawing Non-residential justification
shown on scale bar ❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must be 'fled by installer at time of installatio7No
No0LySignature of DesignerThe undersigned has reviewed this design on behalf of Mason County Pub determined it to be incompliance with state and local on-siu regulations:
Environmental HealtheCAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THENG CONDITION:✓ The design is stamped"Approved"by Mason CounTy Public Health. I'of /�✓ The Onsite Sewage Permit has not expired,the Permit Expiration DatDrainfield site conditions have not been altered to adversely affect cosign 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. ml�v Mason ctwnty web site.
This form may be scanned and available for pu Updated Date: 12/7/2015
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M.Halverson Design LLC Dave Parcel# 52001-77-00020
PO Box 1519 Shelton Wa 98584 e & Verity Dammann
Halversondesi nllc outlook.com Mailing: PO BOX 3155 Shelton WA 98584 480 W SIMPSON RD �n