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Home My WebLink AboutSWG2024-00481 - SWG Application / Design - 12/31/2024 415 N 6TH STREET,SHELTON.WA 985B4 MASON COUNTY $HELTON:360-2754670,EXT 400 BELFAIR:380-275-0467,E%T 400 ELMA:360482-5269,EXT 400 Public Health & Human Services FAX:360427-77B7 On-Site Sewage System Permit: SWG2024-00481 COVAAAK Casey Ford Phone: APPLICANT Address: 150 W Lucas Ln ELMA,WA 98541 FORD ET AL KENNETH ALVAN & phone: 360-660-5238 OWNER SHERRY LOUISE Address: JARED A R FORD; CASSONDRA J FORD ELMA,WA 98541 Phone: 360 753-1226 Hunter,Adam Address: SEPTIC DESIGNER 2201 93rd Ave SW Olympia,WA 96512 150 W Lucas Ln Site Address:Primary Parcel Number: 620177500092 New SFR-4BR OSCAR Permit Description: 12/31/2024 Permit Submitted Date: 0111312025 Permit Issued Date: Jeff Wilmoth Issued By: $805.00 (aeammmal fees may be,Bomred upon installation or syste . Current Permit Fees Paid: Permit Expiration Dale: 0110912028 (based on dale or msl ecuom Permit Conditions: I 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 p backrill 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: masoncountyw3690od/h 96�Oonviro men400onsiteloss-inspection-request.php or call: OFFIOALUSEONLY- �Z� 70y \ um PUBLIC HEALTH APPLICATION U o nGESYSTEM _ S p SheLLDAWA� � z 415% 56'IBId981 2 V � IDD_fi5p41]Afi70 pM400 &M+ir.3fib175-b16]ex[4W WIG T 3606605238 c MMcW WA 98541 ; CASSY FORD LMA m uno.MGAODNEss-amEE*.an.arAreaPcoGE WA 98541 ?? 150 W LUCAS LN LMA I SItEPDDPEBB'BTN�'GTYaA CWE 150 W LUCAS LN 3607531226 I NFMEOFD�NER NE O ADAM HUNTER NM1EpF RSP1LER DMNMNG AI WURGE I TBD i I tj13 VATE INDMOUAL' LL ONEONALLMPIIOEBEE NEED` Y I 01 (NNOLDINGI'Ipo"LT P VATEIWpu o vmm N ❑ NEyy OONSTNUOTION ❑ IN�ALLATION PERA9TONLY 0 O UNftYFUBIJO WATER I O J REPIAOEMEM BTSTEM NAME J p ❑ SMLEG FAMILY J ❑ cGMMERcwL 5 ACRE TABLE9RFFAIR LOT91g O TANAlB10NLY OTNE(L- 4 V C3 UPGRPDETO EXISTNG ,Reaer9Dnwu�Y^eu^°� N b+II1KY0abK Fe)pMe) I � EJ(15TING FAILURE O A LEFT ON LUCAS LN TO SITE ON I AONSE OFPNT NEEDEDHO MAECNFDRA�' MS pjgEO9O'� WE-BEBpEOIRDAND LEFT ON HOMER ADAMS P P w O DTHE RIGHT E RD TO A n o JAN 13 20 I I MASON CO�N�V E�NV�IROWNMENiAI HEA�Th res*Ny✓� rBEM9r��ITlSrM FFICIAL gREMuSrBEMGGEOiRDMM'yND IS UN OCIALU USE ONLY BELO ' ocom"N] POTHER: UPGRFOEIFaILURE SOUItGE M�eO^�AGP'°UW PERMR []HOME C UMPMG OBUILDING Dp,yENIBIOCN JJ VOLUNTARY ❑MMERENAROEIP 3 MBpEDTOR�M1 LOGB ` Y�I� =lOM1 NWTB SFT C=WY E=E%1REM'LY R TWNAPPR EdLCODE9. GRP/01T 5=9ANO L gS.TF N APPDCNIO EwMTICN DM! V=VERY G- \ � BOFEp qHO AyAILgflLE FOR PUBLIOVIEW ON THE MABG ]H FG 620b7-75-00092 DESIGN FORM—PAGE ONE Assessor's Parcel Number: design will be reviewed when 3 copies of each of the following Scaled layout sketch,including all applicable items on checklist �Completed design form that has been signed and dated. y including applicable items on checklist. v Scaled plot plan,including all applicable items on chceklisl °Cross-sca+tion sketch' kate ebslteMaslmum uer'slve' 11"X17" 110 form may be scanned and available for public view on the Mason ION ..PARCEL IDENTIFICATION ADAM HUNTER ;,<, i_ '.,•• . Designer's Name: Permit N umber. SWG� 360-753-1226 Applicant's Name: CABBY FORD Designer's Phone Number: PO BOX 162 Mailing Address: 150 W LUCAS UN Designer's Address: OLYMPIA WA 98807 ELMA WA 98ml CityState Zi Ci Stale Zi METERS Treatment Device ❑Glendon Biofiller ❑Send Filter ❑Mound ❑Sand Lined Drainfield ❑Recirculating Fibs,s,TTYPe: ❑Aerobic Unit Make/Model ❑Disinfection Unit MakelModd OSCAR III DnieReld Type ❑Sub Surface Drip ❑Pressure ❑Trench ❑Bed❑Gravity Laterals Septic Tank/Dminfteld Speciffcafioas Schedule/Class OSCAR OS100 4 Number of Bedrooms PERK ft Daily Flow:Operating Capacity 380 PER O SCAR in 480 gpd Diameter �— Daily Flow:Design Flow zcats PER-5 UknER S 1500 gal Number Septic Tank Capacity ER OSCAR ft q Separation Receiving Soil Type 0-6) Receiving Soil APPI.Raze 0'6 gpd1fe 54 is PERK OSCAR 800 fit' Number p t Ices Required Primmy Area PER OSCAR in 803 ftz Diameter O 47 7 Designed Primary Area g PER OSCAR in 803 ftz Spacing � Designed Reserve Area A =�sa�ni{old Trench/Bed Width40 73 ft Sched"l 73 5ass,Q' ' TrenchBed Length _ Elevation Measurements Le � V 1 in 0 % Diam Original Drainfield Area Slope NIA % preferred m f configuration used? 9'Yes ❑No Nev,Slope,If Altered Tmmsport Pipe up,Oope OSCAR In 40 Depth ofEzcavmian Schedule/Class from original Grade ooxn-ctope OSCAR in 160 it 18 in Length In Designed Vertical Separation — �No ❑Optional Diameter Chamber Gravelless Chambers Required? Yes posing and Pump P 1(Yes 13 No 180 pump Required? hoaS ifieaRoas Number of Pump/Sip P� gal Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity 1200 � gal L6 it Chamber Capacity — Orifice Pump controls:Please check those required. 9�Evenl Counter Uppermost Orifice Higher ❑Lower than Pump Shu BP eimer 9Eiapw Meter Capacity @ Total Pressure Head 12 22 SEC pump all 7MIN 3aSEC 37.817 ft If Timer: PUMP on Calculated Total Pressure Head Comments DESIGN FORM—PAGE TWO Assessor's Parcel Number: 62017-75_M92 ___ Permit Number: SWG 7�= N CHECKLISTS Scaled Plot Plan out Sketch Croi; Section Sketch Test hole locations ld orientation and layout Reference depth from original grade � Soil logs Trench/bed dimensions and Septic tank 99 Property lines distances within layout Draintield cover Nalve box locations Reference depth from original grade IZ Existing and proposed wells tank pump chamber and restrictive strata: within 100 fl of property ns ❑ Laterals,tremh/bed,top andca Measurements to cuts,banks,and surface water and critical areasation port location Cl Curtain tom r ttaiin drain collector 12 Location and orientation of 19 Cleanout Iccafon ❑ Sand augmentation curtain drain and all absorption Ef Manifold placement components a Orifice placement Other crosssection detail: Observation ports/cleanouts 13 Location and dimension of Ef Lateral placement with distance primary system and reserve area to edge of bed Other information IZ Buildings 9 Audible/visual alarm referenced Yes No 19 Direction of slope indicator Ll Scale of drawing shown on scale staked out 0 ❑ Design Recorded Notices attached Pad P p R 0 V E ❑ ❑ Waiver(s)attached gi ements,driveways, ❑ ❑ pump curve attached Iqp 13 2025 ❑ ❑Evaluation of failure w and scale drawing scale bar MASON COUNTY ENVIRONMENTAL HEALT Non-residential e shength cation JIM ❑ ❑ Flow DESIGN APPROVAL ned designer must ifieIer a[time of installation Yes ❑ No12131/24ator of DesignerDate —ned has reviewe t s design on behalf of Mason County Public Health and determined it to be in compliance with state and Iota 'te regulations: ' J�.Z E 'r tat Health S ialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY TINDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health. LZ_ 3 1 rZ ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ✓ Dminfield site conditions have not been altered to adversely affcet 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 dated Date: 12n/2015 Y.CHECK THE PUMP CAPACRY. PUMP. AY.MCDUNALD3CGPM-12HPPUMP(..EL..0%EY ) (PER DSCAR) EXCESSTDH 50"A (PER OSCAR) TOTAL HEAD LOSS IN SYSTEM 32.82 STANDARD PUMP CONFIGURATION IS SUFFIOIENT9 YES APPROVE JAN 13 2025 MASON COUNTY ENVIRONMENTAL HEALTh Jaw 12/31/24 L | / / ! 2 2 *w _SO4ViOIH-+- 0 LU § | ■ } _, en° m, a iE \ miHMO / {: t{ !! § ! ! ! ` !! k - ! . _ ! ! mg i _, nn. _i _me _ / t / ! � •l ; ' = ( \z } ; � � \ /� \ � > , § \ � 2 / { x _ \ ;! \ \7 ! « HIGIMMV ! \� : . | '!�' ! �! ° ■ , 4 ■ § / § - ■ ! ! I § ! . _ \§! ( § � \ � s ; ;�!| , • ,! ~� &§/ ( / �e§ - - 7- - - - yo - - - - - - :: - k § . ; � tu m E � . a _ o \ + ■ C ) ^ Nazi � �■ . \ \