HomeMy WebLinkAboutSWG2024-00366 - SWG Application / Design - 9/16/2025 sail
® MASON COUNTY 418NB SHELTON; , 0427-97 ,EXT 400
SHELTOR:NO-275-8670,EXT 11M
BELFAIR:380-2T5i487,EXT 400
Public Health & Human Services ELM 360d82-528e,EXT 100
FAX 380i27-7787
On-Site Sewage System Permit: SWG2024.00366 L oU
APPLICANT Sam Skinner Phone:
Address: PO Box 920 FAST OLYMPIA,WA 98540
OWNER USIBELLI COLLEEN F&SUSAN M Phone:
Address: 367 E POINTES DR E SHELTON,WA 98584
SEPTIC DESIGNER JIM HUNTER' Phone: 360-753-1226
Address: PO BOX 162 OLYMPIA,WA 98507
SEPTIC INSTALLER SAMUEL SKINNER" Phone: 360536-7678
Address: PO BOX 920 EAST OLYMPIA,WA 98540
Site Address: 560 E PROBERT RD
Primary Parcel Number: 221287690094
Permit Description: New 31bd pressure trenches
Permit Submitted Date: 08/27/2024
Permit Issued Date: 03/04/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (additional lees may be required upon L,aul onyeum).
Permit Expiration Date: 09/16/2027 (based on lots or lnspeclmn)
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 Dreinfreld installation not to exceed designed upslope and downs/ope 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 Masan 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 wll:
360-427-9670,extension 400.
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH " ° °' _ �a .
ONSITE SEWAGE SYSTEM APPLICATION
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SAM SKINNER 360 536-7678 IT,
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PO BOX 920 EAST OLYMPIA WA 987540 3
SITE ADDRESS-STREET.CITY 2IP DOLE
560 E PROBERT RD SHELTON WA 98584 z
NAMEOFCESIGNER PHONE
JIM HUNTER 360 7543-1226
NAME OF INSTALLER PHONE
SAM SKINNER 360 536-7678
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Of NEW CONSTRUCTION � RV HOLDING TANK ONLY tl PRNATE INONIDVAL WELL 41
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❑ TANK(SUONLY ❑ COMMERCIAL SYSTEM NAME:
UPGRADE TO EXISTMG ❑ OTHER: BEDRODW LOT 92E
❑ EKISTING FAILURE °'SG^AM^��
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GRECM)NS TO SITE-ME SPEOFICANDADNSE OF ANY NEELEO INFORMATION FOR ACC[EEW I[E.9
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INSPECTOR SIGNATURE DATEAPPLICATIONE%PBWT�NI M APPUCMIONAPPROVEDSY WTE
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THIS FORM MAY Eld SCANNED AND AVAILABLE FOR PUBLIC MEW ON THE MAMASON COUNTY WEBSITE RENSE lwml5
DESIGN FORM—PAGE ONE Parcel Number. tl i L 4--
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
Scaled plot plan,including all applicable items on checklist °Cross-section sketch,including all applicable items on checklist.
This form maybe sunned and available for public view on the Mason County Web site.Maximum paper sue: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 202'�' 003(p(a Designer's Name: I-Ic1N-rtnsL
Applicant's Name: SA. S I!_r N+-VAl- Designer's Phone Number: 3W753-1226
Mailing Address: -D - &0)L q' 0 Designer's Address: PO BOX 162
E/r,$? OW q. 9Pr SsEO OLYMPIA WA 98507
Cit PSWuoe zip Ci State Z'
DESIGN PARAMETERS
Treatment Device
O Glendon Biofiher ❑ Sand Filter ❑Mound ❑ Sand Lined Drainfield ❑ Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑ Disinfection Unit Make(Model Other:
Drainfield Type
❑Gravity ❑Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfteld Specifications Laterals
Number of Bedrooms Z Schedule/Class 4r)
Daily Flow:Operating Capacity I-�7p- gpd Length 0,1 35 0 ft
Daily Flow:Design Flow Wit'}O gpd Diameter s(¢ in
Septic Talc Capacity (1.-00 gal Number $
Receiving Soil Type(1-6) Separation to ft
Receiving Soil Appl.Rate 0.(0 gpd/ftr Orifices
Required Prhnary Area 400 ftr Tool Number of Orifices (a 0
Designed Primary Area -{OS ft' Diameter 3(kr in
Designed Reserve Area 400 ftt Spacing 7A in
TreachBed Width "3 ft Manifold
Trenched Length '3$ ft Schedule/Class 40
Elevation Measurements Length -1-0 It
Original Drainfield Area Slope % Diameter .. //'2.. in
New Slope,If Altered % Profecred manifold configuration used? y.Y es 0 No
Depth of Excavation Up-slope L 2" in Transport Pipe
from Original Grade Duwnslopa 1�11 .• in Schedule/Class 40
Designed Vertical Separation 2Y in Length (4S ft
Guvelless Chambers Required? Yes 0 No 0 Optional Diameter Z— in
Pump Required? I�Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day CQ
Difference in Elevation Between Pump Shuoff and Uppermost Dow quantity de O gal
Orifice 9 ft Chamber Capacity ( 'Loa gal
Uppermost Orifice 01Glfigher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Qa Total Pressure Head 31. 6(a0 gpm P1'imer M8,lapse Meter Event Counter
Calculated Tom]Pressure Head 41-'t, Pump off 91. 0
Comments
MAR 0 4 2025
MASON COUNTY ENVIRONMENTAL HEALTH
DESIGN FORM-PAGE TWO Assessor's Parcel Number: $2 1 7- 6 - �l to -- S Q 0 4
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
19 Test hole locations V Drainfield orientation and layout Reference depth from original grade:
IZ soil logs 19 Treach/bed dimensions and d Septic tank
EZ Property lines critical distances within layout 6d Drainfield cover
69 Existing and proposed wells 9 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 9 Septic tank/pump chamber and restrictive strata:
IZ Measurements to cuts,banks,and locations ❑ Laterals,trench/bed,top and
surface water and critical areas EY Observation port location bottom
EA Location and orientation of EZ Clean-out location ❑ Curtain drain collector
curtain drain and all absorption d Manifold placement ❑ Sand augmentation
components El Orifice placement Other cross-section detail:
19 Location and dimension of Lateral placement with distance E9 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
E9 Buildings E9 Audible/visual alarm referenced Yes No
19 Direction of slope indicator SY Scale of drawing shown on scale 9 ❑ Design staked out
19 Waterlines bar ❑ ❑Recorded Notices attached
9 Roads,easements,driveways, ❑ ❑Waiver(s)attached
puking ❑ ❑Pump curve attached
Qf North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must be notifi er at a of installation 4-yes ❑ No
-4. 7- -
Si 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:
3/�tzs
Environmental Health Specidlist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: _l
✓ 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 required.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
V/AE t
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE R: PARCEL* 22128-76-90094
DATE SUBMITTED:1/8I2025 LEGALAOT A: LOT 0 SP 5AO
SISMITTEDBY: JIM HUNTER
APPLICANT: SAM SKINNER
ADDRESS: PO BOB 920
EAST OLYMPIA,WA 98540
L CALCULATIONS
NUMBER OF BEDROOMS= 2
RESIDENTIAL GPD FLOW= 240
IF NON-RESIDENTIAL-GPO FLOW
WILL BE AS FOLLOWS:
GPD-
APPLICATION RATE• 0S GPDIFT2
REDUCTION=LEAVE BLANK IF NO REOUCOON TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 405 FT2
TRENCH LENGTH OR BED CONFIG.= 135 FT
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SD:E= 1200 GAL.CONCRETE
NEW OR EXISTING NEW
Ill.DRAINFIELD CROW SECTION
DEPTH TO DRAINROCK BOTTOM= GRAVELLESS CHAMBER
ROCK DEPTH BELOW PIPE- GRAVELLESS CHAMBER
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIALJSEASONAL SATURATION= >2'-0"
FILL DEPTH- 1'-T
TRENCH WIDTH= 3'-T
IV.PUMP REQUIREMENT
DOSING VOLUME IN GALLONS= 40
NUMBEROFDOSESPERDAY= 6
V.PRESSURE CALCULATIONS
USING PIPE CLASS 40
ORIFICE W16
APPROVED
MAR 04 2025
MASON COUNTY ENVIRONMENTAL HEALTH `-
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LATERAL#1=
SQUIRT HEIGHT(FT)= 2.00
(NOTED) Q IFICE DISCHARGE RATE=111]B)%(MV CE DMMETER, Q2%
SD ROOT Q(MTAL PRESSURE HEAD)
ORIFICE DISCHARGE RATE= 0.58618
LATERAL LENGTH IN FEET= 40.00
ORIFICE SPACING= 2.17
DISTANCE FROM END CAP- 110.
NUMBER OF HOLES= 20
LATERAL DISCHARGE RATE• 11.T24
LATEMA =
SQUIRT HEIGHT(FT)= 2.W
ORIFICE DISCHARGE RATE= 0,58618
LATERAL LENGTH IN FEET= 35.00
ORIFICE SPACING= 20"
DISTANCE FROM END CAP- 96"
NUMBER OF HOLES= 18
LATERAL DISCHARGE RATE= 10.551
LATERAL*=
SQUIRT HEIGHT(FT)= 2.00
ORIFICE DISCHARGE RATE- 0.58618
LATERAL LENGTH IN FEET= 20.00
ORIFICE SPACING= 2 0"
DISTANCE FROM END CAP= 1-0"
NUMBER OF HOLES= 10
LATERAL DISCHARGE RATE= 5.862
LATERAL A=
SQUIRT HEIGHT(FT)= 2A0
ORIFICE DISCHARGE RATE= 0.58818
LATERAL LENGTH IN FEET= 20.00
ORIFICE SPACING= 2'0"
DISTANCE FROM END CAP= 1'0"
NUMBER OF HOLES= 10
LATERAL DISCHARGE RATE= 5.862
LATERAL IIS-
SQUIRT HEIGHT(FT)= 2.00
ORIFICE DISCHARGE RATE= 0.58618
LATERAL LENGTH IN FEET= MIX)
ORIFICE SPACING= 2'0"
DISTANCE FROM END CAP= 111.
NUMBER OF HOLES= 10
LATERAL DISCHARGE RATE= 5.862
'APPROVED
MAR 04 YD25
MASONCOUNTYE"PNMENWHILTN ``°°f,'k
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LENGTH DIAMETER FLOW FRICTION LOSS
SECTION (FT) (IN) (GPM) (FT)
AS 155.00 2.00 39.850 4.3494
BC 1.00 2.00 28.137 0.0138
CD 1.W 2.00 2295 0.0D90
DE 35A0 2.00 11.724 0.0959
EF 40.00 125 11.724 0.7827
TOTAL 52M
"TOTAL HEAD LOSS
1)FRICTION LOSS THROUGH SYSTEM= 5.251
2)ELEVATION DIFFERENCE 9."
3)RESIDUAL 2.M
TOTAL= 16.251
APPROVE
MAR04 L - R - zS
MASON
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APPROVEp . ..
MAR 04 2025
MASON COUNTYENVRONhENTALHEALTH ucn'sEbnESEk
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