HomeMy WebLinkAboutswg2025-00122 - SWG Application / Design - 4/8/2025 415NB
® MASON COUNTY H STREET,
SHELTON,
HEL O 60427- N, EXT70,EKT 5M
4W
SHELTON:S
BELFAIR:360-275J467,EXT 400
Public Health & Human Services ELM:360.482.5289,EXT 400
FAX:3e0.427-77e7
On-Site Sewage System Permit: SWG2025-00122 CNN"
APPLICANT PETERSEN THOMAS E a VANESSA L Phone:
Address: 1001 SE COLE ROAD SHELTON,WA 98584
OWNER PETERSEN THOMAS E a VANESSA L Phone:
Address: 1001 SE COLE ROAD 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: 1001 BE COLE RD
Primary Parcel Number: 320324100000
Permit Description: Repair 4bd pressure trench
Permit Submitted Date: 04/0812025
Permit Issued Date: 04/08I2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $825.00 laeemmal rese may be required upon Nsatelon olsriwmi.
Permit Expiration Date: 03/2812026 Ibesea m dw dmpeodonl
Permit Conditions:
i Proposed development subject to zoning requirements and approval by the planning
department staBper 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 Drainlre/d installation not to exceed designed upsiope and downslope depth speed on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installeris responsible for obtaining Septic Designer/Engineer installation approval prior to
ball of system components.
6 Mason County Asbuik Form, Record Drawing,and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF DES.
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/onslteloss-inspection-request.php or call:
360-427-9670,extension 400.
DDcusign En,P1OpE ID'. 520B3012-0929 862-8999-6DA967l E260E
OFFICIAL USE ONLY
MASON COUNTY �� w
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Public Health & Human Services RL y
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ON-SITE SEWAGE SYSTEM APPLICATION m
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APPLICANT 1—
PETERSEN, THOMAS E c
MAILING ADDRESS-STREET CNY,STATE.ZIP CODE " L c� r
look % Ca.E W-0 SrTL VVN '19s-Sy M
SREAODRESS-STREETCm.ZIPCODE 1001 SE COLE RD shelton Wa 98584 I W
NN.IE OF DESIGNER PHONE I N
MICAH HALVERSON 360-490-6365
NFMEOFINSPLIER PHONE Q I o
JAMIE WORKMAN ?
PERMRTYPE(eCaY are) DRINKMG.TERSWRCE y I W
If'TRESIDENTNL OSS ff COMMUNITY OES COMMERCIAL OSS If PRNATEINDMDUALWELL GPRIVATETWO-PARWMLL Z I N
TYPE CF WORN(aMart aM) Q PUBLIC V MR SYSTEM ,
I]NEW CONSTRU"ONIUPGRADES WRERUR/REPLACEMENT MENOETALSpNveA0&N ) OTABLEIXREPAIR I A
sUSMITTALs O SURFACING SEWAGE IS EXInNG FAILURE 0SHORELINE
c ODESIGN FORM(REQUIRED) WSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE wAS LOTCRFATFDAFTEReNO@ST
GW4NER(S)(IFAPPUCABLE) 4 12.5 ❑ YES ❑/ NO x I 1
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DIRECTONSTOSREANDSITECONDRN)NS:(.b[ PUCU
MEET WITH RHONDA 3/28/2025 o
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81IEM/STBEfIADOFD iNDY MAN ROAD ANOlESTNDLF5YRT1l MBO[O NIIM 1E81NIXEN4NYOM. I o
OFFICIAL USE ONLY BELOW THIS LINE
UPGPAOE/FAILURESWRCEWPPIIHr P.)
OVOLUNTARY OMAINTENANCEIPUMPING OBUIWINGPENMIT OHOMESALE OCOMPLAINT QOWER:
IN8PECTORS0LLLOGS /� COMMENTSICONDRIONS
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RECORD DRAWNGAND INSTKIAPON REPORT
SCILCODES:
V=VERY G=CUNCUY S•SAND L=1_004.1 8i.SILT C•CIAY E=EKIREWLY ft•ROOTB REQUIRED FOR FINKAPPROVOI
INSPECTORSIGMWRE DATE A➢PUCJnT EXPMTIONDAM APPUWIONAPPROWIN ISSUED W DATE
�Y` 3/7Jb 3/25I ZG `�'''1 L1 SIZ�
THMFORM MAY BESCANNEDAND AVAILABLE FOR PUBLIC WEWON THE MASON COUNWI EBIDT! REVISED NTSOou
Docusign Envelope ID:520B3Dl2-0929 862-89W5DA967IE26DE 32032-41-00000
DESIGN FORM—PAGE ONE Assessor's Parcel Number:_____ -- --
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. 0 Scaled layout sketch, including all applicable items on checklist
"Scaled plot plan,including all applicable items on checklist. Y Cross-section sketch,including all applicable items on checklist.
This form maybe scanned and available for public view on the Mason County Web site.Marimum paper size.: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG OO Imo-- Designer's Name: MICAH HALVERSON
Applicant's Name: PETERSEN,THOMAS E Designer's Phone Number: 360-490E365
Mailing Address: 1001 BE COLE RD Designer's Address: PO BOX 1519
SHELTON WA 985& SHELTON WA 98584
City State Zip
Ci State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Bioliker ❑Sand Filter ❑Mound ❑ Sand Lined Draifield ❑Recirculating Filter,Type:
❑Aerobic Unit MakelModel ❑Disinfection Unit Make/Model Other. SEPTIC TANK
Drainfield Type
❑Gravity ii(Pressute gTrench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 40
Daily Flow:Operating Capacity 360 gpd Length 50 ft
Daily Flow:Design Flow 480 gpd Diameter 1 1/4 in
Septic Tank Capacity(working) 1200 gal Number 4
Receiving Soil Type(1-6) 3 Separation 9'ON-CENTER ft
Receiving Soil Appl.Rate .8 gpd/ft? Orifices
Required Primary Area 600 fl2 Total Number of Orifices 40
Designed Primary Area 600 ft, Diameter 3/16 in
Designed Reserve Area 600 fft Spacing 60 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class 40
Elevation Measurements Length PREFERRED ft
Original Drainfield Area Slope 2 % Diameter 2 in
New Slope,If Altered SAME % Preferred manifold configuration used? SKYes ❑No
Depth of Excavation Upalope 13 in Transport Pipe
from Original Grade 13 , -Mope 6-12 in Schedule/Class 40
Designed Vertical Separation 24+ in Length 100 ft
Gravelless Chambers Required? ❑ Yes III No O Optional Diameter 2 in
Pump Required? Ef Yes O No Dosing and Pump Chamber
Pump/Siphon Specifications Numberofdoses/day 8
Diff.in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2+ ft Chamber Capacity(flood) 1500 gal
Uppermost Orifice 2f Higher ❑Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 30.3 gpm fidTimer G(Elapse Meter G(Event Counter
Calculated Total Pressure Head 11.8 ft If Timer: Pura T 3HRS
Comments
APR 0 8 2025
MASON COUNTY ENVIRONMENTAL HEALTH
Docusg9 Envelope lD:520B3Dl2-09294B62-999"DA967IE260E
i,c.vvi� rvnin—rave rwv assessor's Parcel Number: -- --
PermitNumber. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
RJ Test hole locations 19 Drainfield orientation and layout Reference depth from original grade:
67 Soil logs 16 Trench bed dimensions and Rf Septic tank
W1 Property lines critical distances within layout 19 Drainfield cover
6d Existing and proposed wells 59 D-BoxNalve box locations Reference depth from original grade
within 100 ft of property Ed Septic tank/pump chamber and restrictive strata:
Ib Measurements to cuts,banks,and locations 1Z Laterals,nench/bed,top and
surface water and critical areas [Z Observation port location bottom
Id Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Gd Manifold placement ❑ Sand augmentation
components Ed Orifice placement Other cross-section detail:
9J Location and dimension of 56 Lateral placement with distance Ed Observation ports/cleanouts
primary system and reserve area to edge of bed Other Information
E6 Buildings 56 Audible/visual alarm referenced Yes No
lid Direction of slope indicator la Scale of drawing shown on scale Ed ❑ Design staked out
66 Waterlines but ❑ Rf Recorded Notices attached
66 Roads,easements,driveways, O Elevation benchmark and relative ❑ 56 Waiver(s)attached
parking elevations of system components lig ❑Pump curve attached
6d North arrow and scale drawing ❑ Rf Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation Rf Yes ❑ No
�Dmuft W' 4/7/2025
kcaL r RA"YWA
gfr@esigner 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. >'•J✓In I2"P
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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:4/3/2025
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