HomeMy WebLinkAboutswg2025-00093 - SWG Application / Design - 3/25/2025 ® MASON COUNTY 418NBSHELTON: 60427ON,WA90680
SHELTON:360427A870,EXT 100
aELFAIR:380-2754487,EXT 400
Public Health & Human Services ELMA:380i3 289.EXT 4W
FAX:3811127-7r87
On-Site Sewage System Permit: SWG2025-00093 (OU LKJ
APPLICANT CAPPIELLO GEORGE J&ANN MARIE Phone:
Address: 890 W WYNWOOD DR SHELTON,WA98584
OWNER CAPPIELLO GEORGE J&ANN MARIE Phone:
Address- 890 W WYNWOOD DR SHELTON,WA 98584
SEPTIC DESIGNER MICAH HALVERSON' Phone: 360490-6365
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: 890 W WYNWOOD DR
Primary Parcel Number: 420257500300
Permit Description: Repairlupgrade to 3bd pressure trench
Permit Submitted Date: 03/21/2025
Permit Issued Date: 03/25/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $825.00 ladditl.,ul r.o.m.y bo re Wrxl won lo.I.bwn m.r.Iom7.
Permit Expiration Date: 03/10/2026 (b.e.d.nd.Wdln.p von)
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 Drainfiekl installation not to exceed designed upslope and downs/ope depth specified on
design form.
4 Installeris responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 installer is responsible for obtaining Septic DesignerlEngineer installation approval prior to
ball of system components.
6 Mason County Asbutlt Form, Record Drawing, and Installation fee must be submitted fa
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 USE ONLY
MTF NurvFu
MASON COUNTY 03-2/ - 20Z5 DO N
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CAPPIELLO, GEORGE J 81 ANNV A\RIE 360-943-1420 z
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890WY WOOD DR SHELTON WA 98584 m
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MICAH HALVERSON ti 360-490-6365
NAME OF WSTMIER 4w
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JAMIE WORKMAN O y
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�NEWCONSTRUCTION UPGRADES EREPAIR/REPLACEMENT OTHER DETAILS(MHMMefRpry) []TABLE O REPAIR I'V
SUBMITTALS p O SURFACING SEYAGE EXISTNG FAILURE ❑SHORELINE
DESIGN FORM(REQUIRED) I SEPTC DESIDN(REQUIRED) BEDROOMS LOTSD£ r h
6NAIVER(S)OFAPPUCABLE) 3 11.13AC 0 ^
DIRECTIONSTO SITEMD SITE CONOMONS:(u.kvYn ) I I V
MEET WITH RHONDA 3/1 012 0 2 5
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4/IEMRTIFMBD®FROM MAIN ROAD ANO TESTHOLESMUBTBEFl GGED NTIN TESTHOLENUMB6IS. I IO
OFFICIAL USE ONLY BELOW THIS LINE
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OVOLUNTARY OMAINTENANCEIPWIRING OBUILDINGPERMIT L714011ESALE [3COMPIAINT C30THER:
INSPECTORSOBLOGS COAMFNf3IC01DRN)NB
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V=VERY 3-GRAVELLY S-SIAD L-LOM 51=SILT C=CLAY E-EXTREMELY R=ROOTS I REQUIRED FOR Ffl AF WV
NSPECTDR IRGMTURE MTE APPLIGTIDII EXPMATICNOATE APPUCATIONMPROVEDIISSUED BY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WESSIM REVISED IW=15
DESIGN FORM—PAGE ONE Assessor's Parcel Number:y Z C`Z .$ _ 7 S — C C7 3 O C)
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. I Cross-section sketch,including all applicable items on checklist.
This form=be srararnd and available for 1,111c view on the Mason Coup Web are.Maximum ersLe: /f"X/7"
Permit Number: S W G_ 202S—WOrl3 Designer's Name: MICAH HALVERSON `
Applicant's Name: CAPPIELLO,GEORGE a ANN Designer's Phone Number: 360490-6365
Mailing Address: 690 W W VNWOOD DR Designer's Address: PO 60x 1519
SHELTON WA SSW SHELTON WA 98584
Ci Sta[e Zi Ci State Zip
Z' M . NhEgfii
Treatment Device
❑Glendon iliofilter O Smd Filter ❑Mound ❑ Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other SEPTIC TANK
Drainfleld Type
O Gravity 19Pressure LsrTrench ❑Bed ❑ Sub Surface Drip
Septic Tank(Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 40
Daily Flow: Operating Capacity 270 gpd Length 72 ft
Daily Flow:Design Flow 360 gpd Diameter 1 12 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 5'+ON-CENTER g
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 600 ft' Total Number of Orifices 54
Designed Primary Area 611 ft' Diameter 3/16 in
Designed Reserve Area Goo W Spacing 46 in
TrmchBed Width 3 ft Manifold
Trench/Bed.Length 216 ft Sebedule/Class 40
Elevation Measurements Length PREFERRED ft
Original Drainfield Arm Slope 7 % Diameter 2 in
New Slope,IF Altered SAME / Preferred manifold config
uration used? ffYw ❑No
Depth of Excavation Up-slope 10 in
Transport Pipe
from Original Grade n�-slope 7.5
in Schedule/Class 40
Designed Vertical Separation 24+ in Length 25 ft
Gravelless Chambers Required? ❑Yes O No If Optional Diameter 2
in
Pump Required? !ryes O No Dosing and Pump Chamber
Pump/Siphon Specifleations Number ofdosesiday 6
Diff.in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2_+ ft Chamber Capacity(flood) 1200 gal
Uppermost Orifice O Higher PrLower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 41.2 Spot NrTim elapse Meter 6f Eveat Counter
Calculated Total Pressure Head 12.5 R I If Timer: Pump on 4HRS
Comments
MAR 2 5 2025
MASON COUNTY ENVIRONMENTAL HEALTH
DESIGN FORM—PAGE TWO Assessor's Parcel Number:c/ Z C Z S — 7 5 — C30 3 0 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
9 Test hole locations ® Drainfield orientation and layout Reference depth from original grade:
16 Soil logs IY Trench bed dimensions and FI Septic tank
F1 Property lines critical distances within layout B Drainfield cover
0 Existingand proposed wells 19 D-BoxNalve box locations
P oP Reference depth from original grade
within 100 R of property 19 Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,and locations Id Laterals,trenchlbed,top and
surface water and critical areas H Observation port location bottom
H Location and orientation of Id Clean out location ❑ Curtain drain collector
curtain drain and all absorption pJ Manifold placement ❑ Sand augmentation
components Id Orifice placement Other cross-section detail:
H Location and dimension of pf Lateral placement with distance If Observation ports/clean-outs
primary system and reserve area to edge of bed
B Buildings Other Information
15 Audible/visual alarm referenced Yes No
B Direction of slope indicator 11 Scale of drawing shown on scale of ❑Design staked out
16 Waterlines bar ❑ N(Recorded Notices attached
19 Roads,easements,driveways, ❑ Ef Waiver(s)attached
parking 9 ❑Pump curve attached
19 North arrow and scale drawing Off ❑ Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer most be tified by installer at time of installation el Yes ❑ No
7Q . 3/z/A" 's
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:
RkNmw
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. 2/B '�
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: J
✓ 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
1 3 8 DROOM QN-SITF WAST WAT R DESIGN
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Th'=is net a c r a Site featured,topography,elevations,and footages are based on data provided by the property
sor_a- .i.e_*Ho rwsewesT csT,ausHeoeroTHcc owTer and from Mason County public records.This Site Plan and the Septic Design are intended for review by the
Mason County Heats Department and the contractor hired to install Me septic system.Micslhii- r__ah_a=the.ro'm
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