HomeMy WebLinkAboutSWG2025-00224 - SWG Application / Design - 6/12/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
J BELFAIR:360-275-4467,EXT 400
' ` Public Health & Human Services ELMA:360-482 5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00224
APPLICANT Hunter, Adam Phone: 360 753-1226
Address: 2201 93rd Ave SW Olympia,WA 98512
OWNER MICHAEL GLASER Phone: 360-789-5960
Address: 1450 E BALLOW RD SHELTON, WA 98584
SEPTIC DESIGNER ADAM HUNTER* Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
SEPTIC INSTALLER DARIN OGG* Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT, WA 98548
Site Address: 1450 E Ballow Rd
Primary Parcel Number: 220121290114
Permit Description: Repair: SFR 3-bedroom gravity system
Permit Submitted Date: 06/12/2025
Permit Issued Date: 06/23/2025
Issued By: David Anderson
Current Permit Fees Paid: $825.00 (additional fees may be required upon Installation of system).
Permit Expiration Date: 06/20/2028 (based on dale of inspection)
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
backlit!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: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
F
OFFICIAL USE ONLY -
0 ,,, MASON COUNTY DATE RECEIVED: (Vl i &I cn c
D
-- Public Health & Human Services 4
AMOUNT RECEIVED: RECENEDBY:
Environmental Health 360-427.9670,ext.400 or 360-275-4467,ext.400 � r C 0)
415 N.6th Street-Shelton,WA 98584 SWG /V(� V,— — Pawl 5O
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION z SI
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APPLICANT PHONE IT1
MIKE GLASER 3607895960 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
1450 E BALLOW RD SHELTON WA 98584 m
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SITE ADDRESS-STREET,CITY,ZIP CODE '•
1450 E BALLOW RD SHELTON WA 98584 I N
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NAME OF DESIGNER PHONE
ADAM HUNTER 3607531226 N)
NAI.IE OF INSTALLER PHONE v I IU
ROYAL FLUSH I
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PERMIT TYPE(select one) DRINKING WATER SOURCE
117 RESIDENTIAL OSS COMMUNITY OSS lu COMMERCIAL OSS IM PRIVATE INDIVIDUAL WELL 6-PRIVATE TWO-PARTY WELL Z ( 'P
TYPE OF WORK(solar)ono) PUBLIC WATER SYSTEM
I
6 NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I
SUBMITTALS CISURFACING SEWAGE a EXISTING FAILURE CISHORELINE CO
C
LN DESIGN FORM(REQUIRED) INJ SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/20257 r
ffWAIVER(S)(IF APPLICABLE) 3 3.44 • YES NO O r
DIRECTIONS TO SITE AND SITE CONDITIONS:(or.locked gale)
E HARSTINE ISLAND RD N TO A RIGHT ON BALLOW TO SITE AT THE END. ( I
CALL OWNER FOR ACCESS! r I
I
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED W TH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE -------
UPGRADE/FAILURE SOURCE(tor repor7ng purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
1141: U— '1 f'I'l(
N_6r' Pu,05 (Tr/e/3) to 6c'Nor-
1(1t.U- (("1, rit
y-as n } / bd/ori)
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSP )TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLIC N APPROVEOI ISSUED BY DATE
/,'' 6/.?(//7g7 c-- ‘( 000 7 7
67?? /?c-2 14-
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
i
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 220121290114 -- --
A design will be reviewed when 3 conies 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.
v Scaled plot plan,including all applicable items on checklist. 'l Cross-section sketch, including all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Harimum paper size: 11"A'17"
PARCEL IDENTIFICATION
Permit Number: SWG 101 S - 00 ? ? Li Designer's Name: ADAM HUNTER
Applicant's Name: MIKE GLASER Designer's Phone Number: 3607531226
Mailing Address: 1450 E BALLOW RD Designer's Address: PO BOX 162
SHELTON WA 98584 City State Zip OLYMPIA WA 98507
City State Zip Designer's Email JHANDASSOCIATES@HOTMAIL.COM
DESIGN PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter Cl ATU U Other
Treatment Level(check all that apply): J A I B _I C I BLI J BL2 J BL3 Nn E J N
Drainfield Type
'Gravity 0 Pressure 0 Trench 0 Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 40
Daily Flow:Operating Capacity 270 gpd Length 40 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 4
Receiving Soil Type(1-6) 3 Separation 6 ft
Receiving Soil Appl. Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices GRAVITY
Designed Primary Area 480 ft2 Diameter GRAVITY in
Designed Reserve Arca 450 ft2 Spacing GRAVITY in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 160 ft Schedule/Class 40
Length 20 ft
Elevation Measurements Len g
Original Drainfield Area Slope 0 % Diameter 4 in
New Slope, If Altered 0 % Preferred manifold configuration used? ElYes 0 No
Depth of Excavation up-slope 30 in Transport Pipe Ilifrom Original Grade Dcmn-slope 30 in Schedule/Class 13-. jolty
Designed Vertical Separation 36 in Length 40 ft
Gravel-based Drainfield Required? 0 Yes 0 No ✓ Diameter 4 in
Pump Required? 0 Yes E2'No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day GRAVITY
Diff. in Elevation Between Pump&Uppermost Orifice N/A ft Dose quantity GRAVITY gal
Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) GRAVITY gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head N/A gpm 0 Timer 0 Elapse Meter 0 Event Counter
Calculated Total Pressure Head N/A ft If Timer: Pump on GRAVITY ,Pump off GRAVITY
Comments
Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 220121290114 -- --
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
P1 Test hole locations ®' Drainfield orientation and layout Reference depth from original grade:
O Soil logs Ed Trench/bed dimensions and Ef Septic tank
O Property lines critical distances within layout ES Drainfield cover
0 Existing and proposed wells ' D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
O Measurements to cuts,banks,and locations ®' Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
O Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption Ed Manifold placement ®" Sand augmentation
components ®' Orifice placement Other cross-section detail:
• Location and dimension of 0 Lateral placement with distance El Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
O Buildings 1l Audible/visual alarm referenced Yes No
• Direction of slope indicator Ed Scale of drawing shown on scale d 0 Design staked out
O Waterlines bar 0 0 Recorded Notices attached
O Roads,easements,driveways, E Elevation benchmark and relative 0 0 Waiver(s)attached
parking elevations of system components ' 0 Pump curve attached
121 North arrow and scale drawing 0 ❑ Evaluation of failure
shown on scale bar Non-residential justification
0 0 Waste strength
0 0 Flow
DESIGN APPROVAL
The undersigned designer must b- m otifi l •n\ler at time of installation Ni Yes 0 No
6/12/25
•ignat tii- Designer Date
undersigned has reviewed this desi i on behalf of Mason CountyPublic Health and determm 5i �'�j
The b ��` �1 H
compliance with state and local on-site re ions: / /(f ,(� i
6( ?3(mi o oUh N432025
Envii nmental Health Specialist Date rye/vV/RO
DJ h�;E�yrA(fitAtrJ!
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: V za(zo Zy
V 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. Revised:4/14/2025
PAGE 1
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL#:220121290114
DATE SUBMITTED: 6/12/2025 LEGAL/LOT#: LOT 4
SP#3028
SUBMITTED BY: ADAM HUNTER
APPLICANT: MIKE GLASER
ADDRESS: 1450 E BALLOW RD
SHELTON,WA 98584
I.CALCULATIONS
NUMBER OF BEDROOMS= 3
RESIDENTIAL GPD FLOW= 360
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= 0.8 GPD/FT2
REDUCTION=LEAVE ELANK IF NO REDUCTION TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 480 FT2
TRENCH LENGTH OR BED CONFIG.= 160FT
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE= 1500-GAL.CONCRETE
NEW OR EXISTING= NEW
III.DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM= 2'-6"
ROCK DEPTH BELOW PIPE= 0'-6"
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIAL/SEASONAL SATURATION= >3'-0"
FILL DEPTH= 1'-0"
TRENCH WIDTH= 3'-0"
6/12/25 41
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