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HomeMy WebLinkAboutSWG2025-00210 - SWG Application / Design - 6/3/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 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: SWG2025-00210 APPLICANT ANDERSON DOUGLAS J &JESSICA M Phone: Address: 50 W SIMPSON RD SHELTON, WA 98584 OWNER ANDERSON DOUGLAS J &JESSICA M Phone: Address: 50 W SIMPSON RD 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: 50 W Simpson Rd Primary Parcel Number: 520013490081 Permit Description: Replacement 3BR nuwater+ pressure bed Permit Submitted Date: 06/03/2025 Permit Issued Date: 06/17/2025 Issued By: Jeff Wilmoth Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/12/2028 (based on date 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 backfill 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. PI.r. -„ . 1:111,,J OFFICIAL USE ONLY DATE RECEIVED: MASON COUNTY a° - 03 - 2025 Cn Cl) AMOUNT RECEIVED: RECEIVED Public Health 8/ Human Services 565ciebe v cn Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 C 0 415 N.6th Street -Shelton,WA 98584 S W -G Z5 - 60 21 b z x) 13 ON-SITE SEWAGE SYSTEM APPLICATION 3 rn C) APPLICANT PHONE rTI ANDERSON, DOUGLA 360-918-6742 U1 z u ,e MAILING ADDRESS-STREET,CITY,STATE,ZIP g= 7:;--) 3 50 W SIMPSON RD uvu Shelton Wa 98584 M s N SITE ADDRESS-STREET.CITY,ZIP CODE CD CV '' Same as Mailing © _I CP NAME OF DESIGNER Piji O PHONE I l v n Micah Halverson � 360-490-6365 NAME OF INSTALLER PHONE v I O Jamie WorkmanC:Z R PERMIT TYPE(select one) DRINKING WATER SOURCE 0 ill RESIDENTIAL OSS h COMMUNITY OSS in COMMERCIAL OSS Ik- PRIVATE INDIVIDUAL WELL b PRIVATE TWO-PARTY WELL Z I— TYPE OF WORK(select one) r PUBLIC WATER SYSTEM i NEW CONSTRUCTION/UPGRADES rl REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I W SUBMITTALS 0 SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE CO DESIGN FORM(REQUIRED) 01 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? O I n WAIVER(S)(IF APPLICABLE) 3 1.23ac 0 YES ❑r NO 0 I DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) "' From W Shelton Matlock Rd @ Mill 5 turn onto W Hanks Lake Rd. Turn right on W Martin I O Rd travel east to W Simpson Rd. Site will be on the right test holes are marked with pink ribbon. o I(i r > I0Q. SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS - "E6 SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. ECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE AP TION APPROVED/ISSUED BY DATE (,N\ Q G z-25 6 — 7- a ,r (4)1LfrV. I6—(7'tv1:1 T I MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 520013490081 -- -- 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. '0 Scaled plot plan,including all applicable items on checklist. 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.Maximumpaper size: 11 X 17 Y ��>' `FrAj :e..Z���`%" �°� �'�.,,`s����5�:, �.`.�.��a. rr w � zk i...Ft�cS�'�5:��_` Rr,.: r.W .. Permit Number: SWG 2025.OoZ to Designer's Name: Micah Halverson Applicant's Name: ANDERSON, DOUGLAS J Designer's Phone Number: 360-490-6365 Mailing Address: 50 W SIMPSON RD Designer's Address: PO Box 1519 Shelton Wa 98584 City State Zip Shelton Wa 98584 Cit' State Zip Designer's Email Iver ondeslgn c@o r �. h u oo c Treatment Device CIGlendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter El ATU BNR-500 0 Other Treatment Level(check all that apply): 0 A 0 B 0 C 0 BL1 Cl BL2 0 BL3 fl E 0 N Drainfield Type ❑ Gravity Pressure 0 Trench SBed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 40 Daily Flow: Operating Capacity 270 gpd Length 36 ft Daily Flow: Design Flow 360 gpd Diameter 1 1/4 in Septic Tank Capacity(working) 500+ Nuwater gal Number 4 Receiving Soil Type(1-6) 1 Separation 2.5 ft Receiving Soil Appl.Rate 1.2 gpd/ft2 Orifices Required Primary Area 300 ft2 Total Number of Orifices 60 Designed Primary Area 360 ft2 Diameter 3/16 in Designed Reserve Area 360 ft2 Spacing 28"On-Center in Trench/Bed Width 10 ft Manifold Trench/Bed Length 36 ft Schedule/Class 40 Elevation Measurements Length 8 ft Original Drainfield Area Slope <1% % Diameter 2 in New Slope,If Altered same % Preferred manifold configuration used? 0 Yes 'No Depth of Excavation Up-slope 36 in Transport Pipe from Original Grade Down.slope 36 in Schedule/Class 40 Designed Vertical Separation 36 in Length 200 ft 1 Gravel-based Drainfield Required? eYes 0 No Diameter 2 in Pump Required? Ef Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 6 Diff.in Elevation Between Pump&Uppermost Orifice 10 ft Dose quantity 45 gal Drainfield Squirt Height/Selected Residual(head) 2+ ft Chamber Capacity(flood) 1223 gal Uppermost Orifice Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 49.87 gp P i r f t se Meter 111 Event Counter Calculated Total Pressure Head 20.13 ft f tm p n ,Pump off Comments JUN 1 7 2025 MASON COUNTY ENVIRONMENTAL HH,;_ i-i JBW Revised:4/14/2025 vommummomminimimaik DESIGN FORM—PAGE TWO Assessor's Parcel Number: 520013490081 -- -- Permit Number: SWG , DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch O Test hole locations li3 Drainfield orientation and layout Reference depth from original grade: I f Soil logs 0 Trench/bed dimensions and L( Septic tank O Property lines critical distances within layout 0 Drainfield cover O Existing and proposed wells 0 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 0 Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: O Location and dimension of 0 Lateral placement with distance 0 Observation ports/clean-outs primary system and reserve area to edge of bed 0 Buildings Other Information !g Audible/visual alarm referenced Yes No O Direction of slope indicator I3 Scale of drawingshown on scale Er 0 Design staked out O Waterlines bar 0 0 Recorded Notices attached O Roads, easements,driveways, El Elevation benchmark and relative 0 0 Waiver(s)attached parking elevations of system components Er 0 Pump curve attached 0 North arrow and scale drawing 0 0 Evaluation of failure shown on scale bar Non-residential justification ❑ ❑ Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be tified by installer at time of installation Lot Yes 0 No ....)27 ---- Cfi(?e?,s Signature of Designer Date The undersigned has reviewed . design on behalf of Mason County Public Health and determined it to be in compliance with state and loc. • site regular' ns: (4) 6,4-2 --2s E vi ��ental Health Specialist 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: G - I.Z._'2$ ✓ 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 Mas o . -alth. JUN 1 7 2025 s An Installation Fee is required. .' aNcThis form may be scanned and available for public view on the Mason ColitT lswakNovgAt-6414/2025 JBW • Ko \ / . m o o / cct I CD�� \ c, r `,, \ I \\• m % , cn . . v DJ \ \ 6, •p� • \ ' u 1 IV ‘‘‘‘' .0) - 3Ico 1rD,\ •_ : . C D i,, Fg I. 1;f ill tlY,t .. - N y co #. 73..Leoor..." O y . ' O as .• \ , O N c • \ 41, • 6; s O re � r' \ Ili • 5. m a p W j _p \ N a o • -s o m 4eitte 0 _____ -,.. . .,.., N t0'Q • m \ N. A s. - • m d re F O \ \ _ o / O m snippy IIaM A� , va`- •• x• _j — f rs . / , Boa / =\ \ T /y --Ve \ / \\, \ m / \\l'''('Z'./.1, ti-,z_ \\ \ (2...,X'•--... ..cul,- • CO I6',.. # V."' cro p I w I-. 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