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HomeMy WebLinkAboutSWG2025-00224 ON-SITE SEWAGE - SWG Application / Design - 6/12/2025 s er;it , 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: SWG2025-00224 APPLICANT Hunter, Adam Phone: 360 753-1226 Address: 2201 93rd Ave SW Olympia, WA 98512 —j' 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 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 Drain field 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/environmentallonsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY A . MASON COUNTY DATERECENED: v Jl & fV C AMOUNT RECEIVED: RECEIVED BY: CO (n � Public Health & Human Services ©►'1\1 3 Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.460 �/r`�'�� C i r 415 N.6th Street-Shelton,WA 98584 S W G ��/ — 00 7 7 1 6 0 Z N CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION n m C) m APPLICANT PHONE m r MIKE GLASER 3607895960 z MAILING ADDRESS-STREET CITY,STATE,ZIP CODE g 1450 E BALLOW RD SHELTON WA 98584 ED 51450ITE EE BALLOW-STREET,CITY,ZIP cODE RD SHELTON WA 98584 I N O NAME OF DESIGNER PHONE I ADAM HUNTER 3607531226 N PHONE �I N NAME OF INSTALLER ❑ � ROYAL FLUSH I Q PERMIT TYPE(select one) DRINKING WATER SOURCE — RM C IN 6 RESIDENTIAL OSS L I COMMUNITY OSS ID COMMERCIAL OSS 117 PRIVATE INDIVIDUAL WELL 6-PRIVATE TWO-PARTY WELL Z I TYPE OF WORK(select one) U PUBLIC WATER SYSTEM ❑f NEW CONSTRUCTION I UPGRADES ff REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I SUBMITTALS CI SURFACING SEWAGE ES EXISTING FAILURE 0 SHORELINE a C I L�7 DESIGN FORM(REQUIRED) I 1 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/12 r0 025? c Ly WAIVER(S)(IF APPLICABLE) 3 3.44 • YES El NO n DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) E HARSTINE ISLAND RD N TO A RIGHT ON BALLOW TO SITE AT THE END. I CALL OWNER FOR ACCESS! o I I 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(tor reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE ['COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS ' / tt F' (I q-6g" p A5 (T7/[ 3) fo boNoill . In.' C'... { 1 r<<( y- 6$ Ipili - 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 APPROVED/ISSUED BY DATE 6 -2v 7a7 S- 6-( 0 I to 7 6/is)00-2 f- THIS FORM 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: 220121290114 -- -- 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 may be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"X 17" PARCEL IDENTIFICATION Permit Number: SWG ZGZ S- 00 ? Z L( 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 0 ATU LJ Other Treatment Level(check all that apply): J A J B .J C J BLI J BL2 J BL3 ✓J E J N Drainfield Type 'Gravity 0 Pressure 0 Trench 0 Bed 0 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 Area 450 ft2 Spacing GRAVITY in Trench/Bed Width 3 ft Manifold Trench/Bed Length 160 ft Schedule/Class 40 Elevation Measurements Length 20 ft Original Drainfield Area Slope 0 % Diameter - 4 in New Slope,If Altered 0 % Preferred manifold configuration used? 'Yes 0 No Depth of Excavation Up-slope 30 in Transport Pipe from Original Grade Do -slope 30 '46. 303� in Schedule/Class Designed Vertical Separation 36 in Length 40 ft Gravel-based Drainfield Required? 0 Yes 0 No V Diameter 4 in Pump Required? 0 Yes EiNo Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day GRAVITY Dill 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 g Test hole locations 6a' Drainfield orientation and layout Reference depth from original grade: g Soil logs tgi Trench/bed dimensions and M' Septic tank 62f Property lines critical distances within layout ®' Drainfield cover 62i Existing and proposed wells ' D-Box/Valve box locations Reference depth from original grade within 100 ft of property ' Septic tank/pump chamber and restrictive strata: Lif Measurements to cuts,banks,and locations ®' Laterals,trench/bed,top and surface water and critical areas g Observation port location bottom 6I Location and orientation of 6' Clean-out location 0 Curtain drain collector curtain drain and all absorption Iif Manifold placement 6' Sand augmentation components 6' Orifice placement Other cross-section detail: g Location and dimension of f ' Lateral placement with distance 11 Observation ports/clean-outs primary system and reserve area to edge of bed g Other Information 6' Buildings El Audible/visual alarm referenced Yes No g Direction of slope indicator 0' Scale of drawing shown on scale 51 0 Design staked out O Waterlines bar 0 0 Recorded Notices attached O Roads,easements,driveways, Q Elevation benchmark and relative 0 0 Waiver(s)attached parking elevations of system components l' 0 Pump curve attached O 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 tlotifi-d b 'n\ler at time of installation Ef Yes 0 No 1 6/12/25 ignat i • Designer Date A pp The undersigned has reviewed this desi„ on behalf of Mason County Public Health and determma®e i� compliance with state and local on-site re ions: JU �® ?l� c V N N 2 3 2025 Envi nmental Health Specialist Date ry,NV/RO DJA NMFNrAC HEAL rH 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: 67Z0(2'Cl zg ✓ 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 PACE 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 BLANK 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'-Or' TRENCH WIDTH = 3'-0" / MASCNC,�N NZ 3 2O?5 6 12/25 ryFNVIRCNMF `�` uJA mit HEAL ty • ADMA J.HUNTER T53•T�-lXSZ1�11?.�' • 0.0000. 00000000 // T-----_— 73 x A X x X X x y 0 x X x ( — T.U£Z \ 2 O O = O z z Z zD m Z Z 0cn cn -I mO O O O O m 0 O • m m O 0 n . 0 0 D = w m • mm -1m x -0 JrY o WmZ A -0m � IrOo rm 0 =� 4 n m _ O p 70 ii p c_ ,..,.!:1, , , _ m w • z O D O K "r-.E •y G v > D x m-1 z m ✓•'n o Cil 41 m w At- - m cn O Alr• 1 M o m ' -1 rn r 00 0 2 x _, 0 r O Ncn A Ul o y ibiz A �. 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