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HomeMy WebLinkAboutSWG2025-00263 - SWG Application / Design - 7/2/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON: S 42 TON, ,EXT 400 584 rMit . 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: SWG2025-00263 00UK)) APPLICANT THOMPSON LAURIE A &WILLIAM E Phone: 360.229.0837 Address: 1400 W HURLEY WALDRIP RD SHELTON, WA 98584 OWNER THOMPSON LAURIE A &WILLIAM E Phone: 360.229.0837 Address: 1400 W HURLEY WALDRIP RD SHELTON, WA 98584 SEPTIC DESIGNER FRANKLIN CLARK* Phone: 360-830-4765 Address: PO BOX 1954 SILVERDALE, WA 98383 Site Address: 1400 W HURLEY WALDRIP RD Primary Parcel Number: 319302390030 Permit Description: Replacement/upgrade 3bd pump to gravity Permit Submitted Date: 07/02/2025 Permit Issued Date: 07/16/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/02/2028 (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/environmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: 01 . 02 -20 Z6 A C D AMOUNT RECFNED sT:(PAD BY C Cn Cn ... Public Health & Human Services 555 o Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 rn'!(�r^ 0 415 N.6th Street-Shelton,WA 98584 S W G 2oZ 5 �/`�' /35 :L] z c, ON-SITE SEWAGE SYSTEM APPLICATION D AJ 3 m C) APPLICANT PHONE m 1— Franklin J Clark rc ;1 360.830.4765 Z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE r1 11 �1 g 1400 W Hurley Waldrip Rd,Shelton,WA 98584-8635 I��'' N m SITE ADDRESS-STREET.CITY,ZIP CODE 4 1400 W Hurley Waldrip Rd,Shelton,WA 98584-8635 = t IILON NAME OF DESIGNER ____I t j i PHONE • Q J-li+. Franklin J Clark -5 v 360.830.4765 /� NAME OF INSTALLER PHONE v I\� J m 360.830.4765 �/ Franklin J Clark PERMIT TYPE(select one) DRINKING WATER SOURCE Iuj RESIDENTIAL OSS ❑ COMMUNITY OSS 0 COMMERCIAL OSS PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z IO TYPE OF WORK(select one) ❑ PUBLIC WATER SYSTEM i ❑ NEW CONSTRUCTION PGRADES REPAI LACEMENT THER DETAILS(select all that apply) 0 TABLE X REPAIR IN SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W I� MI DESIGN FORM(REQUIRED) •SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER4/1/2025% I"" � I ❑ WAIVER(S)(IF APPLICABLE) 3 1.41 Acres ❑YES •NO 0 x I, DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate) Mason County Community Services-415 N 6th St,Shelton,WA 98584>Head south on N 6th St toward W Pine St>Turn right at the 1st cross street onto W Pine St 10 IO r Turn left at the 1st cross street onto N 7th St>Turn right onto W Railroad Ave>Turn left to merge onto US-101 S toward Olympia o iW Turn right onto W Hurley Waldrip Rd>Destination will be on the right:1400 W Hurley Waldrip Rd,Shelton,WA 98584 O SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS W>e-CA D ot0e_ A 3 col \ CG`��S size RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: V=VERY G=GRAVELLY S=SAND L=LOAM St=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 711.cl z42:6 . 7 Ji 6)i 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: 3193 0 -- 23 -- 90030 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 2076 - 0024,3 Designer's Name: Franklin J Clark Applicant's Name: Thomspon,Laurie&William Designer's Phone Number: 360.830.4765 Mailing Address: 1400 W Hurley Waldrip Rd Designer's Address: P.O. Box 1954 Shelton,WA98584-8635 City State Zip Silverdale,WA 98383 City State Zip Designer's Email aplusonsite@live.com DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Other Treatment Level (check all thatapply): ❑A ❑B ❑C ❑BLl ❑BL2 ❑BL3 ■E ❑N Drainfield Type ❑Gravity 0 Pressure 0 Trench ❑Bed ❑Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 3034 Daily Flow:Operating Capacity 0 IAD gpd Length 50 ft Daily Flow: Design Flow 360 gpd Diameter 4 in Septic Tank Capacity(working) 1,200 gal Number 4 Receiving Soil Type(1-6) 4 Separation 5'On Center ft Receiving Soil Appl.Rate Pri:.6/Res:.6 gpd/ft2 Orifices - N/A Required Primary Area 600 ft2 Total Number of Orifices Designed Primary Area 600 ft2 Diameter in Designed ReserveArea 600 ft2 Spacing in Trench/Bed Width 3 ft Manifold-N/A Trench/Bed Length .5t 2 00 ft Schedule/Class Elevation Measurements Length ft Original Drainfield Area Slope 1 -2 % Diameter in New Slope,If Altered N/A % Preferred manifold configuration used? ElYes I No Depth of Excavation Up-slope in Transport Pipe from Original Grade Down-slope to in Schedule/Class 3034 Designed Vertical Separation 36 in Length 50 ft Gravel-based Drainfield Required? 0 Yes ■ No Diameter 4 in Pump Required? )<Yes ■No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day -Bertrand' S 0 Diff. in Elevation Between Pump&Uppermost Orifice 10 ft Dose quantity 30 gal Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) 1200 gal Uppermost Orifice\Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 20 Pm "4 Timer J2(Elapse Meter All Event Counter Calculated Total Pressure Head 1 Timer: Pump on l:s-ri i► i ,Pump off 3 hrS Comments A P P R dV E� JUL 16 2025 MASON COUNTY ENVIRONMENTAL HEALTH RET Revised:4/14/2025 DESIGN FORM —PAGE TWO Assessor's Parcel Number: 3193 Q -- 23 -- 4QO O Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch I Test hole locations ■ Drainfield orientation and layout Reference depth from original grade: ■ Soil logs ■ Trench/bed dimensions and ■ Septic tank I Property lines critical distances within layout ■ Drainfield cover ■ 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: O Measurements to cuts,banks,and locations I Laterals,trench/bed,top and -N/A surface water and critical areas ■ Observation port location bottom 0 Location and orientation of ■ Clean-out location -N/A® Curtain drain collector -N/A curtain drain and all absorption ®A Manifold placement -N/A® Sand augmentation components N Orifice placement Other cross-section detail: ■ Location and dimension of -N/A ■ Observation ports/clean-outs primary system and reserve area _®A Lateral placement with distance to edge of bed Other Information I Buildings Audible/visual alarm referenced Yes No I Direction of slope indicator jA Scale of drawing shown on scale N ■ Design staked out ■ Waterlines bar 0 ■ Recorded Notices attached ■ Roads,easements,driveways, ■ Elevation benchmark and relative ® ■ Waiver(s)attached parking elevations of system components ■ ® Pump curve attached ■ North arrow and scale drawing N ■ Evaluation of failure shown on scale bar Non-residential justification ® I Waste strength ® ■ Flow DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation ■ Yes 0 No 9 _ 111). 06/28/2025 Signature of Desi_!"D 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: iecwom9931 ifs 6�Z� Environmental Health Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CCONNDITION: N The design is stamped"Approved" by Mason County Public Health. 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. 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