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HomeMy WebLinkAboutSWG2025-00371 - SWG Application / Design - 9/15/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 J L 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: SWG2025-00371 APPLICANT HALVERSON ET AL MICAH T Phone: 360-490-6365 Address: 6711 W Satsop Cloquallum RD ELMA, WA 98541 OWNER HALVERSON ET AL MICAH T Phone: 360-490-6365 Address: 6711 W Satsop Cloquallum RD ELMA, WA 98541 SEPTIC DESIGNER MICAH HALVERSON** Phone: 406-490-1549 Address: PO BOX 698 ELMA, WA 98541 SEPTIC INSTALLER MICAH HALVERSON** Phone: 406-490-1549 Address: PO BOX 698 ELMA, WA 98541 Site Address: 6711 W SATSOP CLOQUALLUM RD Primary Parcel Number: 619284300020 Permit Description: New 4bd pressure sandlined bed Permit Submitted Date: 09/15/2025 Permit Issued Date: 09/16/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system). Permit Expiration Date: 08/28/2028 (based on date of inspection) Permit Conditions: 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 2 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Drain field installation not to exceed designed upslope and downslope depth specified on design form. 5 Installer is responsible for obtaining Mason County installation approval prior to backfill of system components. 6 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. 7 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/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY DATERECENED: 9/15/2025 D en,7,- •: c to AMOUNT RECEIVED: RECEIVED BY: =..1' Public Health & Human Services $555 ONLINE o m cn Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 C 415 N.6th Street -Shelton,WA 98584 SWG 2025 00371 p .L1 - Z 6ON-SITE SEWAGE SYSTEM APPLICATION D E Po APPLICANT PHONE m m BRITTANY K KING 360-490-8173 z c MAILING ADDRESS-STREET,CITY STATE,ZIP CODE 6711 W SATSOP CLOQUALLUM RD Elma Wa 98541 rn SITE ADDRESS-STREET.CITY,ZIP CODE • Same I C) NAME OF DESIGNER PHONE Micah Halverson 360-490-6365 NAME OF INSTALLER PHONE 0 I CO Olympic ConstructionLLC PERMIT TYPE(select one) DRINKING WATER SOURCE EhN .RESIDENTIAL OSS HCOMMUNITY OSS F COMMERCIAL OSS U.PRIVATE INDIVIDUAL WELL b--PRIVATE TWO-PARTY WELL Z I CO TYPE OF WORK(select one) PUBLIC WATER SYSTEM t M NEW CONSTRUCTION/UPGRADES ffREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I SUBMITTALS c 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE Ih DESIGN FORM(REQUIRED) NI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4nn 0 0257 CO I W i1 WAIVER(S)(IF APPLICABLE) 4 5.62 ❑ YES Ela t NO I 1 DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate) Meet with Rhonda 8/28/25 l o O Io IN 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 I FAILURE SOURCE(for reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS TH1/2: 0-24 GLMS, 24-84 EGOS 84+ bottom of hole SOIL CODES: RECORD DRA\MNG AND INSTALLATION REPORT V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE cA1A0 \,419 8/28/25 8/28/28 c� 'o-Yr\oS - 9/16/25 THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 6 1 9 2 8 — 4 3 — 0 0 0 2 0 A design will be reviewed when 3 copies of each of the following are submitted: '1 Completed design form that has been signed and dated. '1 Scaled layout sketch,including all applicable items on checklist. '1 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: I I"X/7" PARCEL IDENTIFICATION Permit Number: SWG 2025-00371 Designer's Name: Micah Halverson Applicant's Name: BRITTANY K KING Designer's Phone Number: 360-490-6365 Mailing Address: 6711 W SATSOP CLOQUALLUM I Designer's Address: PO Box 1519 Elma Wa 98541 City State Zip Shelton Wa 98584 City State Zip Designer's Email halversondesignlIc@outlookd DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU Li Other Treatment Level(check all that apply): 0 A 0 B 0 C 0 I3LI 0 BL2 El BL3 l E ❑N Drainfield Type ❑Gravity G 'Pressure 0 Trench l 'Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 4 Schedule/Class 40 Daily Flow: Operating Capacity 380 gpd Length 48 ft Daily Flow:Design Flow 480 gpd Diameter 1 1/4 in Septic Tank Capacity(working) 1200 gal Number 4 Receiving Soil Type(1-6) 1 Separation 2.5 ft Receiving Soil Appl.Rate 1.0 gpd/ft2 Orifices Required Primary Area 480 ft2 Total Number of Orifices 84 Designed Primary Area 480 ft2 Diameter 1/8 in Designed Reserve Area 480 ft2 Spacing 27 in Trench/Bed Width 10 ft Manifold Trench/Bed Length 48 ft Schedule/Class 40 Elevation Measurements Length 8 ft Original Drainfield Area Slope Level % Diameter 2 in New Slope,If Altered % Preferred manifold configuration used? 0 Yes 6 'No Depth of Excavation Up-slope 48 in Transport Pipe from Original Grade Down-slope 48 in Schedule/Class 40 Designed Vertical Separation 36 in Length 50 ft Gravel-based Drainfield Required? l 'Yes 0 No Diameter 2 in Pump Required? StfYes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 19 Diff. in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 20 gal Drainfield Squirt Height/Selected Residual(head) 5 ft Chamber Capacity(flood) 1500 gal Uppermost Orifice 0 Higher liLower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 36.5 gpm Eif Timer 0 Elapse Meter ❑vEvent Counter Calculated Total Pressure Head 14 ft If Timer: Pump on TBD ,Pump off 1:15hr Comments EH APPROVED Rhonda Thompson 09/16/2025 Revised:4/14/2025 DESIGN FORM—PAGE TWO Assessor's Parcel Number: 6 1 9 2 8 — 4 3 -- 0 0 0 2 0 Permit Number: SWG 2025-00371 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch id Test hole locations Drainfield orientation and layout Reference depth from original grade: g Soil logs g Trench/bed dimensions and g Septic tank g Property lines critical distances within layout Drainfield cover g Existing and proposed wells D-Box/Valve box locations Reference depth from original grade within 100 ft of property g Septic tank/pump chamber and restrictive strata: g Measurements to cuts, banks,and locations Gd Laterals, trench bed, top and surface water and critical areas Wi Observation port location bottom g Location and orientation of g Clean-out location l I Curtain drain collector curtain drain and all absorption g Manifold placement g Sand augmentation components Gd Orifice placement Other cross-section detail: Location and dimension of Eg Lateral placement with distance g Observation ports/clean-outs primary system and reserve area to edge of bed 6d Buildings Other Information g Audible/visual alarm referenced Yes No Direction of slope indicator E Scale of drawing shown on scale 0 L?J Design staked out Waterlines bar 0 i Recorded Notices attached Bj Roads,easements, driveways, El Elevation benchmark and relative ❑ i 1 Waiver(s)attached parking elevations of system components lI 0 Pump curve attached g North arrow and scale drawing 0 i Evaluation of failure shown on scale bar Non-residential justification ❑ 0 Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation g Yes 0 No yS6.44424.4us,i 9//5/Z5- 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: 9 /Abl►'ve 9/16/25 Environmental 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: 8/28/28 ✓ 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 Tabloid 11"X17" .• . . N 7 CO • • O co • _ CO (D S a Spo— N . 0 W - • v i 1.? quallum Rd • - 3� = o. • - C N • • 7 fl VJ NrG a�Oi . • 0 O N — If ' n d-0 0 N = r V • • 7 • `G W co WC) C51 O N < ry N /\,' cD• m •A P N � *• / N n . A A a ocu • ???RRR111ttt111 • - �. N� HI El- ;It 1/:0 CZ p j/ I �l _o •' N _co.�. _ (D N , _4" N 7 CD `G Q r ro N .• CCI CO jfaq T C. • • 7 D n C o.O Q © fn r--� ■ rp a fD In W © O � W • a Q Q I T i+ ■ 431. w• • 48 A"I '— "' o 110- . .• * � • Q r. 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