HomeMy WebLinkAboutSWG2025-00446 - SWG Application / Design - 12/1/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, EXT 400
at
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: SWG2025-00446
APPLICANT Micah Halverson Phone: 360-490-6365
Address: PO Box 1519 SHELTON, WA 98584
OWNER SMITH, HENRIK JAY & ERIN MIRANDA Phone: 408-649-1691
Address: 2546 37TH AVE W SEATTLE, WA 98199
SEPTIC DESIGNER MICAH HALVERSON -Olympic Phone: 406-490-1549
Construction
Address: PO BOX 698 ELMA, WA 98541
Site Address: UNKNOWN
Primary Parcel Number: 321051490040
Permit Description: New 4bd Glendon M-31
Permit Submitted Date: 11/13/2025
Permit Issued Date: 12/04/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $555.00 (additional fees may be requived upon installation of system).
Permit Expiration Date: 12/01/2028 (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 Drainfield 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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
. OFFICIAL USE ONLY
DATE �
OW, MASON COUNTY I 1 � I� 20D� c U)
AMOUNT REC D. , , — RECEIVED BY: 03 �
,f- Public Health & Human Services �j��j ovv�iNE `,o
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 < N
415 N.6th Street- Shelton,WA 98584 S W G . o ,5 - 0 4 y c o 2
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ON-SITE SEWAGE SYSTEM APPLICATION
D x
m n
PHONE
APPLICANT m
1-
SMITH, HENRIK 408-649-1691 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE \\ g
2546 37th Ave w \\\ Seattle, Wa 98592 co
SITE ADDRESS-STREET,CITY,ZIP CODE
cry _ N
co
Undeveloped Land /L10 , `�'
NAME OF DESIGNER 2�,�I PHONE I N
Micah Halverson v . , 360-490-6365
NAME OF INSTALLER PHONE v
Unknown <_
DRINKING WATER SOURCE N I []
PERMIT TYPE(select one) O
J( RESIDENTIAL OSS Fi COMMUNITY OSS Inc. „ RCIAL OSS I PRIVATE INDIVIDUAL WELL 6 PRIVATE TWO-PARTY WELL Z I Cr
TYPE OF WORK(select one) Q PUBLIC WATER SYSTEM
W.NEW CONSTRUCTION/UPGRADES 5-REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I
SUBMITTALS El SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W
DESIGN FORM(REQUIRED) Vif SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER4/1/2025? O
h WAIVER(S)(IF APPLICABLE) 4 2.31 Ac 0 YES ❑✓ NO n I
X I (CI
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
From Shelton travel toward Union on Mcreavy rd, turn right on Manzanita Dr, turn left on I c)
E Alderbrook ridge rd. Driveway is on right behind blue locked gate. o I o
p
I
.
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I 0
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT CI HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
\` (\j,--- 22 clsc-, z- c e 1
rt t'2-`t (iS�fZitt tit <
tki2,-, 0 - 7,-) 65L.72.-/ +-fi-k,
RECORD DRAWING ANC INSTALLATION REPORT
SOIL CODES:
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
11 -).1.0.‘kp`^A 1I i i (z 11 1 2 tQY''1 \ukA Vc
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: 3 2 1 0 5 — 1 4 — 9 0 0 4 0
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: II"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 01b a5- mi-V-1(f Designer's Name: Micah Halverson
Applicant's Name: SMITH, HENRIK Designer's Phone Number: 360-490-6365
Mailing Address: 2546 37th Ave w Designer's Address: PO Box 1519
Seattle Wa 98592 City State Zip Shelton wa 98584
City State Zip Designer's Email halversondesignlic@outlooks
DESIGN PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU Ll Other
Treatment Level(check all that apply): CI A 0 B ❑ C 0 BL 1 0 BL2 0 BL3 El E ❑N
Drainfield Type
❑ Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class Glendon
Daily Flow: Operating Capacity 480 gpd Length " ft
Daily Flow: Design Flow 360 gpd Diameter " in
Septic Tank Capacity(working) 1500 gal Number
Receiving Soil Type(1-6) 4 Separation ft
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 800 ft2 Total Number of Orifices "
Designed Primary Area 800 ft2 Diameter in
Designed Reserve Area 1027 ft2 Spacing in
Trench/Bed Width glendon ft Manifold
Trench/Bed Length ft Schedule/Class "
Elevation Measurements Length II ft
Original Drainfield Area Slope 7 % Diameter " in
New Slope,If Altered same % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope glendon in Transport Pipe
from Original Grade Down-slope in Schedule/Class 40
Designed Vertical Separation 22 in Length 20 ft
Gravel-based Drainfield Required? 0 Yes 0 No Diameter 1 in
Pump Required? le Yes 0 No Dosing and Pump Chamber
,, Pump/Siphon Specifications Number of doses/day Glendon
Diff.in Elevation Between Pump&Uppermost Orifice 10 ft Dose quantity " gal
Drainfield Squirt Height/Selected Residual(head) n/a ft Chamber Capacity(flood) 1500 gal
Uppermost Orifice li Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 1.7 gpm t1 Timer 0 B(apse Meter ❑vEvent Counter
Calculated Total Pressure Head 15.1 ft If Timer: Pump on,periliR CrisippID Glendon
Comments
DEC Oil 2025
MASON COUNTY ENVIRONMENTAL HEALTH
RET Revised:4/14/2025
'DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 0 5 -- 1 4 -- 9 0 0 4 0
Permit Number: SWG a 0a5- ay- 4
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations g 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
10 Existingand proposed wells 6d D-Box/Valve box locations
P p Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
IZI Measurements to cuts,banks, and locations 0 Laterals, trench bed, top and
surface water and critical areas 62( Observation port location bottom
lZi Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components
621 Orifice placement Other cross-section detail:
Fil Location and dimension of it Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
Buildings Other Information
g Audible/visual alarm referenced Yes No
Direction of slope indicator 0 Scale of drawingshown on scale 0 0 Design staked out
g Waterlines bar ❑ 0 Recorded Notices attached
g Roads, easements,driveways, El Elevation benchmark and relative 0 g Waiver(s)attached
parking elevations of system components Z ❑ Pump curve attached
66 North arrow and scale drawing ❑ 62(Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ g Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation It Yes 0 No
7/fa 74/a o-eAaeip ////3/2_02$
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:
RicikokwriNA IZ I L( ryc
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: V?A I Itit
✓ 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,
1 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
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