HomeMy WebLinkAboutSWG2026-00015 - SWG Application / Design - 1/15/2026 ,, 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: SWG2026-00015
APPLICANT Micah Halverson Phone: 360-490-6365
Address: PO Box 1519 SHELTON, WA 98584
OWNER HOAG BERNARD A& BARBARA E Phone:
Address: 1590 E ISLAND LAKE DR SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON -Olympic Phone: 406-490-1549
Construction
Address: PO BOX 698 ELMA, WA 98541
Site Address: 1590 E ISLAND LAKE DR
Primary Parcel Number: 320065002041
Permit Description: Repair 4bd gravity trench
Permit Submitted Date: 01/15/2026
Permit Issued Date: 01/15/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/30/2026 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
• J L MASON COUNTY DATE RECEIVED: O / / 6/aool...(0
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AMOUNT RECEIV a RECEIVED BY: w
f Public Health & Human Services 8'116 0OLJ NE, ° gi
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Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 !\�` - �O�' O 0
415 N.6th Street-Shelton,WA 98584 SWG �`J .:p
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ON-SITE SEWAGE SYSTEM APPLICATION > f
mAPPLICANT PHONE ITt
HOAG, BARBARA 360-426-9285 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE C
1590 E ISLAND LAKE DR SHELTON Wa 98584 co
SITE ADDRESS-STREET,CITY,ZIP CODE Q
Same as Mailing h , I W
NAME OF DESIGNER ^ \ PHONE
Micah Halverson Q 360-490-6365 I N
NAME OF INSTALLER Q PHONE I O
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PERMIT TYPE(select one) DRINKING WATER SOURCE N c
Ir! RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS -PRIVATE INDIVIDUAL WELL 'PRIVATE TWO-PARTY WELL z I
TYPE OF WORK(select one) PUBLIC WATER SYSTEM
ln_ NEW CONSTRUCTION/UPGRADES 7"REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I 101
SUBMITTALS� 0
SURFACING SEWAGE G2f EXISTING FAILURE 0 SHORELINE
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pr DESIGN FORM(REQUIRED) VSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025, 0 I C21
l7 WAIVER(S)(IF APPLICABLE) 4 .73ac El YES ❑✓ NO 0 i
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Met with Rhonda 12/30/25 I m
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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)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS `I( COMMENTS/CONDITIONS
W \ 0 t)-1- 1 ck ./�e �i Vt<� S
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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.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
ONPVW1 \7/(3o1zs t7,1S01 1 '1151
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 0 0 6 - 5 0 - 0 2 0 4 1
. 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 '707-6— Obo`S- Designer's Name: Micah Halverson
Applicant's Name: HOAG, BARBARA Designer's Phone Number: 360-490-6365
Mailing Address:
1590 E ISLAND LAKE DR Designer's Address: PO Box 1519
Shelton Wa 98584 City State Zip Shelton Wa 98584
City State Zip Designer's Email halversondesignlIc@outlookg
DESIGN PARAMETERS
Treatment Device
O Glendon O Sand Filter O Mound O Sand Lined Drainfield O Recirculating Filter O ATU L 1 OtherSeptic Tank
Treatment Level(check all that apply): ❑ A ❑B ❑ C O BL1 ❑BL2 ❑BL3 0 E ON
Drainfield Type
'Gravity O Pressure O Trench 2rBed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 2729
Daily Flow: Operating Capacity 360 gpd Length 27.5 ft
Daily Flow: Design Flow 480 gpd /Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 8
Receiving Soil Type(1-6) 3 Separation 2.5 ft
Receiving Soil Appl.Rate .8 gpd/ft2 Orifices
Required Primary Area 600 ft2 / Total Number of Orifices Perf.
Designed Primary Area 600 ft2 Diameter in
Designed Reserve Area 694 ft2 Spacing in
Trench/Bed Width 10 ft v Manifold
Trench/Bed Length 2 @ 30' ft Schedule/Class D-Box
Elevation Measurements Length ft
Original Drainfield Area Slope Fairly Level % Diameter in
New Slope,If Altered % Preferred manifold configuration used? O Yes O No
Depth of Excavation Up-slope 31 in Transport Pipe
from Original Grade Down-slope 31 in V Schedule/Class 3034
Designed Vertical Separation 36+ in Length 100 ft
Gravel-based Drainfield Required? III Yes 0 No Diameter 4 in
Pump Required? ❑Yes ELI No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
Diff.in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head gpm O Timer O Elapse Meter O Event Counter
Calculated Total Pressure Head ft If Timer: P�n �V C D►ump off
Comments A
PP JAN 15 2026
MASODI rntlWTY ENVIRONMENTAL HEALTH
RET Revised:4/14/2025
-DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 0 0 6 -- 5 0 -- 0 2 0 4 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
66 Test hole locations lid Drainfield orientation and layout Reference depth from original grade:
0 Soil logs g Trench/bed dimensions and lg Septic tank
g Property lines critical distances within layout Drainfield cover
Existing and proposed wells 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:
la Measurements to cuts,banks,and locations121 Laterals,trench/bed,top and
surface water and critical areas GZ( Observation port location bottom
6a Location and orientation of Cg Clean-out location O Curtain drain collector
curtain drain and all absorption g Manifold placement O Sand augmentation
components Pi Orifice placement Other cross-section detail:
Location and dimension of p1 Lateral placement with distance RI Observation ports/clean-outs
primary system and reserve area to edge of bed
Pi Buildings Other Information
g Audible/visual alarm referenced Yes No
• Direction of slope indicator g Scale of drawing shown on scale d O Design staked out
66 Waterlines bar O i Recorded Notices attached
g Roads, easements,driveways, 0 Elevation benchmark and relative O g Waiver(s)attached
parking elevations of system components O g Pump curve attached
Pi North arrow and scale drawing O RI Evaluation of failure
shown on scale bar Non-residential justification
❑ &Waste strength
❑ l'Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation g Yes ❑ No
21: #4 of/5/2026
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: _
74
Environmental Healt 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: ,Z.4?j 0 tap
✓ 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
X Page 1 of 4 4 BEDROOM ON-SITE WASTEWATER DESIGN (REPAIR) w
TS Soil Logs 2
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I- 1560 F Island I ake Dr Nate:Could not locate well for address 1560. G7v o
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Spoke with owner of 1560,says they share well with 1530. ��1
TH 1: 0-24 J VGLMS According to crt2010-00013 this well is in garage at 1530. 30 _i
Disturbed Soils Garage is over 100'from proposed SSAS.
24"-67" Very Gravelly Loamy Sand No Wells were found within 100'from Proposed SSAS. I ui
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Medium Sand 'pA. f117�� a� __----�
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Roots .C�2.i T ro Sea, Old f v It /'� r"--.1
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Edge of Deck .- 10 J, 50,+/- to
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3 0 Y 'Ji ib 1590 F Island Lake Dr A > a
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JAN 15 2026 , _ .
!--• NTY ENVIRONMENTA �iEALTF
MASON COU �r
RET ` 0 Owner/
/ �\ \ Applicant:
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/ 240' +/- �,
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CALLOUTS , D O �t E
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a pry : 1 Existing 500gal Septic Tank to Remain in Place CO O
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�F--I— ^^h; i, i '�V?? See Note Pg4 t MI co
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o �i I '99.14/ 2)4"ASTM3034 with Cleanout I o
�-1 I 'P:�!ne 3) New 1200ga1 2Compartment Septic Tank I
1i I 4)Appox. location of New Parking Pad (per owner) I O
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A I ------♦ 5)4"ASTM3034 grade to D-Box I Q o• `�,,�� I Well 6) D-Box See Pg2 for Details I o =
`% A", it 7) Utilities Located By Other(Relocate if necessary)
f UCENI ED DESIGNER 1, O .�
�„„ 1640 F Island Lake Dr BENCH MARK ELEVATIONS II
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DOMEB'OfYtOf?Z t F)JV1F1: 0" RFNCH MARK(Callout 1) I i -
BME2:-1'6" 500GaI Septic tank outlet
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CONTRACTOR MUST HAVF ALL UNDFRGROUND UTIL ITIFS LOCATFr) BFFORF CONSTRUCTION. BME3: +2" New Tank(Callout 3) / x L
RMF4--5'3" r)-Box(Callout 6) / w m >
This is not a Survey.Site features,topography,elevations,and footages are based on data provided by the property owner 30' 20' 0' 10' 20' 30' / I O CO
and from Mason County public records.This Site Plan and the Septic Design are intended for review by the Mason County BENCH MARK ELEVATIONS ARE / l a =
Health Department and the contractor hired to install the septic system.Micah Halverson as the septic designer hereby
advises the property owner to Ilse a licensed surveyor to prepare a survey of the land that discloses the exact location of the TAKEN FROM ORIGINAL GRADE. Scale: 1"=20'
property lines elevations.tonography and footages /
Page 2 of 4
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6 Hole D-Box S
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APPROVED fl
JAN 15 2026 \1 f �4 !slit M Q
MASON COUNTY ENVIRONMENTAL HEALTH ` � 'la J
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EXPIRES:0W161.2Z
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IL_ 30° 30" 3 p 4"ASTM212 1 Perf Pipe D-BOX to
Note: Interconnect laterals at the ends
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"t. Secured Lid C Firrsned a:ade
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15" O 15" Q i
SPEED LEVELERS Q
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Drainfield Lo �_r/^�
Effie - - - V/
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0 2.5' 5' 10' cancrrete Blocle 4 • Not to Scale c
10' OoP I I BED CROSS SECTION Owner/
Scale 3/16"=1' Applicant:
---____________4 4"O.P.
10' OP \l/f Slip Gap Slope Away
Original Grade A —Finished GradeE
Observation Ports Per RS&G /1 coco o
B"-24"Cover Material over Filter Fabric
24"Disturbed sous a 15" —30" 30" 30" > 15" Sandy Pit run or native VGLMS -
31"
GRAVITY DRAINFIELD CALCULATIONS it -� 2"of Orainrockoverpipe O)
(,N,(��\\ V 0• 0 O 4"Perforated pipe .� D
Soil Type 3 I' `-\}\�\ ° Infiltrative Deptl A V Washed Drainrock I 6"of Drainrock below pipe 0 o`
`�' �\ ..4"A57M 2//129 Pert.Pipe u.
Soil Application Rate: .8 gal/sgft/day p ✓I ebar Or Glued T. • '.
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Designed Capacity: 480 GPD 1_1 HolesPaungDwn c t c
vv 1!Z"Dnlled Holes -,
Operating Capacity: 360 GPD o rn °'
Drainfield Dimensions: Width 2 @ 10' �1c"''- D s\
Len th 2 30' 45° Native Undisturbed
Required Absorption Area: 600s ft 36��+ vs
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q p q Type 3 i with T E > X �'
Calculated Absorption Area: 600 sqft L o a-
Reserve Area Calculated: 694sqft m >
"Washed Drainrock"means clean washed gravel or crushed rock ranging in I O 76
Infiltrative Depth 31" three-quarters containing 0- I
size from inch to two and one-half inches, and
no more than two percent by weight passing a US No. 8 sieve and no 10� "�
more than one percent by weight passing a US No. 200 sieve. V
*Washed Drainrock only Bottom Of Test Pit Not to Scale
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Page 3 of 4
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NEW 2 COMPARTMENT SEPTIC TANK
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Orenco
SYSTEMS
4-in. (100-mm) Biotube® Effluent Filters ,,....
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0renco®4-inch Biotube®Effluent Filters are designed to remove sol- in <
` Vented top plate, ids from effluent leaving residential septic tanks.They can be used in 6 J
standard new and existing tanks at flows of up to 1200 gpd. CD O
cleanout between Z
sewage source 24" access 2X with gas tight lids -4 General co a
and tank ii. ii•
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// -: Orenco 4-inch Biotube Effluent Alters(U.S.Patents No.4,439,323 and U
i Finished Grade i ---- Biotubes 5,492,635)are used to improve the quality of effluent exiting a septic tank MS W
12000x1. Septic Tank - n fr. in a residential septic system.Increased effluent quality improves system � rn
_ =1 .l performance and extends drainfield life. 'f)
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36"Max ! • The Biotube cartridge fits tightly in the vault and is removable for
Biotubes filter — ° 's'-t o
- v E.- maintenance.The tee handle can be extended for easy removal of the
Flow 2% Extend handle if more cartridge _ cartridge m
- - than 24"from Lid. _ f.
I I 111 1__ 1.. Standard Models
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Floating Mat I FTSO444 36,FTSO444 36M,�TW0436 28 FTW0436 28MCe
>1%Grade to v-sox FTW0444 36,FTW0444 36M w
Baffle per code p Y
pass through hole bio-tube ₹ Q
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per plan
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FTW0436-28 Ir Q
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All inlet,outlet, crossover — FT — - X14 w L—
piping to or from tanks o W
Flow modulator and float switch bracket options: 0) I
Bank = no options selected
requires ASTM 3034rn
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or better and must be PVC. sediments Flow modulation m = flow modulation plate installed
A - Hoot sw tcn bracket nsla lea
plate(optional)
ge height,in.(mm): —
Carhid -
.3'sand or Pea Gravel 28= 281711),star�dard cTs
36=36(914),standard
Firer housing height,in.(mm):
Vault 36=36(914),standard
44=44(1118),standard Owner/
4-in.p 00-mm)filter diameter
Applicant:
All Tanks must be on Washington Dept. of Health registered list of sewage tanks. Biotube filter — outtettea:
All tanks must comply with capacity ratings, usage and limitations on list. vault • Inlet holes s = fiLSTSchedul ao ne tee
https://www.doh.wa.gov/Portals/1/Documents/Pubs/337-046.pdf. Alter meal option: U E
Blank = '/e-In.(3-mm)fitter mesh 2 cc o
P = �'/,s-in.(1.6-mm)fitter mesh J ix) 0
Traffic rated tanks and lids must be engineered by manufacturer or licensed engineer. Bintabe�etmamfilter 00 Y
Install Tanks according to manufacturer specifications. C ' o
If tank hole is stony or hard pan, tanks must be bed onto 3" sand or pea gravel. Materials of Construction O) c o
Vault PVC 0
I' Biotube®cartridge Polypropylene and polyethylene Q g g
�,o� t' l — - Handle components PVC,polyethylene,stainless steel
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INf7rI TlYINN gKy6 ;' JAN 15 2026 = O _CD co 0
i UCEMBL�OESK3llER /
-�...,•�.,•, MASON COUNTY ENVIRONMENTAL HEALTH a
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• INSTALLER GENERAL NOTES NOTICE TO PROPERTY OWNER U
r This Septic Design has been created based on the most current regulations found in u- Contact Designer at least 24Hrs Before install. the Washington Administrative Code, Chapter 246-272A, and the Standards and Z Z
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- Install new riser and lid to existing 500 gal septic tank Guidelines adopted by the Mason County Health Department, all of which are to
� - Drainfield may only be installed in dry weather conditions protect public health.
- Installer must divert all stormwater away from all septic components
- Drainfield Must be dug Level and Accurately. The property owner is aware it is the property owner's responsibility to obtain all
- Drainfield Must be dug with toothed bucket and hand rake bottoms and sidewalls to loosen soil. necessary county, state, and federal permits before the commencement of any
- Disturb as little native soil as possible when and if clearing is needed. development of this property or the installation of the On-Site Sewage Disposal N O
- Use tracked vehicles and equipment to build drainfield.
- It is advise to place a rebar stub near observation ports and valve boxes for future locating. System (Septic Project). o w
- Tanks Must be on certified list of approved tanks from DOH o� Q
- Tanks are to be Bed onto 3" of Sand or Peagravel or to manufacturer specs. Neither the Designer, Micah Halverson nor the Mason County Health Department are co
- Installer may use equivalent products meeting same standards with Owner& Designer consent responsible for any disputes which may arise between neighbors, or contractors, c) o
- Contractor is responsible to get underground utilities located before construction N Z
subcontractors, suppliers, and engineers that are chosen to work on the Septic
- Place all components according to this design Project. * Q
-All Materials and Workmanship must meet county and state regulations If this land is in a development that has a Homeowner's Association, it is the property
- Deviation from this design without approval from designer will make this plan null and void. owner's responsibility to review and discuss with that governing body if the Septic W
- Designer May have additional Charges for redesign work and final inspection p y p
Owner is responsible for all permits and fees including any HOA/covenants rules, fees and any approval Project is subject to specific protective covenants, restrictions, rules, or regulations �
process required. that would prevent the installation of the Septic Project. `n
- Designer requires "Owner" to approve the installation,methods and components used by installer o
before final approval by designer. The Designer, Micah Halverson, and the property owner (or the person representing
- Installer must follow all conditions from Mason County to the Designer that he/she is acting as agent for the owner) have signed an
- Reference additional design form attached to this design. employment contract, whereby the Designer has prepared a septic design for an On-
- For any questions Please contact Designer at 360-490-6365 Site Sewage Disposal System for a residential dwelling on the land described herein. cZ
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All additional work by designer is subject to additional payment. Additional Work Y 7r
includes site visits, revisions, record drawings (aka Asbuilt), consulting with owner's Q o
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engineer, project manager and/or county officials. Designer does not warrant his work o Q
to Owner's transferee or buyer. Q
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The property owner shall be responsible for establishing all property lines, easements „LI o
and if an easement for any septic drainfield, tanks, pipes ,wires or ingress/egress, 0o in
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establishing/locating the boundaries lines of that easement. cn
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The property owner shall assist designer and installer in locating all known wells,
surface water, critical areas and buffers within 100' of the property. 2
The property owner is responsible for all costs associated with the employment of Owner/
contractors and those materials/components used in the installation of the designed Applicant:
septic system.
The property owner is responsible for all future maintenance and inspections as O E
APPROVED adopted by Mason County Health Department J Lo o
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JAN 152026 o) (13 o
MASON COUNTY ENVIRONMENTAL HEALTH cn
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o , I Non-survey equipment was used to determine if c _c ..,—
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i� the proposed site would be suitable to support an O cn .-'
A On-Site Sewage Disposal System. The following o� m
f.. equipment was used to prepare this septic — L j -o
/1., s i j,Idesign: Kubota excavator, Spectra Precision X o Laser level (model # LL500), Komelon Steel `�'L
etoo+oo '�V.� Tape (model #N5300, Stanley 30' tape, Suunto m
IrdelGIN `DESIGNER '� Tandem Clinometer and Compass, and a Keson I O c6
������„������ Wheel Tape (Model # RR319N). Software used 2 � I
EMPIRES:09115/..2.7_. to prepare this design: Chief Architect Premier.
"Vertical Datum: Assumed"