HomeMy WebLinkAboutSWG2026-00021 - - 1/22/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
04 . 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 Tank Only Permit: SWG2026-00021
APPLICANT Micah Halverson Phone: 360-490-6365
Address: PO Box 1519 SHELTON, WA 98584
OWNER ORDWAY DALE Phone:
Address: 41 EAST MCBRIDE LN SHELTON, WA 98584
SEPTIC DESIGNER MICAH HALVERSON -Olympic Phone: 360-490-6365
Construction
Address: PO BOX 698 ELMA, WA 98541
Site Address: 41 E McBride Ln
Primary Parcel Number: 221324490050
Install a new 1200-gal septic tank for the new SFR (BLD2025-01174)
Permit Description: and abandon the existing tank for the existing manufactured home
that will be removed.
Permit Submitted Date: 01/22/2026
Permit Issued Date: 02/02/2026
Issued By: David Anderson
Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/22/2027 (based on date of inspection)
Type of Work Other
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: 1200 gal 2-compartment septic tank
Permit Conditions:
4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
5 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
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/OR 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 DATE RECEIVED: 01 /020
1 /O2a /02 c4,14to II. = COMMUNITY SERVICES AMOUNT RECE D: RECEIVED BY: c Nc m
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Public Health(Community Health/Environmental Health) iac 10
360-427-9670,eat 400 or 360-275-4467,ext.400 • (2
415 N.6th Street-Shelton,WA 98584 S /, G 3,Q - Oob z x
ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE r-,.._,.. - m
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ORDWAY, DALE 206-708-9748 II z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE ; N 3
41 E MCBRIDE LANE SHELTON WA 98584
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SITE ADDRESS-STREET,CITY,ZIP CODE J1JU, CV
SAME AS MAILING I N
NAME OF DESIGNER PHONE jf I N
MICAH HALVERSON 360-490-6365 r 2.,- I
NAME OF INSTALLER PHONE
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UNKOWN
(-A)
TYPE OF WORK(select one) DRINKING WATER SOURCE O
® NEW CONSTRUCTION/UPGRADES O REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL Z I IV
COMPONENT(S)TO BE REPLACED/INSTALLED O PUBLIC WATER SYSTEM r
0 SEPTIC TANK O PUMP TANK O RV HOLDING TANK BEDROOMS LOT SIZE I .. '
❑ OTHER 3 2.01 to
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST O
❑ SURFACING SEWAGE O EXISTING FAILURE O SHORELINE III100FT+PUBLIC/COMMUNITY WELLS n r
SUBMITTALS III! SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
XI (O
CI PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) II 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) O WAIVER(S)(IF APPLICABLE)
® 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST 0 I Q
IN PROPERTY LINES AND EASEMENTS IB EXISTING/PROPOSED STRUCTURES IN EXISTING/PROPOSED OSS COMPONENTS AND LINES
O WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I CJ1
0 DIRECTION OF SLOPE/CONTOURS Ii PERIMETER/CURTAIN DRAINS III NORTH ARROW II SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
From Hwy 3 turn onto E Pickering rd, turn right onto E Phillips lake rd, turn right onto E
Mcbride Ln. property is gated and has green privacy fence.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY O MAINTENANCE/PUMPING O BUILDING PERMIT O HOME SALE ['COMPLAINT O OTHER:
COMMENTS/CONDITIONS
In511( new $q kL loft fee new SFR mid abondon exrsfiny twit
for the, exViny MasIvfacfvred howl a llv.tl- LA be (emovteet
SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLIC ION APPROVED/ISSUED BY DATE
rrr.r../.4 //it / 26 7, 7 \ 7 (1 (?07 6
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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3 BEDROOM TANK ONLY DESIGN ,_ W
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�# CALLOUTS ...a. /, ,-...,.. /\, z
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1)4"ASTM 3034 With Cleanout MOM siner_a_ / c w
2) New 1200 Gal. 2 Compartment Septic Tank ;" , �� / j O
3) Replace existing 4" Elbow this location with S' / CV IY
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New 4hole D-Box( See Detail Pg2). �g I / CO
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4) Cap existing 4" PVC Transport line this location ���; ���a�� �� �
5)Abandon existing septic tank per WAC246-272A-0300 cPENI:O Ifir"
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6) Existing 3 Bedroom Gravity Feed Drainfield tea, to -
With 4 PVC Pert pipe and Gravel FEB ooy' �.`; f-----1 N-
MgSo Z026 Q;4 4 ; i o
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HEALTH
T ; ; Well `��3r7 0BENCH MARK ELEVATIONS '
', Proposed SFR ,/i
BME1: 0" BENCH MARK/Existing Flow line DF Pipe o \\ W
BME2: +11" , co
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BME3: +21" + ��
BME4: +25" N W <
rBENCH MARK ELEVATIONS ARE \ V �0 co O
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TAKEN FROM ORIGINAL GRADE. / ;BME1 ' Q�
1210'+/ 1 • — ___-J / \ W W
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Soil Logs_.. i �,
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TH1&2: 0-24" GSL A, L7)
7)s , ' Owner/
24" Bottom of Test hole / N �'�
Applicant:
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Note:Measurements were to existing fence lines. — d
Owner is responsible for establishing property lines. /1
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/ 132'+ - ,/
30' 0' 15' 35' 60' / O
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Scale 1"=30' •
Approximate Land Size: 2.01 Ac \ l......k O
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CONTRACTORMUST HAVF ALL UNDERGROUND UTII ITIFS L OCATED BFFORF CONSTRUCTION. CIS \`/ ¢,Zi CO m
This is not a Survey.Site features,topography,elevations,and footages are based on data provided by the property owner • % \\ \ 1 O T
and from Mason County public records.This Site Plan and the Septic Design are intended for review by the Mason County / \ c G a_ I
Health Department and the contractor hired to install the septic system.Micah Halverson as the septic designer.hereby lG
advises the pia y owner to use a licensed surveyor to prepare a survey of the land that discloses the exact location of the fenc j 280,+/- \ ca
property lines elevations.topography and footages 0
X Page 2 of 3
= NEW 1200 GALLON SEPTIC TANK W, R
cleanout between4Ill I • Technical Data Sheet L N
L.-o SeWage a ource 24" access 2X with gas tight lids I _ cw
and tank
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Finished Grade 4-in. Biotube® Effluent FiltersA
(100-mm)
1200GaI. Septic Tank 6" CD
Minimum-
36" Max — , tee handle
Applications o
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- 0renco 4-inch Biotube®Effluent Filters are designed to remove sol- 0) w
Flow 2% Extend handle if more Vented top plate, ids from&fluent leaving residential septic tanks.They can be used in 4 z
than 24"from Lid. 11 standard new and existing tanks at flows of up to 1200 gpd. - Q
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i=loatin Mat General Cl) w__ i'i_
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I >7%Grade to D-e x Orenco 4-inch Biotube Effluent Filters(U.S.Patents No.4,439,323 and n1 ix
Biotubes 5,492,6351 are used to improve the quality of effluent exiting a septic tank CO
Baffle per code in a residential septic system.Increased effluent quality improves system U 0
pass through hole bio-tube I .t performance and extends drainfield life.
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per plan . , The Biotube cartridge fits tightly in the vault and is removable for a. w
Biotube filter — maintenance.The tee handle can be extended for
FTW0436-28 cartridge easy removal of the
cartridge.
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AU inlet, outlet,crossover _
piping to or from tank Standard Models at
requires ASTM 3034 in
or better and must be PVC. FTSO444 36,FTSO444 36M,FTW0436 28,FTW0436 28M
sediments -- i
' FTW0444-36,FTw0444-36M
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3"sand or Pea Gravel
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Product Code Diagram
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All Tanks must be on Washington Dept. of Health registered list of sewage tanks. - w Q
All tanks must comply with capacity ratings, usage and limitations on list. _
https://www.doh.wa.gov/Portals/1/Documents/Pubs/337-046.pdf.FT j 04 - - m z
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Traffic rated tanks and lids must be engineered by manufacturer orlicensed engineer. TRow modulator V float switch bracket options. 2 J
Install Tanks according to manufacturer specifications. Blank = noapmns selected
ationpa w w
If tank hole is stony or hard pan tanks must be bed onto 3"sand or pea gravel. Fiowmotioation A = �modulation plate
installed _
plate(optional) d' to
Cartridge height,in.(mm): 6')
28= 28(711),standard
Not to Scale 36= 3e(914),standard
—
Filter housing height,in.(mm):
Vault 36= 36(914),standard
44= 44(1116),standard
4 HOLE D-BOX
4-in.(100-mm)filter diameter
Biotube filter — Outlet tee:
vault b•1, Inlet holes W = fits Type 3034 outlet tee Owner/
S =tits scheme 40 outlet tee Applicant:
Filter mesh option:
Blank= i/e-in.(3-mm)filter mesh
P = '''An-in.(t.6-mm)fitter mesh
Roadie.emuent fitter E
Secured Lid Materials of Construction J o O
Finished grade J ls0 v
Vault PVC c0 .Y
Biotube®cartridge Polypropylene and polyethylene 0) co Cn O
Handle components I PVC,polyethylene,stainless steel
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SPEED LEVELERS 0
Orenco Systems®Inc.,814 Airway Ave.,Suthertln,OR 97479 USA•800-348-9843•541-459-4449•www.orenco.com NTo-FT-FTS-1 N —
Rev.3.0,®05/78 -�
ELBow INLET PIPE ti� Page 1 of 2 O Cr) .�VED 07
Outlet to Flow ^rye i
\ Drainfield — I)/441*\:)a
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em�ent ie�ei — APPR® cn
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oConcrete Block FEB 0 2 2026 ° _UCEIim OESKRIE
Not to Scale l e eta - MASON COUNTY ENVIRONMENTAL HEALTH
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x Page 3 of 3 NOTICE TO PROPERTY OWNER
INSTALLER GENERAL NOTES This Septic Design has been created based on the most current regulations found in
- Contact Designer at least 24Hrs Before install. the Washington Administrative Code, Chapter 246-272A, and the Standards and
- Installer must divert all stormwater away from all septic components Guidelines adopted by the Mason County Health Department, all of which are to
I-- - It is advise to place a rebar stub near observation ports and D-boxes for future locating. protect public health.
-Tanks Must be on certified list of approved tanks from DOH
-Tanks are to be Bed onto 3" of Sand or Peagravel or to manufacturer specs. The property owner is aware it is the property owner's responsibility to obtain all
- Installer may use equivalent products meeting same standards with Owner& Designer consent o
- Contractor is responsible to get underground utilities located before construction necessary county, state, and federal permits before the commencement of any o
- Place all components according to this design development of this property or the installation of the On-Site Sewage Disposal o
-All Materials and Workmanship must meet county and state regulations System (Septic Project). CD Z
- Deviation from this design without approval from designer will make this plan null and void. d- Q
- Designer May have additional Charges for redesign work and final inspection Neither the Designer, Micah Halverson nor the Mason County Health Department are c• I
- Owner is responsible for all permits and fees including any HOA/covenants rules, fees and any approval responsible for any disputes which may arise between neighbors, or contractors, co W
process required. subcontractors, suppliers, and engineers that are chosen to work on the Septic o
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- Designer requires "Owner" to approve the installation,methods and components used by installer Project. co
before final approval by designer. oU
If this land is in a development that has a Homeowner's Association, it is the property
- For any questions Please contact Designer at 360-490-6365 owner's responsibility to review and discuss with that governing body if the Septic ca
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Project is subject to specific protective covenants, restrictions, rules, or regulations
that would prevent the installation of the Septic Project.
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The Designer, Micah Halverson, and the property owner (or the person representing
to the Designer that he/she is acting as agent for the owner) have signed an c�
employment contract, whereby the Designer has prepared a septic design for an On-
Site Sewage Disposal System for a residential dwelling on the land described herein.
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All additional work by designer is subject to additional payment. Additional Work Q CO
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includes site visits, revisions, record drawings (aka Asbuilt), consulting with owner's o <
engineer, project manager and/or county officials. Designer does not warrant his work E
to Owner's transferee or buyer. v o
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The property owner shall be responsible for establishing all property lines, easements w w
and if an easement for any septic drainfield, tanks, pipes ,wires or ingress/egress, w
establishing/locating the boundaries lines of that easement. 6>
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The property owner shall assist designer and installer in locating all known wells, 2
surface water, critical areas and buffers within 100' of the property.
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 d- E
adopted by Mason County Health Department J co o
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Non-survey equipment was used to determine if
the proposed site would be suitable to support an O ._
On-Site Sewage Disposal System. The following U)equipment was used to prepare this septicdesign: Kubota excavator, Spectra PrecisionFEB 0 2 2026 Laser level (model #LL500), Komelon Steel Tape (model #N5300, Stanley 30' tape, Suunto = m o
MASON COUNTY ENVIRONMENTAL HEALTH Tandem Clinometer and Compass, and a Keson I. pTo
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Wheel Tape (Model # RR319N). Software used a- I
EXPIIIE6:01,101
to prepare this design: Chief Architect Premier.
"Vertical Datum:Assumed"