HomeMy WebLinkAboutSWG2026-00205 TANK ONLY - SWG Application / Design - 6/30/2026 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 Tank Only Permit: SWG2026-00205
APPLICANT Micah Halverson Phone: 360-490-6365
Address: PO Box 1519 SHELTON,WA 98584
OWNER RICHARDSON LIVING TRUST BRYAN Phone:
Address: BRYAN D RICHARDSON &KERRILYN A RICHARDSON TRUSTEE CAMAS, WA
98607
SEPTIC DESIGNER MICAH HALVERSON*-Olympic Phone: 360-490-6365
Construction
Address: PO BOX 698 ELMA,WA 98541
Site Address: 1991 E MASON BENSON RD
Primary Parcel Number: 221035000037
Permit Description: Relocating lift station for future build.
Permit Submitted Date: 06/30/2026
Permit Issued Date: 07/10/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/10/2029 (based on date of inspection)
Type of Work Other
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? No
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: Zoeller pump basin
Permit Conditions:
2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
I Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
5 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
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
o-�`+ f1, MASON COUNTY DATE RECEIVED: D/_ 3Q f 9 d-co W r�
COMMUNITYSERVICES AMOUNT RECEIVED: 75 RECEIVED BY: v m
a
a � Public Health(Community Health/EnvironmentalHealth)
u 4Y� 360-427-9670,ext.400 or 360-275-4467,ext.400 ^ in
415 N.6th Street-Shelton.WA 98584 S W G O�OO�1 ( _ MO o O
J T V Z CAI
ON-SITE SEWAGE TANK ONLY APPLICATION
APPLICANT PHONE m m
BRYAN D RICHARDSON 360-335-7128 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE c.cj
3141 NW 9th Ave Camas, WA 98607 ® 0°
C= m
SITE ADDRESS-STREET,CITY,ZIP CODE - . p . X
1991 E MASON BENSON RD, GRAPEVEIW 98546 N
NAME OF DESIGNER PHONEflrtrT N
Micah Halverson 360-490-6365
NAME OF INSTALLER PHONE IC.] th'
Unknown <_ I
O
TYPE OF WORK(select one) DRINKING WATER SOURCE O
❑� NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I GJ
COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM
❑ SEPTIC TANK ❑ PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I C)I
OTHER Lift Station 3 .73ac
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q C
❑ SURFACING SEWAGE O EXISTING FAILURE ❑� SHORELINE I] 100FT+PUBLIC!COMMUNITY WELLS 0
IO
SUBMITTALS 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
II PLOT PLAN(REQUIRED) ❑9 TANK CROSS SECTION(REQUIRED) ❑ I0FT+DRINKING WATER SUPPLY LINES I
O
I] PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST Q I O
❑ PROPERTY LINES AND EASEMENTS Ll EXISTING/PROPOSED STRUCTURES IN EXISTING/PROPOSED OSS COMPONENTS AND LINES
Il WELLS WITHIN 100FT IN WATER SUPPLY LINES IN DRIVEWAYS/PARKING IN SURFACE WATERS,STREAMS,RIVERS,ETC... I G.)
DIRECTION OF SLOPE/CONTOURS IJ PERIMETER!CURTAIN DRAINS IN NORTH ARROW IN SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Locked Gate contact applicant or designer for access.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING )BUILDING PERMIT ❑HOME SALE ❑COMPLAINT DOTHER:
COMMENTS/CONDITIONS
t 10O" 2 C61111 f . i} Vk1 I P 12 aka€5 ► +- - 4
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 APPLICATION APPROVED/ISSUED BY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
X Page 1 of 3 RELOCATE SEWAGE LIFT STATION FOR FUTURE CABIN EXPANSION OR REMODEL
SHOWING 3 BEDROOM RESERVE SSAS z rN
Q W S
co / \ N
r
/ \
N- ❑
• I o
o Z
I Well 9 O
qC/)TR3q M w
' app o m
I N co
'ZZ O)
--- - - /
/ Qw
/ ww
Edge of Surface Water-�,' \ / TR3g / \
/ / \ 0)
Q35 \ /
240 245 4 250 J255 '260 265 270 06sgft Reserve Trenched \ \ / 270 / /
i / / s'+ i '_ 496+ -
FAO'+
/
-
C _ —— Prima Trench / l
i
cDLI z ' \ — _ �---_=Pri a Trench --- / [T� \
O � � Existing Cabin I � __________________
- - -_:::: / TR7 0, . Q - QCO
I �, /
R=100' Well o M
n, / \ \ / 511'+/- I I
APPROVE �,a / / / - \ \ \ 1 Driveway I
C)
JUL 10 2026 ; / I \
P
MASON COUNTY EN�1RONMENTA/.I1'EALTH R=100'
\ /
RET / ; I Well \ I \ Owner/
L_ G-� \ TR36 /
Applicant:
�� / r \ - - - - -� - / U
E
\ / \ \ N Arno
i \ Well R=100 I /
/ •� O
O
• I i I /
Ism /
tJCENBED DESK�ER \ \ / / 0' 20' 40' p c --
q)
\ —I-- Scale:1"=40' r—
\ • O CALLOUTSLogs > x
CONTRACTOR MUST HAVE ALL UNDERGROUND UTILITIES BEFORE CONSTRUCTION. Soil m ;
This is I not a Survey. Site features,topography,elevations,and footages are based on data provided by the property 1) Existing Sewage Lift Station to be Abandoned per WAC246-272A-0300 =TH 1&2: 0-30" GSL O M
owner and from Mason County public records.This Site Plan and the Septic Design are intended for review by the 2) New Zoeller Fiberglass Lift Station 30" Bottom of test holes d =
Mason County Health Department and the contractor hired to install the septic system. Micah Halverson.as the septic 3) 2" Sch40 Sewage Pump Line
designer. hereby advises the property owner to use a licensed surveyor to prepare a survey of the land that discloses 4)A-Series Control Panel mounted on post or structure
the exact location of thpropertye lines, elevations.topography and footages. 5)Waterline
r Page2of3
x https://zoellerpumps.com/product/fiberglass-basin/ W
Zoeller 24" x 60" Fiberglass Basin https://zoellerpumps.com/product/e292-sewage-pump-with-20-cord/ �OELLt�/P D N s
�
Or Equivalent
Electrical J-Box 300 System Curve Fittings
to A-Series 270- GPM 'TDH(ft) 45°Elbows^14
Control Panel 240 0.00 131.00 so°Elbows �2 M
Gas Ti ht Lid v 41.00 139.01 Gate Valves_11 O W
Cap Finished Grade 210 180 82.00 59.91 Check Valves I1 o Z
123.00 !92.25 O a
2" Tru-Union Check Valve o 120 164.00 j135.35 toZ
/ 205.00 —,188.75 M W
To inlet of 1200 gal Septic Tank ,/ Flow 90 246.00 252.11 CD m
o {� so n12jn I
N 3o Flow(GPM)": 21.00 Q
U 0 TDH(ft)": 33.32 Q LLJ
CC
0 25 50 75 100 125 150 175 200 225 250 Per user data L...� C >
2% Flow q Flow(GPM} Pump Specs W Q
Curve Models Eq.Flow E
Head Electrical 1230 volt,1
292 28.52 35.09 phase,60 6 (�
4"ASTM3034 from Sewage Source 293 469 41.19 _- _- f Hertz
Physical
-- -- C0
Discharge Size 12.00"NPT
High Level Alarm Pipe Size ;2.00"
Gaskets Use E292 Series pump Pipe —
Length(ft) 250.0000
Or equivalent — - -
Pipe Type j Plastic
Solids Handling(in.) I2
Static Head(ft) 130.0000
W
]o
60•r a M
4
A-Series Simplex Alarm Panels z Q
Applications General C `r<
Pump On/Off Float DrersoASakss9nplaAlannParelsweusedtoconbdpamp sa lumber Ia A-se�sa �a �°ane� de cAred rp0
moM aM alum hmchons in si Wa(cme momdpump)pmping breaker;.an alltomaWMMaVdf toggle s+rm,and anaudve/
system They areimmnded as a bn-costoption for pumpconbols visbe ligh mteralan wth auto reseLSee Standard Fustures and
torgrx.rtyapre5satred ma imAb Masse-rated root a�tcnes are option Feahues on page 2.LMxd panes��g too use 'c0
orderedseparatey. mA nredarucal and/or memory Coat wAiches.listed pm1A.5o8;a
AL-Canada IAtirg is available.
Standard Models
AIJJ Owner/
Product Code Diagram Applicant:
Zoeller E292 Series A
2" Solids Handling y� ° uoe
em
l6rFL CTlit'.predfrtdmbix r ,
m.h n- v LJz=zamx : U
s r� xsmea manwe co ,Y
r d�
I xmmAedm9muesanadesm+rmr.,aaerrsssr�e„nwmucm O
2
Materials of Construction O)
F>tLloorre W-resamnl llterglass,Type 4X(Pf5) �
A-Series samples alum panel starless stee °C O
farm stainless see fro
\ /
3" Sand or Pea Gravel P�ulmip Block V010.Specifications 7.5(1n
YAtlm,n(mm) 7.3(1857
b o' a o a o •�o •��0 1+ Depth.in(mn) 5.0(127) O
'ib9 .,'�b9�ga';bf .,';b9 �b9 .,';69 w'1b9 r'�b9�g,°'�b9 a'X89 .,'X59 .v tb9�w:b9�'°.'•6f n:b9 n•:Sfa-b'.:69 Al pare)ra s 12WAC1M 10.75ktM1g1(i45mglo�hase.DOFtr
'n d�n dr n dj n di n di n di n di c dr n di a dip di u dr a dr n dr a di n dr n ^,o A2purerratans M4 ,lhp(0.75k",1K sen}e9tase. t W O
> x cn
All Tanks must be on Niashington Dept.of Health registered list of sewage tanks. 3 Co
All tanks must comply with capacity ratings,usage and limitations on list.
https:lluu.w.doh.wa.gov/Portals/1/Documents/Pubs/331-04b.pcif. � R O W
C d
Traffic rated tanks and lids must be engineered by manufacturer or licensed engineer. Orenca m°°°asst°° soo Sae de43.,1 541.459-4440.wwneorwcsacom ra° l
alV mdn�'9vv+>neamaxssara�ximpva�9l9sra'r2°n.4.�'/aGa2s/ faits/°t9 E)IIIE$OOna_2Z_
Install Tanks according to manufacturer specifications. Not to Scale w A T E F >�nma�:a.a"corm anon
If tank hole is stony or hard pan tanks must be bed onto 3"sand or pea gravel.
Page 3 of 3
x NOTICE TO PROPERTY OWNER
INSTALLER GENERAL NOTES This Septic Design has been created based on the most current regulations found in M o
- Contact Designer at least 24Hrs Before install. the Washington Administrative Code, Chapter 246-272A, and the Standards and V)
0 - Installer must divert all stormwater away from all septic components Guidelines adopted by the Mason County Health Department, all of which are to protect
- It is advise to place a rebar stub near observation ports and valve boxes for future locating, 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 necessary county, state, and federal permits before the commencement of any c�irV
- Emergency Disconnect and Pump Controls Require L&I inspection and permit
QLL
-All Electrical wires should be placed in conduit and No direct Bury wire should be used development of this property or the installation of the On-Site Sewage Disposal System Z
o
- Contractor is responsible to get underground utilities located before construction (Septic Project). 9 0
QCI
- Place all components according to this design u? Z co
-All Materials and Workmanship must meet county and state regulations Neither the Designer, Micah Halverson nor the Mason County Health Department are c' w
- Deviation from this design without approval from designer will make this plan null and void. responsible for any disputes which may arise between neighbors, or contractors, o Co 00
- Designer May have additional Charges for redesign work and final inspection subcontractors, suppliers, and engineers that are chosen to work on the Septic Project. C Z 0)
- Owner is responsible for all permits and fees including any HOA/covenants rules, fees and any approval If this land is in a development that has a Homeowner's Association, it is the property Lt U
process required.
owner's responsibility to review and discuss with that governing body if the Septic
- Designer requires "Owner"to approve the installation,methods and components used by installer L
before final approval by designer. Project is subject to specific protective covenants, restrictions, rules, or regulations that co w
Project.
Pro Se the installation of the prevent a w IL
- Installer must follow all conditions from Mason County would p � � Q
- For any questions Please contact Designer at 360-490-6365
The Designer, Micah Halverson, and the property owner(or the person representing to o 0
the Designer that he/she is acting as agent for the owner) have signed an employment
contract, whereby the Designer has prepared a septic design for an On-Site Sewage co
Disposal System for a residential dwelling on the land described herein.
All additional work by designer is subject to additional payment. Additional Work
includes site visits, revisions, record drawings (aka Asbuilt), consulting with owner's
engineer, project manager and/or county officials. Designer does not warrant his work
to Owner's transferee or buyer.
W^
The property owner shall be responsible for establishing all property lines, easements a
and if an easement for any septic drainfield, tanks, pipes ,wires or ingress/egress, 2m
establishing/locating the boundaries lines of that easement. z a
The property owner shall assist designer and installer in locating all known wells, m"
surface water, critical areas and buffers within 100' of the property.
The property owner is responsible for all costs associated with the employment of
contractors and those materials/components used in the installation of the designed Owner/
Applicant:
A P P R septic system.
JUL ' 20260 Designer does not guarantee water adequacy from proposed well location or depth of o
well to water source. Owner and well driller are responsible for final well location. It E
MASON COUNTY ENVIRONMENTAL HEALTH
RET The property owner is responsible for all future maintenance and inspections as , o
adopted by Mason County Health Department c .2
N c
o� 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 W _ W
equipment was used to prepare this septic
design: Kubota excavator, Spectra Precision > X
• Laser level (model#LL500), Komelon Steel O L
StOD�oo Tape (model #N5300, Stanley 30'tape, Suunto m >
i�crwl�wNei Tandem Clinometer and Compass, and a Keson = 0 @
UCENBEDDES)GNEa K Wheel Tape (Model#RR319N). Software used 0 _
to prepare this design: Chief Architect Premier.
E &oand-�- "Vertical Datum:Assumed"