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HomeMy WebLinkAboutSWG2026-00242 - SWG Application / Design - 8/4/2026 MASON COUNTY "SN6THELTON , 0427-970,E 99584 SHELTON'. 360-027-9670,EXT 400 JM BELFAIR.360-2754497. EXT 400 Public Health & Human Services ELMA:360-482.5269.EXT 400 I_IFAX:360427-7787 On-Site Sewage System Permit: SWG2026-00242 APPLICANT ZOOK LLOYD Phone: Address: 1310 W GOLDEN PHEASANT RD SHELTON, WA 98584 OWNER ZOOK LLOYD Phone: Address'. 1310 W GOLDEN PHEASANT RD SHELTON,WA 98584 SEPTIC DESIGNER MICAH HALVERSON* -Olympic Phone: 360-490-6365 Construction Address: PO BOX 698 ELMA, WA 98541 SEPTIC INSTALLER WES GRAVES* Phone: 360-490-9428 Address: PO BOX 1460 SHELTON, WA 98584 Site Address: 1310 W Golden Pheasant Rd Primary Parcel Number: 319065000030 Permit Description Repair: SFR 3-bedroom NuWater BNR500 pressure system with trash/pump combo tank, bed drainfield Permit Submitted Date: 08/03/2026 Permit Issued Date: 08/1312026 Issued By: David Anderson Current Permit Fees Paid: $845.00 (additional fees bey be required upon installation of system). Permit Expiration Date: 08/06/2027 (based on date of inspection Permit Conditions: I 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. 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/environmentallonsite/oss-inspection-request.php or call: 360-427-9670,extension 400. MASON COUNTY 415N6TH STREET,SRELTQN,WA 98584 SHELTON:36042]-96]0. EXT 400 BELFAIR 360-275-4467. EXT 400 Public Health & Human Services ELMA:360482-5269.EXT 400 FAX:360-427-7787 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/healthlenvironmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY °" ""FIND 03/3 .2c1 w N AMWMNECENLD. RECEIVED vED BY: W Cfl M Public Health & Human Services o Environmental Health 360-421.9670,ext4W or 360-275- 67,eat am S 415 N.6tM1 Street-811elton,WA 98584 SWG — I7y ON-SITE SEWAGE SYSTEM APPLICATION D ED n m APPLICANT PHONE mr Lloyd Zook 360 791-3724 z MAILING ADDRESS-STREET CITY STATE.ZIP CODE 3 1310 W GOLDEN PHEASANT RD Shelton Wa 98584 a SITE ADDRESS-STREET CITY ZIP C ('I I( same as mailing p E1 NAME OF DESIGNER II1 PHONE Micah Halverson Ull AUG P + 360-490-6365 I NAME OF INSTALLER PHONE Wes Graves BY _J14 5 o PERMIT TYPE(Seed one) GRINNING WATER SOURCE — FI RESIDENTIAL OSS fl COMMUNITY 055 fl COMMERCIAL 055 gPRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL = I � PUBLIC WATER SYSTEM TYPE OF WORK(select one) n NEW CONSTRUCTION/UPGRADES flI REPAIR REPLACEMENT OTHER DETAILS(soled an @9l apply) ❑ TABLE X REPAIR Icn SUBMITTALS m SURFACING SEWAGE EXISTING FAILURE 0 SHORELINE 7t DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER a/lUO25> r0 I � 19 WAIVERS)(IF APPLICABLE) 3 5.1 Ac ❑ YES Q NO T. O DIRECTIONS TO SITE AND SITE CONDITIONS (ex lacked pate) Property is at the end of Golden pheasant rd. test holes are marked with pink ribbon. 10 IC O ti IW SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED I1TN TEST HOLE NUMBERS. I O OFFICIAL USE ONLY BELOWTHIS IINE - _ UPGRADE I FAILURE SOURCE ten repoding purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING O BUILDING PERMIT ❑HOME SALE OCOMPLAINT ❑OTHER'. INSPECTOR SOIL LOGS COMMENTS I CONDITIONS A+1=0. 18 (115 O- Y9" f(1LCogc (Typel) V+ O '44'L 4-( hlof fI came . Tffi,- Z$ (llc 74 'i7" r, 6t Coot Rey cif 9 'L ' ½' mof ti (6mg RECORD DRAWING AND INSTALLATION REPORT fl�) ' S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R-ROOTS REQUIRED FOR FINALAPPROVAL. DATE APPLICATION EXG RATOION DATE APPLICATION 7R VEOI SUEED DATE 6/�ze THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEWON THE MASON COUNTY WEBSITE Eo/•/ S` Z ReVISed 4/14/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 1 9 0 fi — 5 0 - 0 0 0 3 0 A design will be reviewed when 33�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: U"X 17" � PARCEL IDENTIFICATION Permit Number: SWG LD.irr,, C`jo s-{y. Designer's Name: Micah Halverson Applicant's Name: Lloyd Zook Designer's Phone Number: 360'4906365 -- Mailing Address: 1310 W GOLDEN PHEASANT Designer's Address: PO Box 1519 Shelton Wa 98594 City State Zip Shelton Wa 98584 City State Zip Designers Email halversondesignllc@outlookg DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand filter ❑ Mound ❑ Sand Lined Drainfield 0 Recirculating Filter C ATU BNR-500 LJ Other Treatment Level(check all that apply): ❑ A IE B ❑C ❑BL I E BL2 7 BL3 ❑ E ❑N Drainfield Type ❑ Gravity fir!Pressure ❑ 1 reach 6'Bed ❑ Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 40 Daily Flow: Operating Capacity 270 gpd Length 36 ft Daily Flow: Design Flow 360 gpd Diameter 1 1/4 in Septic Tank Capacity(working) 500+NuWater - 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 360 ft1 Total Number of Orifices 60 Designed Primary Area 360 ft2 Diameter 3/16 in Designed Reserve Area 360 ft2 Spacing 28 in Trench/Bed Width 10 ft Manifold Trench/Bed Length 36 ft Schedule/Class 40 Elevation Measurements Length 7.5 ft Original Drainfield Area Slope level Diameter 2 in New Slope, If Altered % Preferred manifold configuration used? D Yes 62(No Depth of Excavation up-elope 24 in Transport Pipe from Original Grade nvm-smpc 13-24 in Schedule/Class 40 Designed Vertical Separation 18+ in length c150 ft Gravel-based Drainfield Required? Ed Yes D No Diameter 2 in Pump Required? Id Yes D No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 6 Diff. in Elevation Between Pump&Uppermost Orifice 5 It Dose quantity 45 gal Drainfield Squirt Height/Selected Residual (head) 2+ ft Chamber Capacity(flood) 1223 gal Uppermost Orifice f Higher ❑ Lower than Pump Shutoff Pump controls: Please check those required. Capacity @ Total Pressure Head 43.18 gpm G Timer D Filapse Meter ❑vEvent Counter Calculated Total Pressure Head 10.71 g If Timer: Pump on TBD ,Pump off 4hrs Comments Revised:4/14/2025 DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 1 9 0 6 — 5 0 -- 11111 Permit Number: SWG 9t-≥9'Cr OcD '4) DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch lid Test hole locations [9 Drainfield orientation and layout Reference depth from original grade: Soil logs Rf Trench/bed dimensions and Ed Septic tank 1 Property lines critical distances within layout IZ Drainfield cover Ib Existing and proposed wells 19 D-Box/Valve box locations Reference depth from original grade within 100 ft of property 6Q Septic tank/pump chamber and restrictive strata: 14 Measurements to cuts,banks, and locations [Z Laterals,trench/bed,top and surface water and critical areas 19 Observation port location bottom m Location and orientation of 19 Clean-out location O Curtain drain collector curtain drain and all absorption R1 Manifold placement ❑ Sand augmentation components IZ Orifice placement Other cross-section detail: R1 Location and dimension of 56 Lateral placement with distance Observation ports/clean-outs primary system and reserve area to edge of bed Other Information 0 Buildings R1 Audible/visual alarm referenced Yes No 91 Direction of slope indicator m Scale of drawing shown on scale lil ❑ Design staked out 6d Waterlines bar 0 E6 Recorded Notices attached R1 Roads,easements,driveways, O Elevation benchmark and relative II O Waiver(s)attached parking elevations of system components E6 O Pump curve attached ib North arrow and scale drawing 66 O Evaluation of failure shown on scale bar Non-residential justification ❑ R1 Waste strength ❑ l6 Flow DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation RI Yes O No Signature of Designer Date A f, The undersigned has reviewed this design on behalf of Mason County Public Health and determine compliance with state and local on- egulations: +•@.•G st12 C AUG 13 2076 Envi onmental Healt Spec alist Date r" 4 _Y7q[HEALTH CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health. (' /6 /20 Z_ ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: b / /L ✓ 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 maybe scanned and available for public view on the Mason County Web site. Revised:4/14/2025 Tabloid 11"X 17" Y7 oJ CD Tz0o0000 Dm (JDm -ID > > -l -� -3 � c00000 0 S .Y' ti N N 0 S —. in N O ' -' at J . m c)c. 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