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TC 2013102611 10900 Bald Hills Rd SE ' Thurston County Permit Assistance Center 2000 Lakeridge Dr.SW,Olympia,WA 98502 :,�„`�, (360)786-5490 / (360)754-2939(Fax) -�e��,�,;�''� � TDD Line(360)754-2933 �� Email:permit(a�co.thurston.wa.us � �= �.: THURS`TC�N CCJLII'*ITY www.co.thurston.wa.us/permitting �,�-�,�s: Creating Solutions for Our Future MASTER APPLICATION STAFF USE ONLY DATE STAMP � 3 107483 BS TNt}RSTON COUNTY Permit Type: Site Application �,��F�U�� S�ib Type: Residential Lot:B site: 10900 BALD HILL RD SE YELM WA 98597 M�Y �� '�13 Assessor Property ID: 22729310700 Applicant: BALD HILL ROAD LLC ��N�'f�' AS51S�T��C� ��hTE� Owner: BALD HILL ROAD LLC � � � � �� Intake by: The Master Application is required for all projects and shall accompany a project-specific supplemental application(s). The Master Application may not be submitted alone. Check the appropriate box for each supplemental application being submitted with this Master Application. T e of Pro�eCt(check all that apply): BUILDING PLANNING ❑Residential(�orm SAOO1) ❑Administrative Variance(�orm SAO21) ❑Non-Residential(�orm SA002) ❑Binding Site Plan(�orm SAO22) ❑Non-Residential Hood&Duct(�orm SA003) ❑Boundary Line Adjustment/Lot Consolidation(�orm SA0z3) ❑Non-Residential Sign(�orm SA004) ❑Critical Area Review(�orm SAO24) ❑Manufactured Home Placement(�orrn SAOOS) ODesign Review(�orm SAO25) ❑Minor Permit(form SA006) �Division of Land(f'orm SA026) (Mechanical/Plumbing/Fire/Re-roof/Re-siding/Demo) ODivision of Land Final Map(form SA026a) 0 Adult Family Home Inspection (form S.4007) ❑Environmental Checklist(SEPA)(�orm SAO27) ❑Fire Code Permit(form SA008—SA012) ❑Forest Practice Activities(jorm SA028) ❑Innocent Purchaser(�orm SA029) ROADS ❑Joint Aquatic Resources Permit Application(JARPA) 0 Encroachment Permit(�orrn SA013) (form SA030) ❑Construction Permit(�orm SA014) ❑Legal Lot Determination (�orm SA031) �Variance (form SA015) ❑Other Administrative Actions(�orm SA032) ❑Scoping Review Request(�orm SAO15a) ❑Presubmission Conference(�orra SA033) ❑Access Permit(form SA0156) ❑Reasonable Use Exception (�orm SAO34) ❑Release of Moratorium(�orm SA035) ENVIRONMENTAL HEALTH ❑Rezone, Comp Plan Amendment,Open Space�'ormSA036) 0 On-Site Sewage System(form SAOI6) ❑Shoreline Administrative Variance(�orm SA037) ❑On-Site Sewage System Abandonment(�o.m SAO1�) ❑Site Plan Review(�orm SA038) REC „�� v ❑On-Site Sewage Evaluation (�orra,SAO18) ❑Special Use Permit (�orm SA039) ❑Water System Design(Group B or 2 Party)(�orm �Variance-Hearing Examiner(�orm SAD 0) JUN 21 2013 SA019) Q Well Site(form SA020) Revised 3-11 Form No. MA001 Thurston County Permit Assistance Center Master Application Page 2 of 3 Property Tax Parcel Number(s): 22729310700 Zoning: RR1/5 Acreage: 10.5 Subdivision Name(if applicable): BLA04104565TC Lot#: B Property Address: 10900 BALD HILL RD SE City: yELM State: WA Zip Code: 98597 Directions to the Property: GOING SOUTH ON HWY 507 THROUGH YELM TO RIGHT AT TRAFFIC LIGHT ONTO BALD HILL RD SE TO SITE ON LEFT. Property Access Issues(locked gate,code required,dogs or other animals): �No �X Yes If yes,Describe: LOCKED GATE-LOCK BOX ON LEFT SIDE OF GATE,CODE:3-6-0 OWNER IS RESPONSIBLE FOR�ECURING ANIlYIAI,S BEFORE SITE VISIT. Type or Print: Additional property owner sheet can be obtained online at ivww.co.thurston.wa.us/nermittinQ or copy obtained from the PermitAssistant Center. Property Owner(s): BALD HILL ROAD LLC CHAD HALTERMAN Mailing Address: 15705 92ND CRT SE City: YELM State: WA Zip Code: 98597 Phone#: (253)380-2954 Ext. Fax#: Cell#: E-mail: Signature:* Date: Applicant(if different than owner): Mailing Address: City: State: Zip Code: Phone#: Ext. Fax#: Cell#: E-mail: Signature:* Date: Point of Contact: JIM HENRY DESIGN SERVICES INC Mailing Address: PO BOX 14531 City: TUMWATER State: WA Zip Code: 98511 Phone#: 956-7242 Ext. Fax#: 956-7242 Cell#: 507-1267 E-mail: HENRYJIM@COMCAST.NET � Signature:* __�_;._., � Date: m5 -,Z - Revised 7-11 Form No. MA001 Thurston County Permit Assistance Center Master Application Page 3 of 3 BRIEF DESCRIPTION OF PROJECT PROPOSAL NEW CONSTRUCTION FOR PRIMARY MOBILE HOME AND FUTURE FMU BILLING INVOICES The base application fee charged at the time of application covers base hours listed on the fee schedule. When the base hours by a Department are used, a monthly billing invoice will be generated for additional hours at the hourly rate listed on the fee schedule. Should review of the project exceed the base hours allotted,billing invoices shall be mailed to: ❑X Owner ❑Applicant ❑Point of Contact �Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief,such information is true, complete,and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby b ant to the agencies to which this application is made or forwarded,the right to enter the above-described location to inspect the proposed, in-progress or completed work. I agree to start work only after all necessary permits/approvals have been received. Revised 3-Il FoTm No. MA001 h � �-�`,.�`�'`_� Thurston County Environmental Health _._.--�'`'f; `�_: 2000 Lakeridge Dr. SW Olympia,VJA 98502 --�� Y (360)867-2673/(360)867-2660(Fax) � TDD Line(360)754-2933 `I"�-TE_�€2,I�L'�: C c��'ti�(-s` �,.i ,lr.�;�l ��'c��i�:;i,.i �r��r��s�� —.— Supplemental Application ONSITE SEWAGE SYSTEM STAFF U5E ONLY DATE STAMI' 13 107484 H D =�:�b�fa�'�T(JN CQ�lJtV�Y Permit Type: On Site Sewage Systems Sub Type: On Site Sewage 5ystem Lot: B ��F`''�t�� site: 10900 BALD HILL RD SE YELM WA 98597 MqY 2� ZQ13 Assessor PropertylD: 22729310700 Applicant: BALD HILL ROAD LLC r'��Q�S�S��,�G� �GF�t'�� Owner: BALD HILL ROAD LLC �`��4�� vC � I o � C� C c - �.�:�� Intake b • �~ This application cannot be submitted alone.In addition to this form,a complete package includes: Ap U C�ant SUBNIITTAL CHECKLIST S Onl se QX Master Application_ ❑ � For new septic systems requiring a design: � a. Site plan(5 copies—11"X 1T'maximum size), 1"=20'or 1"=30'scale.(See attached checklist) b. On-site sew e s tic stem desi 3 co ies � For replacement of existing septic systems requiring a design:On-site sewage(septic)system design � 3 co ies . � For submittals not requiring a design: (examples: sand filter and/or mound rebuild using e�usting � design,septic tank or pump chamber replacement,septic tank placement):Site plan(3 copies—11"X 1T'm�iinum size . � For onsite sewage system projects within a city jurisdiction,the application must be taken to the city � for review and comment prior to submitting an application with Thurston County. If unable to obtain comments from the city,Environmental Heaith will route the appucation to the city. The project will be laced on hold until comments from the ci have been received. � Applicable processing fees.Refer to current fee schedules. Depending on the adopted fee � structure, additional ees m occur i base hours/ees at intake are exhausted. SEPTIC DESIGNER: Name: ��NRZ' Company Name: JIM HENRY DESIGN SERVICES INC Mailing Address: PO BOX 14531 City: TiJMWATER State: WA Zip: 98511 Phone#: 956-7242 Ext. Cell Phone# 507-1267 Fax#: 956-7242 E-mail Address: HENRYJIM@COMCASTNET Revised 5-9-11 Form No. SA016 Thurston County Environmental Health Supplemental Application for Onsite Sewage System Page 2 of 3 JURISDICTION: ��`�' � 0 Thurston County ❑City of Select City from List CTTY JURISDICTION REVIEW AND COMIVIENT: ❑Approved ❑Disapproved Y Comments: � �" � f.'. . �'�' % `. -_'�,C�. �� ' �� ' � "c.��CC �� Signature: �� i' l ?,� � �. -_ _��._T�tl�. f�w4i��C�e�� )� 1 Date: �i �.`� �� "' 1,�. �.� .� d'' � TYPE OF PROJECT: 0 Onsite Sewage System with Residential Site Plan Review (Project includes a new structure or addition/remodel to existing structure) [�Qnsite Seu�age System only(HD) (no cl�ange to structure that septic will serve) 0 Residential Single Family ❑ Residential-Multifamily #Units �Ton-Residential TYPE OF PERNIIT: 0 On Site Sewage System ❑Tank Only ❑Sand Filter and/or Mound Rebuild or Replace ❑Community Drainfield WORK TYPE: �x New ❑Repair of a Failure ❑Modification Upgrade Number of Bedrooms: 6 WATER SUPPLY: ❑Existing x�Proposed 0 Single Family well ❑Two Party well ❑Group A ❑Group B System Name of Community system ID# ACCESS: 0 Existing Access ❑Proposed Access ❑X Private Driveway ❑Shared Driveway ❑Private Road (list name of road,if applicable) Ox Public Road BALD HILL RD (list name of road,if applicable) PROPERTY INFO: Water on or within 300' of property: ❑None ❑Salt �RiverlCreek/Flood Zone ❑Lake/Pond ❑Wetland�Ditch Name of body of water: FLOOD ZONE ACROSS ROAD WITHIN 20(?FT OF SW PROP CORNER Has the property ever flooded? ❑No �Do not know ❑Yes,when? (//rc•ti. s�r�rnr<ar��a�,rt ��Cr��i:r�e� Slopes greater than 20%? ❑No ❑Yes APPEAL: A�person aggrieved by a decision,an inspection,or notice made by the Health Officer shall have the right to appeal the matter as specified in Article 1 of the Thurston County Sanitary Code. EXPIRATION: Sewage System applications expire one year from date of application per Thurston County's Sanitary Cod,Article IV, Section 9. This period may be eartended for a single one-year period without charge,if specifically requested by the applicant prior to the eapiration date. Revised 5-9-11 Form No. SA016 � l �l� f�'I ��JIM HENRY DESIGN SERVICES, INC. THURSTON COUNTY HEALTH DEPARTMENT ON-SITE WASTEWATER DISPOSAL SYSTEM DATE: May 29, 2013 APPLICANT: BALD HILL RD LLC. (CHAD HALTERMAN) 15705 92ND CT. SE YELM, WA 98597 �� LEGAL: TR B OF BLA 04104565TC �,�°"" ,T�F2T �?,Q�I� PARCEL#: 22729310700 � 1z ��.''F� JIM HENRY , � I.ICENSED DESIGNER PROJECT#: ExPiRES: �oLi i i�fy DESCRIPTION: NEW CONSTRUCTION PROJECT DETAILS: �'�11R$�'QN C�U]�'��( NUMBER OF BEDROOMS 6 �'�G��D GALLONS PER DAY(GPD) FLOW 72� MAY 29 2013 APPLICATION RATE 0.80 ��°��'�S5lSTANGE C�NTER DRAINFIELD -Absorption Area Required 900 SQ.FT -Absorption Area Designed 900 SQ.FT -Trench/Bed Length 100 FT -Trench/Bed Width 9 FT DRAINFIELD CROSS SECTION - Depth below Original Grade 36 INCHES - Graveless Chambers 12 INCHES - Sand under Trench/Bed O INCHES -Vertical Separation 30 INCHES - Fill Depth 24 INCHES SEPTfC TANK - Size & Composition 1200 GAL CONCRETE - New/Existing New G � ��J `� JIM HENRY DESIGN SERVICES, INC. APPLICANT: BALD HILL RD LLC. (CHAD HALTERMAN) DATE: May 29, 2013 PARCEL #: 22729310700 PRESSURE SYSTEM - 6 LATERALS System Parameters Pressure Calculations Orifice Size 3/16 inches Minimum Orifice Discharge Rate 0.62 gpm Residual Head at Last Orifice 2 feet Total Lateral Length 294 feet Orifice Spacing 2 feet Number Orifices Lateral 1 25 Number Orifices Lateral 2 25 Number Laterals 6 Number Orifices Lateral 3 25 Lateral 1 Length 49 feet Number Orifices Lateral 4 25 Lateral 2 Length 49 feet Number Orifices Lateral 5 25 Lateral 3 Length 49 feet Number Orifices Lateral 6 25 Lateral 4 Length 49 feet Total Discharge Rate 93.00 gpm Lateral 5 Length 49 feet Lateral 6 Length 49 feet Friction Loss Pipe Class 200 TighUine Friction Loss 4.18 feet Lateral Line Size 1.25 inches Manifold Friction Loss 1.85 feet Lateral Elevation 353 feet Lateral Friction�oss 1.06 feet Friction Loss through System 7.10 feet Manifold Length 6 feet Manifold Size 1.5 inches Dynamic Head Residual Head at Last Orifice 2 feet Elevation Difference 3 feet Add-on Friction Loss 0.2 feet Elevation Difference 3 feet Tightline Length 40 feet Friction Loss through System 7.10 feet Tightline Size 2 inches Total Dynamic Head Loss 12.30 feet Add-on Fric6on Loss 0.2 feet Total Discharge Rate 93.00 gpm Total Dynamic Head 12.30 feet Drain Down Calculation: If orifice orientation is 12 0'clock,the following calcula6on does not apply. Orifice Orientation 12 0'Clock Length of Pipe 294 feet Liquid Volume in Pipe 27.05 gal Drain Down Volume 13.52 gal �4� a 7X Volume 94.67 gal �o�WU��,,� Dose Volume 40 ��'" � �' S'�g��' i000i ��s�F Dose volume meets 7X rule: N/A o�' JIM MENRY � �ICENSED 4ESIGtJER i�. EXPIR�S: 08/11/�� G-=�� .y �� 'r�JIlVI HENRY DESIGN SERVICES, INC. APPLICANT: BALD HILL RD LLC. (CHAD HALTERMAN) DATE: May 29, 2013 PARCEL #: 22729310700 PRESSURE SYSTEM - 3 LATERALS FROM INDEXING VALVE TO DRAIN FIELD System Parameters Pressure Calculations Orifice Size 3f16 inches Minimum Orifice Discharge Rate 0.62 gpm Residual Head at Last Orifice 2 feet Total Lateral Length 147 feet Orifice Spacing 2 feet Number Orifices Lateral 1 25 Number Orifices Lateral 2 25 Number Laterals 3 Number Orifices Lateral 3 25 Lateral 1 Length 49 feet Total Discharge Rate 46.5 gpm Lateral 2 Length 49 feet Lateral 3 Length 49 feet Friction Loss Pipe Class Z00 Tightline Friction Loss 1.16 feet Lateral Line Size 1.25 inches Manifold Friction Loss 0.51 feet Latera►Elevation 353 feet Lateral Friction Loss 1.06 feet Friction Loss through System 2.74 feet Manifold Length 6 feet Manifold Size 1.5 inches Dynamic Head Residual Head at Last Orifice 2 feet Elevation Difference 3 feet Add-on Friction Loss 0.2 feet Elevation Difference 3 feet Tightline Length 40 feet Total Dynamic Head Loss 7.94 feet Tightline Size 2 inches Total Discharge Rate 46.5 gpm Add-on Friction Loss 0.2 feet Total Dynamic Head 7.94 feet ADD ON HEAD FOR INDEXING VALVE 6.0 feet �..��a"'"'� �If/b1 � l Drain Down Calculation: If orifice orientation is 12 0'clock,the following calculation does not apply. Orifice Orientation 12 0'Clock Length of Pipe 147 feet Liquid Volume in Pipe 13.52 gal Drain Down Volume 6.76 gal �,�' �� 7X Volume 47.33 gal ��,�'ot,„ „�� Dose Volume 40 �=�/ � ?� �S-� �(—/,� 6 ,<,�. ti�� 510001 � Dose volume meets 7X rule: N/A o`'�_ ��M HENRY � LICENSED DESIGNER EXPIRES: 08/11/�� so � G O P5015 � Series 1/2 hp to 1-'t/2 hp�� »o � � � �� P5010 _ ; ... � c t00 � � I � P�7 i i � � � ( d � � Z � I E — - ; c� � i O 60 P5a15 � F° ' � �o � � � � ; ; ' � � i � 0 0 10 2(1 30 40 50 60 7t1 Gallons per Minute(gpm) "��S � � �tV�4�FWKM �F SE/ll.ED RISERS TO SURF�I�CE �� Z�, s;z c�_�,3 � 51000121 �'F • JIM HENRY �' � . � LICENSED DESIGIJER � YW J�G�OC. . - . 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