HomeMy WebLinkAboutBLD2025-00055 ADU2024-00016 - BLD Application - 1/16/2025 Permit No l bOWas-00055
MASON COUNTY RECEIVE®
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning JAN 16 2025
BUILDING PERMIT APPLICATION 615 W. Alder W
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: J Aso,, ZGL,IL NAME: S flW16
MAILING ADDRESS: l0"10 g LA51c rt or MAILING ADDRESS:
CITY: S ke 1tu STATE:, ZIP: CILt} CITY: STATE: ZIP: ou
PHONE#1: jCoo- Aqb- 6-1%1 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: ' S o h 0.f ,a (r kk,%%r, .c c r L&I REG# EXP._/ /_
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ r
NAME 5Prme EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) `I Z 22 2 0 Q ZQ ZONING
LEGAL DESCRIPTION(Abbreviated) �` FIRE DISTRICT
SITE ADDRESS I o 10 � t,AS 0t 6;v�,t tVt 1 Vt- CITY 5 ine k)r-a.
DIRECTIONS TO SITE ADDRESS
1 f Yo-� Ny1;
w 0, ri!�1 r OA} CLaAIIQLS5�
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YEVK NO❑ SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chentall rhai appy):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW(K ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Resrdorcro,Gauge,Caeseerria/Bldg Ex.) A Q U - C1 V-t5+ h a.JSt
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Pangs)oJB1dg)V NO❑
DESCRIBE WORK eti> ROV ,)i 6lA0.(A ' a
SQUARE FOOTAGE:Ompowd)
I ST FLOOR1 I�sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft BASEMENT sq.R
DECK N.ft. COVERED DECK N.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE_sq.ft. Attached Detached❑ CARPORT _sq.ft. Aaached❑ Detached❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTTNGO�
PLUMBING IN STRUCTURE? YEt�f NO❑ Ijyes,attach completed Water Adequacy Form
PERIMETERIFOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS Z PROPOSED BEDROOMS___A— TOTAL BEDROOMS_
OWNER admaMedpes#w anamsaion of imamate oft maYm may result in a stop work order or permit revocation.Admowledgemert of such is by
sipnMre below.I ceders OW I am#M avow and I h~declare to I am ern"I b receive 8*permit and 10 do to vrork es proposed.I have
obtained pemdueonkom sift necessary Parties,wwkrdn0 any easerrwd holder or perties of interest regrdii Ifis pnojed.The owwer or legd
reprasefdogve,repreaeris that the tnforr wdon provided is accurate and grants employees of Mason County access to Ow above described property
and slnchss(s)for review and Inspedbn.This pertn#fappicallon becomes mD d void if work or authorized conatuction is not commenced nced wifim 180
days or if canabuc6o n work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACITVITY OF THIS
PERM APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) t
Signature of OWNER(Must be slaved by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE I DENIED DATE TAGS/NOTES/CONDMONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
Permit No: -
MASON COUNTY
COMMUNITY DEVELOPMENT RECEDED
JAN 16 2025
mp
Permit Assistance Center, Building,Planning
615 W. Alder Steet
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: 3«sc,, Ze_c NAME: SAyy%t✓
MAILING ADDRESS: I o-lo & Lc.�\e Vbr MAILING ADDRESS:
CITY: SV lk-,a, STATE: Vacs ZIP: clj cV q CITY: STATE: ZIP:
1`PHONE: PHONE: CELL:
2°1 PHONE: EMAIL :
EMAIL:� L&I REG# EXP. I /
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): �'L 1 ZZ- li Z- O 00 Za Zoning:
LEGAL DESCRIPTION(Abbreviated):
SITE ADDRESS: CITY:
DIRECTIONS TO SITE ADDRESS:
Fry N— WN �-U/vv 0-.. C—Sk 'P"ry of- aw A tool, l� CJJIr*-SS 0—
TYPE OF JOB:
NEW®ADD=AL'I=REPAIR=OTHER=USE OF BUILDING C-1ue5t V.Q.,c'm-
LOCATION OF FIXTURES/UNITS-ffr FLOOR=2ND FLOOR=BASEMENT=GARAGE=OTHER=
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
rvae of Fixture No.of Fixtures Fees Fuel Type:Electric=LPG=Natural Gas[�Ductless®
Toilets Type of Unit No.of Units Fees
Bathroom Sink y Furnace
Bath Tubs I Heat Pump
Showers 1 Spot Vent Fan
Water Heater Propane Tank Q
Clothes Washer I Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher 1 Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is
by signature below. I declare that I am the owner,owners legal representative,or contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of
interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of
Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void
if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF
OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL IN=---Z-l
HE APPLICATION.
X I- 1(-0 - 2
Signature of Owner Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev:1/27/2016 JBN
\\\� �`�.i I o i o E �s•e4�`oi..k�r
EH APPROVED
Rhonda Thompson 02/03/2025
i
�}2122-12-00020
EH Setbacks ftAZZLH-000�ro
A.) Drainfield/Reserve requires 10'setback from tooting/foundations
/ B.)Septic tank(s)requires 5'setback from all footing/foundations
t r� C.)No foundation/Perimeter Drains within 30ft,downgradient of
+ l ( Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area
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Name Parcel# 4 -172- 1 Z— O yo zo BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment', with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area All dimensions in feet
Buildings X
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
D
riveways X
X = Length of drive begins at the right of way
X =
Areas X
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X
X = Any paved, gravel or packed area per definition
above table
X =
Others X
X If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read, acknowledge and sign below.
Based Upon the information you have provided a Stornrwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/A aent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
41- N
Name Parcel# 4-L\1 z— j 2— O O O z0 BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stornnvater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website:
http//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stonnwater Site Plan". This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stornmater•Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) e relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
n err entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
13) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT. 450
Mail: P 0 Box 1850, Shelton WA 98584
Physical: 415 N 6th St, Shelton WA 98584
If this development has, or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other, parcel. You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT. 352
Mail: P 0 Box 1666, Shelton WA 98584
Physical: 426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
describr-21
ty for review and inspection as may be required.
K Owner Agent/Contractor(circle one)Date:
Page 2 of 2
e �
For Mason County Permit Center use:
MASON COUNTY
COMMUNITY SERVICES ADU nn0l lo/.
Recv'd by: �Irl L Planner: a0L";Vi_
Building,Planning,Environmental Health,Community Health
615 W Alder St.,Bldg 8,Shelton, WA 98584 Date Stamp Recv'd.
Shelton Phone: (360)427-9670 ext 352 ❖ Fax (360)427-7798
ACCESSORY DWELLING UNIT PERMIT RECEIVE?
(Special Use Permit with ADU criteria) UEC 17 20
4
615 W. Alder TA
�
Permit and Fee:
ADU Special Use Permit application fee: $ ,
o
*If ADU is within 200'of a shoreline you must apply for a Shoreline Substantial Development Permit(SHR)—fee:
$880.00 - Environmental Health fee: $ 0
In rural lands, accessory dwelling units (ADU) are subject to a special use permit, unless in the shoreline
jurisdiction, it is subject to a shoreline permit. A "Special Use" is one that possesses unique characteristics
due to size, nature, intensity of use, technological processes involved, demands upon public services,
relationship to surrounding lands, or other factors. The purpose of this application is to provide for
adequate oversight and review of such development proposals, in order to assure that such uses are developed
in harmony with surrounding land uses, and in a manner consistent with the intent of the Development
Regulations for Mason County; Ordinance No. 82-96. Acceptance of this application by Mason County does
not guarantee approval of request.
Applicant(s) Name Jason Zack
Mailing Address: 1 070 E Eagle Point Drive
Shelton, Wa. 98584
Phone: 360-490-6711 E-mail:jason@arcadiadrilling.com
Property Owners Name: (if different than applicant)Same
Site Address: 1070 E Eagle Point Drive
Brief Legal Description: TR 2 OF N 1 /2 NE
Tax Parcel #: 42 22 _12 _00020 Zoning: 0
Project Description:
New one bedroom ADU with attached garage
Rev.January 2018 ADUPermit Page 1 of 4
1
❑ SITE PLAN CHECK-LIST Please provide a site plan that includes the following:
❑ Indicate Scale and North Arrow.
❑ Property line dimensions, easements, and right-of-ways.
❑ The location of all existing and proposed structures. Include square footage of existing and proposed structures.
❑ Setback distance, in feet from all property lines and structures.
❑ Existing and proposed road access to and from the site.
❑ Parking spaces.
❑ Location of OnSite Sewage System (OSS) components (including tanks, drainfields, reserve areas, etc.)
❑ Location of existing and proposed wells, within 100ft. of property, shown with 100ft. radius.
❑ Location of existing and proposed waterlines.
❑ Steep bluffs, wetlands, streams, and bodies of water.
❑ Surface and storm water run-off routes.
Mason County Code Title 17.03.029 requires the following criteria to be met for
consideration of an Accessory Dwelling Unit (ADU) Permit:
ACCESSORY DWELLING UNIT (ADU) REQUIREMENTS YES NO INFORMATION
1. Is the ADU in a shoreline jurisdiction? ❑ 0
Please inquire with Mason County
1 a Are you in the Flood Plain? ❑ ❑ Community Services staff, if unsure.
2. Will the owner of the lot reside in either the principal ❑ ❑
residence or the ADU?
3. Will till the ADU be located on the lot of the principal ❑ ❑
residence or be a conversion of an existing detatched
structure (i.e. garage);
4. The ADU shall not exceed 80%of the habitable area of the primary
residence or 1,200sq feet,whichever is smaller.An existing residence can Elbe converted to an ADU with the development of a new primary residence,
171 the ADU shall be no more than 80%of the area of the primary residence
and up to 1,500sq ft.Will your proposed ADU meet this criteria?
Please inquire with Mason County
5. Will the ADU meet all setback requirements? ❑ Communi Services staff, if unsure.
Please see last page of this packet
6. Will all applicable health district standards for water and ❑ titled "ADU Environmental Health
sewer be met by the ADU? Requirements"
Rev.January 2018 ADU Permit Page 2 of 4
7. Recreational vehicles are not allowed as ADUs. Please
confirm (with YES)that you are not submitting a
Recreational vehicle for review.
8. Your property will only have one 1 ADU? F-. 1 ❑
9. You have provided an additional off-street parking space El ❑
for the ADU?
(Ord.108-05 Attach B.(part),2005)
❑ On a separate piece of paper(#of pages: ), state your reasons for requesting an Accessory
Dwelling Permit and be sure to address the following six criteria. Your request will be evaluated based on
these criteria and the Accessory Dwelling Unit Requirements from the previous section.
1. Will the proposed use be detrimental to public health, safety, and welfare?
2. Will the proposed use be consistent and compatible with the intent of the Comprehensive Plan?
BPS
3. Will the proposed use introduce hazardous conditions, at the site, that cannot be mitigated through appropriate
measures to protect adjacent properties and the community at large?
4. Is the proposed use served by adequate public facilities, which are in place, planned as a condition of approval
or as an identified item in the County's Capital Facilities Plan?
-k!+7 z
5. Will the proposed use have a significant impact upon existing uses on adjacent lands?
6. If located outside of an Urban Growth Area, will the proposal result in the need to extend urban services?
Applicant's Signature Date
Rev.January 2018 ADUPermit Page 3 of 4
MASON COUNTY
COMMUNITY SERVICES
Ruildinq,i'Innninq,Fnvlrnnmental Health,Canmun+ty HPdltn
ADU ENVIRONMENTAL HEALTH REQUIREMENTS
YES NO INFORMATION
1.Will the ADU be served by an EXISTING Onsite Sewage System(OSS)? ® O S WG1a0 f -00 1Ra
OSS's are sized off bedrooms.
Refer to the onsite sewage records
1(a). Total bedroom count from existing and proposed connected structures Q on file with Mason County to find
If
match the approved OSS records on file? your approved size.
bedroom count exceeds system size,
contact a licensed septic designer
for upgrade options.
OSS application and design permit
2. Will the ADU be served by a NEW Onsite Sewage System(OSS)? O Q must be submitted and approved
prior to EH approval of ADU
permits
-Foundation to Drainfield(s):1 Oft
-Foundation to Reserve Area(s):
'Oft
3. Will the ADU meet all setbacks to new or existing OSS components? Q -Foundation to Septic Tank(s): 5ft
Down gradient
Foundation/perimeter drains must
maintain 30ft to Drainfields.
Attach a signed Sewer Adequacy
4. Will the ADU be served by a NEW c6iXISTING sewer connection? O Form from Sewer System Manager
to this application.
5. Will the ADU be served by a NEW or EXISTING public water system Attach a signed Water Adequacy
O(over 3 connections)? Form from Water System Manager
to this application
6. Will the ADU be served by an EXISTING private well? � Q
Well must be permitted and
7. Will the ADU be served by a NEW well that is not constructed yet? Q a constructed prior to EH approval of
ADU permits.
Mason County Code Title 17.03.029 requires EH approval prior to approval of ADU permit.
Environmental Health Review Pre-approval:
Comments: TyO,PA9_V
o *y sus-I- APPROVED
VIELR0a4-0o0l JAN 06 2025
�G I �1n1 �✓� i��(l�ded MASON COUNTY ENVIRONMENTAL HEALTH
RET
pW—(-r\h(jti y —4 I bd ft" (EH approval stamp with Initials of EHS)
�I hdl o SS ��r��P►�-d
ADUPermit Page 4 of4
Mason County
Planning Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
[PROJECT
DU2024-00016 ACCESSORY DWELLING UNIT
(PLANNING)
DESCRIPTION: 1198 SQ FT ADU ISSUED: 01/14/2025
E ADDRESS: 1070 E EAGLE POINT DR SHELTON
EXPIRES: 07/13/2025
PARCEL: 421221200020
APPLICANT: ZACK JASON L&KELLY J OWNER: ZACK JASON L&KELLY J
1070 E EAGLE POINT DR 1070 E EAGLE POINT DR
SHELTON,WA 98584 SHELTON,WA 98584
360-490-6711
FEES: Paid Due
Development Regs. -Accessory $240.00 $0.00
Dwelling Unit(ADU)
Change in Tenant- Minor EH $135.00 $0.00
Plan Review
Totals : $375.00 $0.00
CONDITIONS
" Permit approves the use only. Structure must be reviewed and approved under a building permit prior to construction and
is subject to all regulations.
" There shall be only 1 ADU per lot
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to give authority to violate or cancel
the provisions of any other state/local law regulating construction or the performance of construction.
Issued By: Ainkol f, �1'18011
Contractor or Authorized Agent: _W O I L d Date: 1 ,114 bwE,
Printed by:Annie Wilson on:01/14/2025 02:16 PM
Page 1 of 2
Mason County
Planning Division of Community Development
� �� 615 W. Alder St.
`t Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ACCESSORY DWELLING UNIT (PLANNING) ADU2024-00016
Printed by:Annie Wilson on:01/14/2025 02:16 PM
Page 2 of 2
� I
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PROJECT TITLE
ZACK DADU
i (E)GRAVEL SITE PLAN
DRIVEWAY v
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3601 \\ PROJECT ADDRESS
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I 1071 E EAGLE POINT DR
INGLE Y \ SHELTON,WA 98584
RESIDENCE i 2
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DATE 2024.0829
GRAPHIC SCALE I i TANK
37.50 0 75 150 300 I \
(E)VI` TER '
1INCH=150 FT. (N)DADU \ $.0T SITE PLAN
E)TRAN FOR ER \\\
PROJECT INFORMATION
y' 188.40'
PROPERTY OWNER: ZACK,JASON 8 KELLV ' 25 W \ \� 1 I DRAWN S.RODRIGUEZ
CHECKED
PROJECT# 24-104
TAX PARCEL NUMBER: 421221200020 I \ ' I SHEET SCALE AS NOTED
PROJECTADDRESS: 1071 E EAGLE POINT DR L---- --------- -------- --- -- ---- (A----- - I SHEET NUMBER
SHELTON,WA 98584
ZONING: RR-10 I ? ,// I 1 .0
o
JURISDICTION: MASON COUNTY --�—� ��---------------- emr 4rAl F SHEET 1 0� 1
27 20 0 20 40 80
PARCEL ACREAGE. 7.47 ACRES M ��� {
1INCH=40 FT.
415 N 6TH STREET, SHELTON WA 98584
MASON COUNTY SHELTON: 360-427-9670, EXT. 400
COMMUNITY SERVICES BELFAIR: 360-275-4467, EXT. 400
9u.1dr,q.Ptirr inq.Enwonmenta:Health,Community Health ELMA: 360-482-5269, EXT. 400
FAX: 360-427-7787
June 27, 2018
Active Underground
RE: Design for ZACK
Case No: SWG2018-00198
Parcel No: 421221200020
Your on-site sewage system design for the above referenced parcel has been reviewed and is
APPROVED. The system must be installed by a Mason County Certified Installer. A list of installers is
available on the Mason County Public Health WEB page at www.HealthyMasonCounty.org Select
Environmental Health, then On-site Sewage Systems.
In some cases, homeowners may be allowed to install their own system. Prior written approval by
Mason County Environmental Health is required. Failure to follow the Mason County homeowner
installation procedure may create additional fees and/or permitting requirements.
Please refer to the comments section of this letter for any additional information.
Please call me at (360) 427-9670, ext. 279 if you have any questions.
Sincerely,
2a-
Alex Paysse
Environmental Health
Mason County Public Health
COMMENTS: One observation port to bottom of sand required. Liner or 6" of sand required on sides of
D/F per Sand Lined RSnGs. See Cross Section notes.
6/27/2018 Page 1 of 1 SWG2018-00198
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH DATERECENED S_ —
to D
ONSITE SEWAGE SYSTEM APPLICATION AMOUNT REC IVED: RE�E ca CA
PO Box 1666,415 N 6th Street,(Bldg 8) Shelton WA,98584 G• < cn
Shelton:360�127-9670 ext 4OO Belfair:360-275-467 ext 4W 0
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APPLICANT PHONE 3
m m
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE r
vo Z
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SITE ADDRESS-STREET.CITY,ZIP CODE W
X XX wo.
NAME OF DESIGNER 4iONE I�
' It`s NAME OF INSTALLER PHONE
U6" -Ak—LAZ6—<A'-e--7-7
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 0
` i NEW CONSTRUCTION ❑ RV HOLDING TANK ONLY 01f PRIVATE INDIVIDUAL WELL y
❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY ❑ PRIVATE TWO-PARTY WELL Z 1
❑ TABLE 9 REPAIR �;SINGLE FAMILY ❑ COMMUNITYIPUBLIC WATER SYSTEM 11(\J
❑ TANK(S)ONLY ❑ COMMERCIAL SYSTEM NAME: I I
❑ UPGRADE TO EXISTING ❑ OTHER: BEDROOMS LOT SIZE I'
❑ EXISTING FAILURE "Record Drawing required � ED
for all Installations" OO r II V
DIRECTIONS TO SITE-B SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex.locked ga(e) O 1
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I O
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for ,reportirg purposes)
❑VOLUNTARY ❑MAINTENANCEJPUMPING ❑BUILDING PERMIT ❑HOME SALE []COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
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MAY g
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SOIL CODES: BY---- ----
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
INSP�CTOft Sly URE DATE APPLICATION EXPIRATION DATE APPU ATION APP VE BY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISEb YM015
DESIGN FORM—PAGE ONE Assessor's Parcel Number:l�2 Z ? -- Z -- 0 O Q Zd
A design will be reviewed when 3 co pi 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 ma be scanned and available for ubilc view on the Mason County Web site.Maximum E=r size: 11"X 1 7"
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Permit Number. SWG Zo 1 F3 —(Y)` Designer's Name: J 1v l Q
Applicant's Name: Designer's Phone Number:
Mailing Address: Designer's Address: d 48,3
C► State Zi Ci State Zip
�-�'�12iyi :..'K' ,I�, q_.::..f�A'r:'�, ..S`� , '� A.,$•.�T`s P z i:4.3 ;.
Treatment Device
❑Glendon Biofilter ❑Sand Filter ❑Mound Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity Pressure ❑Trench KBed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 14 Schedule/C-ims 140
Daily Flow:Operating Capacity a00 gpd Length Li(9 ft
Daily Flow:Design Flow gpd Diameter UL5 in
Septic Tank Capacity `Z ` gal Number 3
Receiving Soil Type(1-6) Separation —
Receiving Soil Appl.Rate 'o gpd/ft' Orifices
Required Square Footage _)494 ` ft, Total Number of Orifices �( 2
Designed Square Footage no ft, Diameter Ize in
Percent Reduction Taken _ % Spacing 'Zy in
Trench/Bed Width ft Manifold
Trench/Bed Length LAg ft ScheduleAC-iws
Elevation Measurements Length g ft
Original Drainfield Area Slope j?S % ameter Z in
New Slope,If Altered % Preferred manifold configuration used? gYes ❑No
Depth of Excavation UP-slope Z Il D Transport Pipe
from Original Grade Down slope -Zt i c edule/Gless LAd
Designed Vertical Separation i n�tlt' q(p ft
Gravelless Chambers Required? ❑Yes P(No ❑Optionall Diameter Z in
Pump Required? KYes ❑No B 1- r y� Dosing and Pum Chamber
Pump/Siphon Specifications Number of doses/day
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity !pQ gal /
Orifice & ft Chamber Capacity ''? gal
Uppermost Orifice Higher ❑Lower than Pump Shutoff mp controls:Please check those required.
Capacity @ Total Pressure Head 32_7 gpm Timer XEIapse Meter Event Counter
Calculated Total Pressure Head �.$ ft If Timer: Pump on 1 mia-solct,Pump off q hew.
Comments e`b ` _0-
' ► 9
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DESIGN FORM—PAGE TWO Assessor's Parcel Number:�A_%Z Z-- , Zr -- _Q�_Q��_o
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
1�( Test hole locations Drainfield orientation and layout Reference depth from original grade:
Soil logs Tx=wJ bed dimensions and Septic tank
Property lines critical distances within layout Drainfield cover
Existing and proposed wells -B-Bek/Valve box locations Reference depth from original grade
within 100 ft of property Septic tank/pump chamber and restrictive strata:
Measurements to cuts,banks,and locations X Laterals,trenchibed,top and
surface water and critical areas Observation port location bottom
Location and orientation of Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Manifold placement ❑ Sand augmentation
components
'� Orifice placement Other cross-section detail:
Location and dimension of OC Observation ports/clean-outs
primary system and reserve area � Lateral placement with distance
to edge of bed Other Information
Buildings Audible/visu referenced Yes No
`rDirection of slope indicator
Scale of d wn on scale ❑ Design staked out
Waterlines bar ❑ ❑ Recorded Notices attached
Roads,easements,driveways, ❑ ❑ Waiver(s)attached
parking j, $C ❑ Pump curve attached
North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar s'oo� Non-residential justification
JN k ME ALF ❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be Etf y 1 talle f installation XYes ❑ No
0-iZz
ignature of Designer Date
The undersigned reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local op-sir regul do s:
(DZ�
Envhronment,4 Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. ff
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is����
✓ 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. Z/Cl
This form may be scanned and available for public view on the Mason County Web site.
Revision Date: 1/12/2010
EAGLE POINT DRIVE.APPROX.EASEMENT
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%1ASCN COUNTY ENV RONMENTAL HEALTH
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PROPOSED WELL LOCATION
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PUMP TAN LOCATION
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PROPOSED io'x48'
PRIMARY DRAINFIEL
RESERVE AREA
0-5"FOREST FLOOR SEPTIC SYSTEM SITE PLAN
5"-6o"GRAVELLY LOAMY SANDS FOR:ZAC&JASON JOB# 2018
o-4"FOREST FLOOR PARC#42122-12-00020 DATE: 05/22/2018
4"-57"GRAVELLY LOAMY SANDS BY:JM DESIGN PAGE-3-OF
NORTH ARROW: SCALE: 1"=6o'
ACTIVE UNDERGROUND LLC o 30 6o 120
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6"LATERAL CLEANOUT/OBSERVATION PORTS
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DRAINFIELD LAYOUT DETAIL
FOR ZACK,JASON PROJECT#2018
PARCEL#42122-12-00020 DATE: 05/22/2018
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BY:JM DESIGN PAGE_�OF�_
NORTH ARROW: SCALE: 1"=7.5'
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ACCESS RISER/TANK CONNECTION DETAIL 24"ORENCO GASKETED BOLT
DOWN LIDS
RISER EFFLUENT FILTER
CAULK RISER TO CAST IN RING OSI 4"BIOTUBE
TANK
TWO WAY CLEANOUT FINISH GRADE
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120o GALLON SEPTIC TANK DETAIL
• EXCAVATION BOTTOM TO BE LEVELED AND COMPACTED Fl ^JLl I G TANK. FOR:ZACK,JASON PROJECT#2018
• TANK TO BE MANUFACTURED WITII CAST IN SEAL BOOTS ON PLUMBING PENETRATIONS. PARCEL#42122-12-00020 DATE: 0• TANK TO HAVE 24 INCH ACCESS OPENING OVER EACH COMPARTMENT. 5/222018
• COMPACT ALL BACKFILL MATERIALS TO PREVENT SETTLING AROUND TANKS AND PLUMBING. BY:JM DESIGN PAGE�Q_OF _• ACCESS RISERS MUST BF.INSTALLED TO THE SURFACE.
NORTH ARROW:N/A SCALE:PER MANUFACTURER
ACTIVE UNDERGROUND LLC
ACCESS RISER/TANK CONNECTION DETAIL
24"ORENCO GASKETED BOLT•
DOWN LIDS
RISER ELECTRICAL J-BOX
CAULK RISER TO CAST IN RING CONTROL PANEL:ORENCO MVP
FLOAT TREE
f TANK
BALL/CHECK/UNION
VALVE COMBO
INSTALLED ON r
PUMP DISCHARGE
FINISH GRADE #
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EFFLUENT LINE '
INLET - ZIP TIE EXCESS CORDS
BAFFLE.INSTALLED ON INLET
EMERGENCYSTORAGE
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WORKING VOLUME
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EFFLUENT PUMP:SEE PUMP
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2oo GALLON PUMP TANK DETAIL
"DEXCAVATION BOTTOM TO BE LEVELED AND COMPACTED PRIOR TO SETTING TANK.TANK TO BE MANUFACTURED WITH CAST IN SEAL BOOTS ON PLUMBING PENETRATIONS. ARCEL#42122-12-00020 DATE: 05/22/2oi8
• TANK TO HAVE 2-24 INCH ACCESS OPENINGS FOR EASE OF PUMPING AND MAINTENANCE.
• COMPACT ALL BACKFILL MATERIALS TO PREVENT SETTLING AROUND TANKS AND PLUMBING. +
• ACCESS RISERS MUST BE INSTALLED TO THE SURFACE. ,, _ ,' BY:JM DESIGN PAGE 'T OF�_
• ALL RISER PENETRATIONS TO HAVE GROMMETS INSTALLED TO ENSURE WATER TIGHTNESS. NORTH ARROW:N/A SCALE: PER MANUFACTURER
ACTIVE UNDERGROUND LLC
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P.O. Box 1552
Shelton,Wa 98584 Office: 360-426-9277
INSTALLATION NOTES
N27 2018
Pressure Distribution System:I'Asn� '"'-'`�'"` 18
HEAL rr,
1. The prepared site plan is not a survey. It's the owners responsibility to verify property
lines prior to installation.
2. Install system during dry weather and soil conditions.
3. Time of installation final inspection and as-built will need to be completed by the
designer.A fee of$300.00 for this service will apply.
4. Keep wheeled vehicles off the drainfield area before,during and after installations.
Tracked equipment only.
5. All ground, surface water and roof drains must be diverted away from the tanks and
drainfield. Ensure the final grade slopes away from these areas and water doesn't pool
on or around them. Use swales,berms, along with catch-basins and tight-lines,
curtain drains,ect.to divert ground and surface water.
6. Curtain drains can be no closer than 1o'uphill or 30'downhill from the drainfield.
7. Exposed restrictive layers,cuts,banks, ect. can be no closer than 50' downhill from
the drainfield.
8. Install two 24" access risers on both the septic tank and pump tank.
9. Make sure access risers are epoxyed or caulked to cast in riser rings on tanks.
1o. Lids must form a water and gas-tight seal with the access risers.
11. Install effluent filter specified in this design at the septic tank outlet.
12. Install control panel specified in this design.
13. Install check-ball valve with union on pump discharge in pump tank riser.
14. If drainfield is lower than the pump, install an anti-siphon valve in the pump
discharge above the high level mark.
15. Install pump in a vault/ pump silo designed to draw effluent from 18"off the bottom
of the pump tank.
16.This system must be installed by a licensed septic systems installer.
17. Deviation from this design without prior approval from the Designer and County
Health Department will make this design null and void.
System Owner Responsibilities:
i. Operation and Maintenance is required by the state of Washington and the county for
all septic systems.
2. A current list of certified 0&M technicians is available from the County.
3. System owners are responsible for having maintenance performed according to the
schedule set forth by the County.
4. System owner is responsible for responding to septic issues and alarms in a timely
manner.
5. System owner shall not at any time change or alter setting in the control panel, Only
certified maintenance providers should perform these changes.
6. System owner agrees to read and abide by information regarding their system in User
Manual provided by the County.
��a
Jason Zack
1070 E Eagle Point Dr
Shelton, Wa. 98584
1-360-490-671 1
Mason County Community Services
To whom it may concern,
I would like to build a new one-bedroom house with an attached garage next to my
existing five year old house.
The existing home is supplied by a private well and a four-bedroom septic system that
will support the connection to both from this new building.
Our Previously supplied Geotechnical engineer report included this area for the ADU
inside his original approved building area.
Thank You,
Jason Zack