HomeMy WebLinkAboutswg2025-00095 - SWG Application / Design - 3/25/2025 MASONCOUNTY 415NB SHELTON: , 0427-97 ,EXT400
$HELTON:360-2759 70,EXT 400
BE ELMA:360482-5269,EXT 400
Public Health & Human Services ELMA:360<82-5289,EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2025-00095
APPLICANT POWELL CODY D &STEPHANIE L Phone:
Address: 16014 BAY RIDGE OR POULSBO,WA 98370
OWNER POWELL CODY D&STEPHANIE L Phone:
Address: 16014 BAY RIDGE DR POULSBO, WA 98370
SEPTIC DESIGNER Alex Paysee' Phone: 360426-1803
Address: 3083 E Mason Benson Rd GRAPEVIEW,WA 98546
SEPTIC INSTALLER TBD Phone:
Address: 123 XXX XX, XX. 00000
Site Address: 41 NE Rhododendron Blvd
Primary Parcel Number: 223305000082
Permit Description: New SFR-3BR Nuwater w/Local waiver to 75ft from wells
Permit Submitted Date: 03125/2025
Permit Issued Date: 04128/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (addidonaueas may oe re9wred upon lnslalladon otayslaml.
Permit Expiration Date: 03/25/2028 (basedond.p0mspeodonl
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drainfield installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 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/health/environmentallonsiteloss-inspection-request.php or call:
360427.9670, extension 400.
OFFICIALUSEONLY
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MASON COUNTY ' y s
COMMUNITY SERVICES AMWXi. ,555 .. � • n m y
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SWG 2025 —_ c� ro = N
ON-SITE SEWAGE SYSTEM APPLICATION ; z
APPLICANT PHONE m m
CODY & STEPHANIE POWELL =
c
MAILIN3ADMtE56-STREET,CItt.3TATE,ZIP WDE
16014 BAY RIDGE DR A&MI POULSBO WA 98370 m
SITEA E RHODODENDRON
-STREET CITY.ZIP CODE
41 N p�`' HUYA WA 98588 I ^'
NAME OF DESIGNER PHONE N
ALEX L. PAYSSE 360426-1803o / 360-507-1546c
NWEOFINSTA-LER PHONE O
TBD YZ
PERMIT WEE fa we) pVINMN3 N%TEfl 50lIRCE q Iw
f RESIDENTIALOSS 6COMMUNITYOSS ffCOM OSS III!PRIVATE INDWIDUALWELL EPRIVATET PARTY WELL = IO
TYPEOFNOR(ftwiB y kJj PUBLIC WATERSYSTEM
IINEWCONSTRUCTIONIUPGRADES EIIREPAIR/REPLACEMENT OTHERCETAIJIfa dMMAIpo QTABLE IX REPAIR I ICI
SUBpMITTAL"
ppII 0 SURFACING SEWAGE O METING FAILURE ❑SHORELINE
CISLIDESIGN FORM(REQUIRED) MUSEPOC DESIGN(REQUIRED) BEDROOMS LOT M2E I �
Iy:WAIVER(S)(IF APPLICABLE) 4 0.25 x I I
gRELLION"TO SITE ANO SITE CONgTICNS:(m.4YppM1)
FROM BELFAIR HEAD OUT NORTH SHORE TO RIGHT ON BELFAIR TAHUYA RD. I o
CONTINUE UP TO RIGHT ON HAVEN WAY. FOLLOW TO LEFT ON RHODODENDRON r
BLVD. SITE ON RIGHT (NEWLY CLEARED) PDI SIGN POSTED. o
100
sNErWrm MWEofl MAW aw,u,,D TESTxOLES MUST W PLI 1 TESTMOIF NURSERS. IN
OFFICIAL USE ONLY BELOW THIS LINE
UP3RADE/FAIWRE WURCEQw NFaNq(uryyn)
OVOLUNTARY E3MAINTENANCEIPUMPING O BUILDING PERMIT OHOMESALE OCOMPWNT EOTHER:
INSPECIONSOLLOGS OCMMENTSICONDTIONS
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2 3G `� /� G�Sa�✓
9 Ub 5L 1 ��533
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SOILCODES: RECDRDORAWNGANDIL"TALIATIONREP0RT
V=VERY G=GRAVELLY S•SAND VLOAM M-SILT C-CIAY E-EXTREMELY R-ROOT" NREDFORPNALAPPROVAL.
IN EL R6IGNAT HE WE APPLICATION EXPIRATION GATE MP TIONAPPR OI I660ED BY WE
- a 3 wH
TN FO M A BE"CANNE AND AVAILABLE FOR PUBLIC MEW ON THE MASON COUNTY WEBSIUu XEVIDIII 2 ,[
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 3 3 0 — 5 0 — 0 0 0 8 2
A design will be reviewed when 3 copies of each of the following are submitted:
v Completed design form that has been signed and dated. 0 Scaled layout sketch,including all applicable items on checklist
v Scaled plot plan,including all applicable items on checklist. v 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..tfarimum n rsiZe: 11"XI7"
PARCEL IDENTIFICATION
Permit Number: SWG 20Z15 - (aGl' 5 Designer's Name: ALEX L. PAYSSE
Applicant's Name: CODY S STEPHANIE POWELL Designer's Phone Number: 360-426-1803
Mailing Address:
16014 BAY RIDGE DR Designer's Address:
3083 E MASON BENSON RD
POULSBO WA 98370 GRAPINIEW WA 98545
city State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilicr ❑Sand Filter ❑Mound ❑Sand Lined Dminfield ❑Recirculating Filter,Type:
G(Acrobic Unit Make/Model NUWATERBNR500 13 Disinfection Unit Make/Model Other:
Droinfield Type
❑Gravity Rf Pressure [if Trench ❑Bed 13 Sub Surface Drip
Septic Tank/Drainfreld Specifications Laterals
Number of Bedrooms 4 Schedule/Class SCH.40
Daily Flow:Operating Capacity 360 gpd Length VARIES ft
Daily Flow:Design Flow 480 gpd Diameter 1.25 in
Septic Tank Capacity(working) BNR500 gal Number 7
Receiving Soil Type(1-6) 4 Separation 9+ ft
Receiving Soil Appl.Rate 0.6 gpd/ft' Orifices
Required Primary Area 800 ft' Total Number of Orifices 55
Designed Primary Area 801 ftt Diameter 3116 in
Designed Reserve Area 801 ftr Spacing 60 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 267 ft Schedule/Class SCH.40
Elevation Measurements Length 85 ft
Original Drainfield Area Slope 15 % Diameter 1.25 in
New Slope,If Altered 15 % Preferred manifold configuration used? S(Yes ❑No
Depth of Excavation ua-doce 12- in Transport Pipe
from Original Grade rbva-dace 7" in Schedule/Class SCH.40
Designed Vertical Separation 12-24 in Length 110+/- ft
Gmvelless Chambers Required? ❑Yes 16 No D Optional Diameter 2 in
Pump Required? Iff Yes 13 No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day 6
Diff.in Elevation Between Pump&Uppermost Orifice 35 q { 80 gal
Maw
Dminfreld Squirt Height/Selected Residual(head) Ch 106V(� 1500 gal
Uppermost Orifice Higher 13 Lower than Pump Shuto P Is1 sec ose required.
Capacity @ Total Pressure Head 32.5 Spam.-N N7 Y ENV��mppe��r���� ��nn�� lapse Meter Even[Counter
Calculated Total Pressure Head 46.2 ft Qf'Timer: PamVWTAL HENIMIN Pump off 4 HRS
Comments
** SEE TRENCH DEPTH NOTE ON CROSS-SECTION PAGE
AFTER INSTALL, PERFORM DRAW DOWN AND ADJUST TIMER SETTINGS AS NEEDED
DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 3 3 0 — 5 0 -- 0 0 0 a 2
Permit Number: S WG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ii1 Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
66 Soil logs Rf Trencb/bed dimensions and
Rf Septic tank
21 Property lines critical distances within layout G1 Drainfield cover
ig Existing and proposed wells 16 D-Box/Valve box locations Reference depth from original grade
within 100 R of property Rf Septic tanVpump chamber and restrictive strata:
19 Measurements to cuts,banks,and locations
surface water and critical areas 19 Observation port location EX Laterals,trench/bed,top and
bottom
0 Location and orientation of E9 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Ef Manifold placement ❑ Sand augmentation
components Id Orifice placement Other cross-section detail:
19 Location and dimension of � Observation
primary system and reserve area A Lateral placement with distance l porWclean-outs
to edge of bed
lb Buildings Other Information
lb Direction of slope indicator Audible/visual alarm referenced Yes No
66 Scale of drawing shown on scale G'j ❑Design staked out
!� Waterlines b ❑ 9 Recorded Notices attached
!d Roads,easements,driveways, �aP PROVE 9 ❑ Waiver(s)attached
parking 9 ❑Pump curve attached
North arrow and scale drawing APR 2 8 2025 ❑ 61 Evaluation of failure
shown on scale bar
MASON COUNTY ENVIRONMENTAL HEALTH Non-residential justification
JBW [39Waste strength
❑ 5f Flow
DESIGN APPROVAL
The undersigned designer mus be oti by installer at time of installation Rf Yes ❑ No
ZjAS
Sign [ureof Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local - to regulations: ,
E it et [al Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. -7
✓ 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.
This form may be scanned and available for public view on the Mason County Web site.
Cpdeted Dare 12 7301,
PROPOSED NUWATER
�\
&1500 GAL. PUMP TANK
HAVEN LAKE ��\ (50'+TO LAKE&WELLS)
Alm
- _.� \
�
EXIST. \ \\ -
WELL
EXIST.
•\ ® / L1 _ -- � CABIN \
EXIST. WELL \�
EXIST \ (WAIVERREQ) \\
CABIN
R7 / \ R75, �I
FUTURE \ EXIST I
HOME
30' DRAIN SETBACK LOCATION ` GARAGE /I
(NO FOVNDATION/FOOTING DRAIN5 WITHIN \ v
30'DOWN5LOPE OF DRAINFIELD AREAS)
PARKING / SQ
_ \ ,
10' BLD SETBACK
i
LARGE STUMP/TREE
�O
PROPOSED 4 BEDROOM
\\ p��p
PRIMARY& RESERVE Op0 /
i
'CONNECT EXISTING CABIN &
EXTEND SEWER LINE UP HILL FOR
FUTURE HOME CONNECTION �� \ ,, '•.
EXIST. WELL
Ap PROVED
A "�M g
APR 2 8 2025 /
MASON COUNTY ENVIRONMENTAL
THI (WAIVER REO.) `
AN ASBUILTI INSTALL SIGNOFF FEE WILL
LBW I BE CHARGED AT TIME OF INSTALLATION
CUSTOMER: JOHI`1SONVP(riVkLL TEST HOLE I: TEST HOLE2 TEST HOLE I.
PIONEERPIONEER DIGGIN�ING 'PA CELft 305000082 236GSS [8-52CSSL 45+MOTT/R4,
SEPTIC, DESIGNS ADDRESS, 41
DRONB 36MOTT/R-3 52+MOTT/R 52
3083EMNB )NRD. GRW.WA8 DESIGNER: AL OFFICE-36R4WI803 FAX 36042/-2353 SHEET: SFIEPLAN SCALE 17=40
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OBSERVATION PORT
CLEANOVT FINISHED
APPROX. DISTURBED GRADE
SOILS GRADE (DEPTH VARIES)
_ 6"+ COVER
MATERIAL FILTER
ORIGINAL FABRIC I
GRADEN_
n
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I WASHED i ;y
ROCK f
IN
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V PPER PORTION OF DRAINFIELD AREA HAS SOME DISTURBED/CLEARING DEBRIS.THERE ARE OPTIONS IN
DEALING WITH THIS, BVi OSS INSTALLER NEED5 TO ENSVRE TRENCH DEPTH IS 7" 12'INTO ORIGINAL SOIL
AS SHOWN ABOVE. DO NOT REMOVE NATIVE SOILS AND KEEP TRENCHES LEVEL W/ORIGINAL CONTOURS.
AN EXPERIENCED CERTIFIED INSTALLER/OPERATOR IS SUGGESTEAAPR28
EP115�Of�TACTDESIGNER
ADJUSTTO 1025
# OF LATERALS
MASON COUNTY ENVIRONMENTAL
CHECK VALVES Jaw
(AS NEEDED)
BALL THREADED CAP
VALVES
"ORIFICES 012:00
W/SHIELDS
N®B 90' SWEEP
'cs's5:1. 1 B •i.
BE CHARGED ATTTI E OFIINSTALLATIOOFF FEE LN GLUED TEE
CLLSTOMER: fOFP150W POWFLL TEST HOLE I: TEST HOLE 2 1 EST HOLE L.
PIONEER DIGGING, INC P,�CEL p 223305000382 °-mom 8'n� 4455.MOOTT/R 45
SEPTIC DESIGNS ADDRESS 41RHODODENDILON 36 MOTT/R36 52+MOTL/R-52
30 83 E MASON BENSON RD. GRMEVIEW,WA 9R546 DESIGNER: ALE(L.PAYSSE
OF}KE-3604261H03 FAX-360477 2353 SHEET: DFDErALm SCA1G NA
uxnerr s : i4.. ' Narc
NLEE
—aE TANKS MUST BE o`e
ON STATE DOH
APPROVED NUWATER
OF SEWAGE
' g
TANKS N R500
r
PUMPTANKS
OVER 1000 GAL on..rera�, USE RUBBER
REQUIRES TWO eiFa"'�'^'" ,wWeuti ^ GROMETSFOP,
ACCESS RISERS ;� TRANSPORT LINE
TO GRADE // AND ELECTRICAL
'•t 'J '�.«y 'i.
PUMP TANKS ON RISERS, MAKE
LOCATED ATHIGHER "4 SURE ALL HOLES
ELEVATION THAN ARE WATER-TIGHT
DRAINFIELD MUST
HAVEANTI-SIPHON
DEVICE INSTALLED. NVWATER CONTROL PANEL 24'RIBBED RISERS
W/WATER TIGHT LIDS
FINISHED GRADE
[T0.iGl WDRKpJNE
BV L'CM ELI E=AN
ILIoeuEcorvwv NS O LINE
INLET UNION&BALL VALVE
WATER-TIGHT f"C4LL0NWA7ZR77G.YT
JOINTS c CONCRETEVI/MG TANK
CHECK VALVE
HIGH WATER FLOAT
USE TANKS FITTED
ON/OFF FLOAT W/CASrIN WATER
.� '�''• TIGHT FITTINGS FOR
6;•
e� _p INLET/TUBES AND
CAST IN RISER
ADAPTERSTO
,ur:iiae wra ENSURE WATER
APR 2 8 2025 0 TIGHTNESS
MASON COUNTY ENVIRONMENTAL HEALTH
PIONEER DIGGWG, WG sowrowol SGLE NA
PARCEL P.223305&MM2 INSTALL TANKS ON ORIGINAL OR
SEPTIC DESIGNS ADDR�S 41R110DOD0ID0.0NBJCOMPACTEDLEVELSOILS. RUNCROSS
3083EMA.SONBDSONM. GRMEVIEW,WAw546 DESIGNER. ALEX L PAYSSE CONNECTIONS INTO ORIGINAL SOILS TO
OFFICE-36042661803 FN -36 27-2363 DESIGN PAGE TANKS DETAB. AVOIDSETIING.
a
. . AtF1l(F.�P4tSg
LATERAL LATERAL FEEDER TOTAL ORIFICE ORIFICE DIST.TO TOTAL
LATERAL LENGTH PIPE SIZE LENGTH LENGTH ORIFICE DISCMRGE SPACING ]SFORIFICE TOTAL HEAD
(feet) (intAes) (feet) (feet) SIZE(inch) ORIFICES
1 RATE 18Pm) (feet) (inches)
1 28 1.25 3 31 3/16" 0.59 5 za 6 'I HEAD
2 47 1.25 20 62 3/16" 0.59 5 12 30 0.37
3 48 1.25 29 TT 3/16' 0.59 5 18 30 0.42
4 49 L25 38 8T 3/16" 0.59 5 24 10 0.48
5 SO L25 47 97 3/16" D59 5 3D 10 0.53
6 25 125 ]] 302 3/16" 0.59 5 30 5 0.16
2 20 1.25 85 LOS 3/16" 0.59 5 3D 4 0.11
TOTAL 55
DRAINFIELDHEAD(feet) 2.13
.. TRANSPORT LINE HEAD(feet) 1.98
�- ELEVATION HANGE(feet)
RESIDUAL/SQUIRT(feet) 2 2
DITRA LOSS/FITTINGS(feet) 5
TOTALOYNAMICHEAD(feet) 46.11
_ TDTALGALLONSPERMINUTE 3245
PIONEER DIGGWG WG P P R O V E
CLI5TOA4ER: K1F4y50WPOWJBA
PARCEL.M305000082 APR 2 8 2025
SEPTIC DESIGNS ADDRFS441RHODODR3ILOi(M3 R JVASON BENSON M.. ORAPEYIEW wA 98546 DESIGNER; MEXLPAYSSEMASON COUNTY ENVIRONMENTAL HEALTH
OFt10E-3604261803 FAX 36D42'22353 SHEET. Cw1.CS SCALE NA JBW
Installation & System Notes
1. Installer must contact designer for final inspection of the installation priorto cover. All components,including tanks,lids,
transport line,drainfield,and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2.This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state,county,and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department Eto attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations priorto Installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder,lot
developer,or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any topsoil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
S.The property owner and installer are responsible for locating all underground utilities(ex.water,gas,electric)priorto
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6.All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers(ex.ATU,Glendons,)may have other requirements not listed within this design.
7.All electrical wiring shall be done by a licensed electrician or homeowner(if allowed)and must be permitted through Labor
and Industries. Designer not responsible for electrical permitting or other electrical specific code requirements.
8.The proposed septic system should be installed In dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain 10ft to waterlines with all septic components. If less than Soft is required,sleeving in sch.40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18"above sewage line with one of the lines sleeved in sch.
40 pvc 10ft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11.Stormwater runoff,footing drains,roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and 10ft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or
may not meet other requirements.
13.All onsite septic systems require regular maintenance to verify satisfactory operation. The Aer
{'
responsible for the continuous operation and maintenance of the system per WAC 24G272A. ratiort�la�e
information,refer to Mason County Public Health Homeowner's Manual,which should be rece iAlapicr.3gptpval.
14.System owner should be cautious of landscaping around septic components. Root intrusiorltlA50N COUNTY ENVIRON�`M�OElIN�,T
can cause premature failure of the drainfield area. In addition,bushes and trees should be kept AL�_-
away from lids and other septic maintenance points. W
15. Changes made at time of installation may impact designer calculations,pump sizing,and
compliance w/county and state requirements. Contact designer prior to install w/any
proposed variations from design. Changes may result in additional fees and permitting. :
PIONEER DIGGING, NC— CUS CUSTOMER.
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SEPTIC DESIGNS ADDRESS. 41RHODODENJRON rct nEsi�Rar
30a3EMASONBPEONRD. GRMEMM.WAWa DESIGNER-- ALEXLPAYSSE f
OFFICE-36 261803 FAx-3EP427-2353 SHEER NOM SCAT F. NA