HomeMy WebLinkAboutswg2025-00063 - SWG Application / Design - 4/24/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, EXT 400
J BELFAIR:360-275-4467, EXT 400
Public Health & Human Services ELMA:360-482-5269, EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00063
APPLICANT TAHJA DALE L Phone: 360-426-5940
Address: 2450 W DEEGAN RD W SHELTON, WA 98584
OWNER TAHJA DALE L Phone: 360-426-5940
Address: 2450 W DEEGAN RD W SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 110 N Arnolds Way
Primary Parcel Number: 323312200740
Permit Description: New 3-bedroom Gravity System
Permit Submitted Date: 02/27/2025
Permit Issued Date: 04/24/2025
Issued By: David Anderson
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 03/05/2028 (based on date of inspection)
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/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: O l�o
COMMUNITYSERVICES AMOUNT RECEIVED:— RECEIVED BY, W CD
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Public Health(Community Health/Environmental Health)0
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360-427-9670,ext.400 or 360-275-467.ext.400
415 N.6tlr Street-Shelton,WA 98584 C V 4/ 20 25 -
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE rn
Dale L. Tahja e� '� (360)463-8023 Z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
2450 W. Deegan Rd. W. „• goti Shelton WA 98584 °m°
SITE ADDRESS-STREET,CITY,ZIP CODE q`^ v ��'
110 N. Arnolds Way V Hoodsport WA 98548 1 w
NAME OF DESIGNER
�Q PHONE 1 N
Dale L. Tahja O (360)463-8023
NAME OF INSTALLER PHONE v I CO
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PERMIT TYPE(select one) DRINKING WATER SOURCE 0
K.,RESIDENTIAL OSS E COMMUNITY OSS E.COMMERCIAL OSS E PRIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z 1
TYPE OF WORK(select one) 7 PUBLIC WATER SYSTEM PUD at i
g NEW CONSTRUCTION I UPGRADES 19T REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑TABLE IX REPAIR I N
SUBMITTALS 0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) Ii.SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0I N[-J WANER(S)(IF APPLICABLE) >,,,A
: 1.45 n
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) • I CD
Go north on Hwy 101 past Hoodsport, left on N. Terrace Rd., right on N. Westward Way, I o
right on Arnolds Way. Please contact Dale Tahja at (360)463-8023 to schedule a site visit.
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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
I.UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE DCOMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
iu ;C'-66 " E St- Qsd (riprocks 4 �m ce
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T�3 �0�66 CS� to d� d .S
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_y�, V RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
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INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 3 3 1 — 2 2 — 0 0 7 4 0
A design will be reviewed when 3 conies of each of the following are submitted:
Completed design form that has been signed and dated. '1 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: 11"X/7"
PARCEL IDENTIFICATION
Permit Number: SWG 2025-00063 Designer's Name: Dale Tahja
Dale L.Tahja (360)463-8023
Applicant's Name: Designer's Phone Number:
Mailing Address: 2450 W. Deegan Rd.W. Designer's Address: 2450 W Deegan Rd W
Shelton WA 98584 Shelton WA 98584
City State Zip City State Zip
DESIGN.PARAMETEf Y --,;',,,V.-
Treatment Device
0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: N/A
Drainfield Type
C 'Gravity 0 Pressure G 'Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length 67 - ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1,250 ' gal Number 3 -
Receiving Soil Type(1-6) 4 Separation 10 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices Perf. Pipe -
Designed Primary Area 600 ft2 Diameter Gravity in
Designed Reserve Area 600 ft2 Spacing Gravity in
Trench/Bed Width 3 ft Manifold —
Trench/Bed Length 200 ft Schedule/Class 3034
Elevation Measurements Length 70 ft
Original Drainfield Area Slope 20 % Diameter 4 in
New Slope,If Altered 18 % Preferred manifold configuration used? ❑ Yes giNo
Depth of Excavation Up-slope 30 in Transport Pipe
from Original Grade Dow„-slope 23 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 150 ft
Gravelless Chambers Required? 0 Yes 0 No 12'Optional Diameter 4 in
Pump Required? ❑Yes Ii5No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
Diff.in Elevation Between Pump& Uppermost Orifice ft Dose quantity Gravity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) N/A gal
Uppermost Orifice CIHigher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head Gravity gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on N/A ,Pump off N/A
Comments
ill 1
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 3 3 1 — 2 2 — 0 0 7 4 0
Permit Number: SWG 2025-00063
DOWN Cal#WKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
66 Test hole locations 6d Drainfield orientation and layout Reference depth from original grade:
g Soil logs It Trench/bed dimensions and Eta Septic tank
Et Property lines critical distances within layout Q( Drainfield cover
Ft Existing and proposed wells Iii D-Box/Valve box locations Reference depth from original grade
within 100 ft of property It Septic tank/pump chamber and restrictive strata:
it Measurements to cuts, banks, and locations I;2' Laterals,trench bed,top and
surface water and critical areas RI Observation port location bottom
It Location and orientation of Ft Clean-out location 0 Curtain drain collector
curtain drain and all absorption It Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
Wli Location and dimension of Et Lateral placement with distance 121 Observation ports/clean-outs
primary system and reserve area to edge of bed
Buildings Other Information
0 Audible/visual alarm referenced Yes No
Direction of slope indicator Et Scale of drawing shown on scale Err 0 Design staked out
SS Waterlines bar 0 0 Recorded Notices attached
6Q Roads,easements,driveways, 0 0 Waiver(s)attached
parking 0 0 Pump curve attached
66 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL ,
The undersigned designer must be notified by instal t time of installation It Yes 0 No
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Signature of Designer Date
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The undersigned has reviewed this design on behalf of Mason County Public Health and det laite ii '
4 compliance wi state and local on-si r ulations: ���,-c0 is v c w )
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Q 0 Environmental Health Specialist Date iv,,S 44—' "'rjS —,
CAUTIO N DES APPROVAL IS VALID ONLY UNDER THE FOLLOWING CON si
✓ The desci,�ped"Approved" by Mason County Public Health.
✓ /?O?�The Onsiewage ihas not expired,the Permit Expiration Date is: 34s 'd
✓ 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.
Updated Date: 12/7/2015
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Installation/Maintenance
Gravity Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Divert all storm water run-off away from septic system components.
4. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
11.Locate all utilities prior to starting installation.
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