HomeMy WebLinkAboutSWG2025-00132 - SWG Application / Design - 4/14/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
1. 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: SWG2025-00132
APPLICANT PAYSSE KYLE Phone:
Address: 951 E STRONG RD SHELTON, WA 98584
OWNER PAYSSE KYLE Phone:
Address: 951 E STRONG RD SHELTON, WA 98584
SEPTIC DESIGNER BOB PAYSSE* Phone: 360-507-1498
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
SEPTIC INSTALLER TBD Phone:
Address: 123 XXX XX, XX. 00000
Site Address: 621 E Strong Rd
Primary Parcel Number: 221284490052
Permit Description: NEW SFR -3BR Gravity
Permit Submitted Date: 04/14/2025
Permit Issued Date: 05/05/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 04/24/2028 (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.
OFFICIAL USE ONLY
MASON COUNTY GATE RECEIVED: D` - Iq - ^ ,• w
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07 COMMUNITY SERVICES AMOUNT RECEIVED I RECEIVED BY ( t (�
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ON-SITE SEWAGE SYSTEM APPLICATION >g xi
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APPLICANT PHONE 1--
KYLE PAYSSE 360-507-1703 z
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MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE `
3083 E MASON BENSON : = O \\�, . GRAPEVIEW WA 98546 a)
SITE ADDRESS-STREET.CITY,ZIP CODE ��
621E STRONG RD Q `l S \ SHELTON WA 98584 �"
NAME OF DESIGNER p,QR 1 PHONE I N
ROBERT H. PAYSSE 360-426-1803
NAME OF.\STALLER
PHONE I
TBD 6y R.
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PERMIT TYPE!select one) DRINKING WATER SOURCE �7 —
RM
ICI RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS ff PRIVATE INDIVIDUAL WELL ff.PRIVATE TWO-PARTY WELL Z I CO
TYPE OF WORK(select one) CT PUBLIC WATER SYSTEM t
W.NEW CONSTRUCTION/UPGRADES 6 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I -
SUBMITTALSis
� El SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I
L -P
5-WAIVER(S)(IF APPLICABLE) 3 1.3 AC o r
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DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate)
NORTH HWY 3. RIGHT ON PICKERING RD. LEFT ON STRONG RD. CONTINUE TO I D
SITE ADDRESS 623, NEWLY CLEARED DRIVEWAY ON LEFT. TURN INTO SHARED o I o
DRIVEWAY AND LOT IS ON RIGHT, -
Io
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I N
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
(06 -(- Ai4
(.„ 0 71,0 II ICI r�It
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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.
I :•:CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE ICAT ON APPROVED/ISSUED BY DATE
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T S •' .I AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 0 1 REVISED 12/72015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 2 8 — 4 4 — 9 0 0 5 2
A design will be reviewed when 3 conies 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: 11"X I7"
. �` -.' - r .,...,,,_�. `._. ^may , ».,
-. ,. . �?: ,��, ,"Permit Number: SWG 20215 ' C)013Z Designer's Name: ROBERT H. PAYSSE
KYLE PAYSSE Desi ner's Phone Number: 360-426-1803
Applicant's Name: g
Mailing Address: 3083 E MASON BENSON RD Designer's Address: 3083 E MASON BENSON RD
GRAPEVIEW WA 98546 GRAPEVIEW WA 98546
City State Zip City State Zip
Treatment Device
❑Glendon Biof lter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield Cl Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
'Gravity 0 Pressure 'Trench Cl Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729 PERF
Daily Flow:Operating Capacity 270 gpd Length 50 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 3
Receiving Soil Type(1-6) 3 Separation 10 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices -
' Designed Primary Area 450 ft2 Diameter - in
Designed Reserve Area 450 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 150 ft Schedule/Class 3034
Elevation Measurements Length 20 ft
Original Drainfield Area Slope 2 % Diameter 4 in
New Slope,If Altered 2 % Preferred manifold configuration used? [ Yes ❑No
Depth of Excavation Up-slope 25 in Transport Pipe
from Original Grade Down-slope 24 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 20 ft
Gravelless Chambers Required? 0 Yes 0 No 0 Optional Diameter 4 in
Pump Required? 0 Yes efNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between Pump&Uppermost Orifice - ft Dose quantity - gal
Drainfield Squirt Height/Selected Residual(head) - ft Chamber Capacity(flood) - gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head - gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head - ft If Timer: Pump on ,Pump off
Comments PPROVfr
. .
MAY0520i LI
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
,DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 1 2 8 — 4 4 -- 9 0 0 5 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations G71 Drainfield orientation and layout Reference depth from original grade:
g Soil logs L Trench/bed dimensions and i Septic tank
g Property lines critical distances within layout M' Drainfield cover
g Existing and proposed wells 6d D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
10 Measurements to cuts,banks,and locations l Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
g Location and orientation of 62( Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components Q( Orifice placement Other cross-section detail:
B1 Location and dimension of Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
10 Buildings g Audible/visual alarm referenced Yes No
Eil Direction of slope indicator g Scale of drawing shown on scale g 0 Design staked out
g Waterlines bar 0 g Recorded Notices attached
g Roads,easements,driveways, ►; -•!� g Waiver(s)attached
parking P P R 0 V E v ,`lp g Pump curve Evaluation of failure
attached
'� ❑ 6d
g North arrow and scale drawing MAY 0 5 2025
shown on scale bar on-residential justification
MASON COUNTY ENVIRONMENTAL HEA g Waste strength
J MN 0 Gff Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation Eli Yes 0 No
Pa,44Adx LI((,(Zs
Signatur of Desig er!er Date
The undersigned has reviewed ' esign on behalf of Mason County Public Health and determined it to be in
compliance with state and local o site regulations:
En ' onmental Health Specialist Date
CAUTION: DESIGN A PROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. Y-2✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
--,2,-,
✓ 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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EXPIRES \ MASON COUNTY ENVIRONMENTAL HEALTH
AN ASBUILTI INSTALL SIGNOFF FEE WILL JBW
BE CHARGED AT TIME OF INSTALLATION
TEST HOLE I: TEST HOLE 2:
PIONEER DIGGING, INC. �A RC #:122128-44-90052: KYLE E U 62 CMS(3) 0-62 GALS(3)
ROOTS @ 62 ROOTS @ 62
SEPTIC DESIGNS ADDRFSS: 621 E STRONG RD
S PLATS
OR R:THIS IS NOT A SURVEY.REFERENCES INCLUDE APPLICANT/COUNTYNINTENDED
AND FOR SEPTIC
OFFICE 36c}426 I803 FAX 36(1 427 2353 SITE
7 SCALE: DEPORTPURPOS SE ONLY PROPOSED DEVELOPMENT MBL BE SUBJECT RE OTHER
SHEET: J31 G PLAN S A 1 1"=50' EPARTMENTIOGENCY REVIEW DES GNER ENOTLO RESPONSIBLE FOR SETBACKS UNTO AOT TO
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EXPIRES
AN ASBUILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
CUSTOMER: KYLE PAYSSE HOLE I: HOLE 2:
PIONEER DIGGING, INC. TEST G�\,�(3, TEST`L„s(3)
PARCEL :22128 44�0052 Rt.,-JOTS @ 62 ROOTS @ 62
SEPTIC DESIGNS ADDRES : 621E STRONG RD
3083 E MASON BEN'ON RD. GRAf EVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE RATS OR SURVEYS FIELLD MEASUREMENTSOT A ANDY. CCOUNfYS GIS DESIGNANT/CMS/TY PROVIDED
INTENDED FOR SEPTIC
/y PURPOSES ONLY PROPOSEDDEVELOPMENT MAY BE SUBJECT TO OTHER
OFFICE-360-426-1803 FAX-360-427-2353 SI 1 FFT: DF DETAIL SCALE: I"=IV DEPARTMENT/AGENCY REVIEW DESIGNER
NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
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IInstallation & System Notes
1. Installer must contact designer for final inspection of the installation prior to 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 prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to 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 top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities (ex. water, gas, electric) prior to
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 loft 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 system owner/operator is
responsible for the continuous operation and maintenance of the system per WAC 246-272P Fopp,e_ration and maintenance
information, refer to Mason County Public Health Homeowner's Manual,which should be{'[e�c iveddafter insta a on approval.
14. System owner should be cautious of landscaping around septic components. Root ijn MAY `' Y'\
can cause premature failure of the drainfield area. In addition, bushes and trees shoultt apt 0 5 ?off
away from lids and other septic maintenance points. COL/Ai7-
15. Changes made at time of installation may impact designer calculations, pump sizing,and J ,. ,'r'��NTg1 H ALT'.
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. „,. 0,,N ,;
PIONEER DIGGING, NC. LUSTONtER: KYLE PAYSSE
PARCEL#:22128-44.90052 :� ice=_zr r°,"va;sse fr
SEPTIC DESIGNS ADDRESS: 62.1 E STRONG RD Cr
3083 E MASONBE\�OI�RD. GRAPEVIEW,WA 9854(i DESIGNER: ROBERT H.PAYSSE EXPIRES
OFFICE 36l}426-1803 FAX 36l?427 2353 SHEET: NOTES SCALE NA