HomeMy WebLinkAboutSWG2025-00133 - SWG Application / Design a ,
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, EXT 400
==�_= Public Health & Human Services BELFAIR:360-275-4467,EXT 400
ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00133
APPLICANT PAYSSE ROBERT H & PATRICIA
Address: Phone: 1.360.426.1803
3083 E MASON BENSON RD GRAPEVIEW, WA 98546
OWNER PAYSSE ROBERT H & PATRICIA
Address: Phone: 1.360.426.1803
3083 E MASON BENSON RD GRAPEVIEW, WA 98546
SEPTIC DESIGNER BOB PAYSSE*
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546 360-507-1498
SEPTIC INSTALLER TBD
Address: 123 XXX XX, XX. 00000 Phone:
Site Address: 623 E Strong Rd
Primary Parcel Number: 221284490053
Permit Description: NEW SFR -3BR Gravity
Permit Submitted Date: 04/14/2025
Permit Issued Date: 05/05/2025
Issued By:
Current Permit Fees Paid: Jeff Wilmoth
$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 DATE RECEIVED: Oq-
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COMMUNITY SERVICES AMOUNT RECEIVE,5.5 RECEIVEDBY:�
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Public Health(Community Health/Environmental Health) (n
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415 N.6tth Street-Shelton,WA 98584 SWG20 "500f OT
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ON-SITE SEWAGE SYSTEM APPLICATION >
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APPLCANT PHONE r
ROBERT PAYSSE 360-426-1803 / 360-507-1498 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
3083E MASON BENSON RD GRAPEVIEW WA 98546 CO
ADDRESSSITE CITY.
ELTON WA 98584 I N
623 E STRONG RD te5t‘k.""
ISHNAME OF DESIGNER PHONE INROBERT H. PAYSSE % PQC 360-426-1803
NAME OF INSTALLER PHONE
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TBD
I IvPERMIT TYPE(select one)
DRINKING WATER SOURCE
W.RESIDENTIAL OSS ff COMMUNITY OSS MERCIAL OSS 5 PRIVATE INDIVIDUAL WELL ff PRIVATE TWO-PARTY WELL Z I CO
TYPE OF WORK(select one) PUBLIC WATER SYSTEM I
iii NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I -
SUBMITTALS El SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE W
5 WAIVER(S)(IF APPLICABLE) 3 1.3 AC
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DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gale)
NORTH HWY 3. RIGHT ON PICKERING RD. LEFT ON STRONG RD. CONTINUE TO I o
SITE ADDRESS 623, NEWLY CLEARED DRIVEWAY ON LEFT. CONTINUE ON NEW o I o
SHARED DRIVEWAY UP TO BACK LOT. —I
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I W
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT El HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS / / < COMMENTS/CONDITIONS
(P, U }-4 )62 3/1,42/1 <.
/-)-61
(91-
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
CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE ATION APPROVED/ISSUED BY DATE
��i ��J�� - �� -� �T C 1t1� s
T S R MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE /AP
REVISED 12/7/2015
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 2 8 — 4 4 — 9 0 0 5 3
A design will be reviewed when 3 copies 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 17"
PARCEL IDENTIFICATION . +a i
Permit Number: SWG ZOZ5-CO/15 Designer's Name: ROBERT H.PAYSSE
ROBERT 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
Ci State Zip
4003014 1
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
l 'Gravity 0 Pressure 'Trench 0 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 ft 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 10 % Diameter 4 in
New Slope,If Altered 10 % Preferred manifold configuration used? GiYes 0 No
Depth of Excavation up-slope 28 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 It No 0 Optional Diameter 4 in
Pump Required? 0 Yes 56No 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 ❑ElapRse Meter 0 Event Counter
Calculated Total Pressure Head - ft If Timer: Pu r.n0 ,', -
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Comments ;: ,'
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DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 1 2 8 -- 4 4 -- 9 0 0 5 3
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
El Test hole locations 121 Drainfield orientation and layout Reference depth from original grade:
It Soil logs It Trench/bed dimensions and g Septic tank
It Property lines critical distances within layout Igi Drainfield cover
Et Existing and proposed wells RI D-Box/Valve box locations Reference depth from original grade
within 100 ft of property It Septic tank/pump chamber and restrictive strata:
6Z1 Measurements to cuts,banks,and locations g Laterals,trench/bed,top and
surface water and critical areas It Observation port location bottom
It Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components g Orifice placement Other cross-section detail:
it Location and dimension of It Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
6d Buildings It Audible/visual alarm referenced Yes No
Direction of slope indicator Scale of rawin h n d 0 Design staked out
P P RD
It Waterlines Au ❑ 11 Recorded Notices attached
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Roads,easements,driveways, 0 It Waivers)attached
parking MAY 0 5 2025 440, ❑ g Pump curve attached
g North arrow and scale drawing ❑ gEvaluation of failure
shown on scale bar MASON COUNTY ENVIRONMENTAL HEALTH Non-residential justification
J BW ❑ Er Waste strength
❑ It Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation It Yes 0 No
Signature o 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 o ' regulations:
�/ (41 S=f25
En ron 'e.vv ealth Specialist Date
CAUTION: DESIGN APPR VAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
V The design is stamped"Approved"by Mason County Public Health.
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V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: / -2-y-.2s•
✓ 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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AN ASBUILTI INSTALL SIGNOFF FEE WILL PROPOSED 00
BE CHARGED AT TIME OF INSTALLATION
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PIONEER DIGGING, INC. CUSTOMER: ROBERTPAYSSE TEST HOLE I: TEST HOLE 2:
PARCEL 4 22128 4-4+90 53PA0-36(MS(3) 0-36 CMS(3)
36-67 MS(3) 36-67.ms(3)
SEPTIC DESIGNS ADDRESS: 623 E STRONG RD kOOTs @ 67 ROOTS @ 67
DESIGNER: ROBERT H.PAYSSE DISCLAIMER THE IS NOT A SURVEY.REFERENCES INCLUDE'APPLICANDCOUNTY PROVIDED
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 PUTS OR SURVEYS.FIELDMEASLREMENTSANDCOLRRYOIS.DEMON INTENDED FOR SEPTIC
OFFICE 3604261803 FAX 3604272353 SHEET: SITE PLAN SCALE 1"=50 PURPOSES ONLY PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER
DEPARTMENT/AGENCY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS
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AN ASBUILT/INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
CUSTOMER: ROBERT PAYSSE TEST HOLE I: TEST HOLE 2:
PIONEER. DIGGING, INC. 0 36 CMS(3) 0-36 GALS(3)
PARCEL# 22128 44 90053 '36 67 BLS(3) 36-67 MS(3)
SEPTIC DESIGNS ADDRFSS: 623 E STRONG RD R: I`Cs 67 R...'0 I S @ 67
DISCLAIMER:THIS IS NOT A SURVEY.REFERENCES INCLUDE'APPLICANT/COUNTY PROVIDED
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE PLATS OR SURVEYS.FIELDMEASLREMENTS AND COUNTY GIS DESIGN INTENDED FOR SEPTIC
OFFICE-360 426-IA03 FAX-360-427-2353 DETAIL
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SHEET:EET: DF DL 1/ � Jl./�L..L In-lU DEPARTME.•ROGENCY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS.
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Installation & 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 10ft 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 246-27<' F operation and maintenance
information, refer to Mason County Public Health Homeowner's Manual,which should b el ed after installation approval.
14. System owner should be cautious of landscaping around septic components. Root i ,n 14Y u 5 ')91.:
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can cause premature failure of the drainfield area. In addition, bushes and trees shouldaa�'�� pUNTY ENUIRONMENTAL Hof;
away from lids and other septic maintenance points. E i_i
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15. Changes made at time of installation may impact designer calculations, pump sizing,and "4
compliance w/county and state requirements. Contact designer prior to install w/any 1�t `�
proposed variations from design. Changes may result in additional fees and permitting. of„ , '
Ik �I' '414
PIONEER DIGGINrr � PAR I O.v1E 2 ROBERT PAYSSE . . r r''' •
DIGGING, PARCEL it 22128 49 90053 4/0:' Fceenr 1.4 DAME E •
SEPTIC DESIGNS ADDRESS: 623 E.STRONG RD .... `' . •v •c
3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE EXPIRES
OFFICE-360-426-1803 FAX 360-427-2353 -I I I FT: NOTES SCALE NA