HomeMy WebLinkAboutSWG2025-00172 - SWG Application / Design - 5/27/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, EXT 400
.I L 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: SWG2025-00172
APPLICANT KIBBEY TUCKER Phone: 575-200-0552
Address: P 0 BOX 1202 SHELTON, WA 98584
SEPTIC DESIGNER Hunter, Adam Phone: 360 753-1226
Address: 2201 93rd Ave SW Olympia, WA 98512
Site Address: 40 E Tree Top Ln
Primary Parcel Number: 220157600060
Permit Description: 3BR SFR -Subsurface Drip
Permit Submitted Date: 05/08/2025
Permit Issued Date: 05/27/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/20/2031 (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.
It
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: 5/9(zo zS
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AMOUNT RECEIVED 5 w RECEIVED RY. / ( W rn
Public Health & Human Services S l!/( o 09
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 > /1� — 0
415 N.6th Street -Shelton,WA 98584 SWG L / )Z C - O �]
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION D
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APPLICANT PHONE
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KIBBEY TUCKER 5752000552 z
MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE E
PO BOX 1202 SHELTON WA 98584 co
SITE ADDRESS-STREET.CITY,ZIP CODE
40 E TREE TOP LN SHELTON WA 98584 I N
NAME OF DESIGNER PHONE O
ADAM HUNTER 3607531226 rs
NAME OF INSTALLER PHONE 0 CD
TBD TBD - o
PERMITC TYPE(select one) DRINKING WATER SOURCE O I 0)
L�J RESIDENTIAL OSS ECOMMUNITY OSS ILJ COMMERCIAL OSS ff-PRIVATE INDIVIDUAL WELL E PRIVATE TWO-PARTY WELL Z CD
TYPE OF WORK(select one) 0- PUBLIC WATER SYSTEM I
R-NEW CONSTRUCTION/UPGRADES EREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR
SUBMITTALS 0 SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE CO
C
L�J DESIGN FORM(REQUIRED) IM SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER4/112025� 0
ff WAIVER(S)(IF APPLICABLE) 3 4':9• ' • YES • NO (-) I
DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate) , ' ,9
SOUTH ISLAND DR TO A LEFT ON TREE TOP LN TO SITE ON THE LEFT.
I-
0
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: ^9�Jr
INSPECTOR SOIL LOGS COMMENTS/CON• IONS "T
0., ""4..4.,, `-/
rr,A
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RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
-VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQ 'ED FOR FINAL APPROVAL.
d,'EC OR SIGNATURE DATE APPLICATION EXPIRATION DATE TIO APPROVED/ISSUED BY DATE
,,, 0,4Am540:2 s. , _ L L(SQ 5--27 z5
' I'�ail M MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
f 1
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 220157600060 -- --
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. 1Waximum paper size: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG aZ ws - oo (-TA, Designer's Name: ADAM HUNTER
Applicant's Name: KIBBEY TUCKER Designer's Phone Number: 3607531226
Mailing Address:
PO BOX 1202 Designer's Address: PO BOX 162
SHELTON WA 98584 City State Zip OLYMPIA WA 98507
City State Zip Designer's Email JHANDASSOCIATES@HOTMAIL.COM
DESIGN PARAMETERS
Treatment Device
❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU LI Other
Treatment Level(check all that apply): J A J B _I C J BL1 1 BL2 I BL3 ✓1 E J N
Drainfield Type
❑ Gravity 0 Pressure 0 Trench 0 Bed ErSub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class DRIP
Daily Flow:Operating Capacity 270 gpd Length 225 ft
Daily Flow: Design Flow 360 gpd Diameter 1/2 in
Septic Tank Capacity(working) 1200 gal Number 2
Receiving Soil Type(1-6) 4 Separation 2.22 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 900 ft2 Total Number of Orifices 450
Designed Primary Area 900 ft2 Diameter DRIP in
Designed Reserve Area 900 ft2 Spacing 12 in
Trench/Bed Width 20 ft Manifold
Trench/Bed Length 45 ft Schedule/Class 40
Elevation Measurements Length 20 ft
Original Drainfield Area Slope 5 % Diameter 1 in
New Slope,If Altered 5 % Preferred manifold configuration used? Eh/es 0 No
Depth of Excavation Up-slope 8 in Transport Pipe
from Original Grade Down-slope 8 in Schedule/Class 40
II Designed Vertical Separation 24 in Length 40 ft
Gravel-based Drainfield Required? 0 Yes dNo Diameter 1 in
Pump Required? Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 12
Diff. in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 30 gal
Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) 1200 gal
Uppermost Orifice 'Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 7.2 gpm l Timer Er Elapse Meter ' Event Counter
Calculated Total Pressure Head 111.3 ft If Timer: Pump 411;r111
Vp .,.?HRS
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Comments ` t'
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MAY272025 1
"';.SON COUNTY ENVIRONM:T
J B W Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number:220157600060 -- --
Permit Number: SWG ZD' — QO t7 Z
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations 0' Drainfield orientation and layout Reference depth from original grade:
9' Soil logs 9' Trench/bed dimensions and El' Septic tank
1 Property lines critical distances within layout ®' Drainfield cover
Q( Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0' Septic tank/pump chamber and restrictive strata:
la Measurements to cuts,banks,and locations ®' Laterals,trench/bed,top and
surface water and critical areas 0' Observation port location bottom
9' Location and orientation of 9' Clean-out location 0' Curtain drain collector
curtain drain and all absorption Ef Manifold placement 0' Sand augmentation
components 9' Orifice placement Other cross-section detail:
• Location and dimension of E Lateral placement with distance I' Observation ports/clean-outs
primary system and reserve area to edge of bed
• Buildingsg Other Information
f� Audible/visual alarm referenced Yes No
1 Direction of slope indicator 9' Scale of drawing shown on scale Nr 0 Design staked out
1 Waterlines bar 0 0 Recorded Notices attached
62i Roads,easements,driveways, Q Elevation benchmark and relative 0 0 Waiver(s)attached
parking elevations of system components I' 0 Pump curve attached
I' 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 • fp
•• by '•..• ler at time of installation 9'Yes 0 No
ii
5/$CZ5
Si. e of 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 ite regulations:
. L,i6
E 4 ental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved" by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 5,2 0 ✓fig
✓ 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 requiredRCORVISE
S4
This form may be scanned and available for public view on the Mason a:25
MAY 2 1 2025
MASON COUNTY ENVIRONMENTAL HEA,.--
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ASON COUNTY ENVIRONMENTAL HEALTH
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Orenco Technical Data Sheet
SYSTEMS
Using a Pump Curve
A pump curve helps you determine the best pump for your system.Pump curves show the relationship between flow and pressure(total dynamic
head or"TDH"),providing a graphical representation of a pump's optimal performance range.Pumps perform best at their nominal flow rate.These
graphs show optimal pump operation ranges with a solid line and flow rates outside of these ranges with a dashed line.For the most accurate pump
specification,use Orenco's PumpSelect`"software.
Pump Curves
500 400
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MASON COUNTY ENVIRO MENTAL HEALTH
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NTD-PU-PF-5 Orenco Systems®•800-348-9843•+1 541-459-4449•www.orenco.com
Rev.3®01/21
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