HomeMy WebLinkAboutSWG2025-00056 - SWG Application / Design - 5/22/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
at .:
BELFAIR:360-275-4467,EXT 400
s-- • • Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00056 COO Klr'f
APPLICANT NOLAN ET AL AMBER Phone: 1.360.741.7334
Address: 3254 SE MAHALI LN PORT ORCHARD, WA 98366
OWNER NOLAN ET AL AMBER Phone: 1.360.741.7334
Address: 3254 SE MAHALI LN PORT ORCHARD, WA 98366
SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: UNKNOWN
Primary Parcel Number: 221232250030
Permit Description: New 4bd gravity trench
Permit Submitted Date: 02/20/2025
Permit Issued Date: 05/27/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/22/2028 (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 Drain field installation not to exceed designed upslope and downslope depth specified on
0 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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH DATE RECEIVED: e ,(7p If?-- —
ONSITE SEWAGE SYSTEM APPLICATION AMOUNT RECEIVED: <it RECEIVEDB 0 m
415 N 6th Street,(Bldg 8) Shelton WA,98584 �� �� < cn
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Shelton:360-427-9670 ext 400 Belfair:360-275-4467 ext 400 SWG 1,0 2'� - 000S1 5 oo
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APP.(CANT
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SHOMARI BURTON 3606891186 m m
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MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE
3254 SE MAHALI LN PORT ORCHARD WA 98366 C
SITE ADDRESS-STREET,CITY,ZIP CODE 985464CO
54 E ADONAI WAY GRAPEVIEW WAm
NAME OF DESIGNER PHONE
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3607531226
PHONE I `.\
NAME OF INSTALLER `
TBD TBD o
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 2 ,,�`
0 PRIVATE INDIVIDUAL WELL N
NEW CONSTRUCTION 0 RV HOLDING TANK ONLY 0 PRIVATE TWO-PARTY WELL 0
❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLYZ
❑ TABLE 9 REPAIR 0 SINGLE FAMILY f' COMMUNITY/PUBLIC WATER SYSTEM
❑ TANK(S)ONLY El COMMERCIAL NAME: ADONAI COMMERCIAL El UPGRADE TO EXISTING 0 OTHER: BEDROOMS LOT SIZE I
❑ EXISTING FAILURE "Record Drawing required 4 5 co I V
for all Installations" O
DIRECTIONS TO SITE•BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS lee.locked gate) 0
THOMAS TO A RIGHT ON APRIL TO A RIGHT AT GATE ON ADONAI TO SITE ON THE x I C�
RIGHT. I °
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I 0
OFFICIAL USE ONLY BELOW THIS LINE -- --
UPGRADE!FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT ❑OTHER:
COMMENTS!CONDITIONS
INSPECTOR SOIL LOGS
-.W 0 SA-1 LO,5( T-it-4- co 6,- -tAni\
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- ti!hY 2 7 2025 H
' " '' b j MASON COUNTY ENVIRONMENTAL HALT
��'� ����SOIL CODES: RET
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED BY DATE
a...iiwovy\ 't.)p72.4 7A-
cle?;TO 1(6\0101 'Ci74/7/S1
T S FORM MAY B SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
REVISED 12/7l2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 22123225003E --
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 17"
PARCEL IDENTIFICATION
Permit Number: SWG 2D27S'— ()p6T(o Designer's Name: Jim Zimny
Applicant's Name: Shomari Burton/ l�,,\ Designer's Phone Number: 360-516-7287
Mailing Address:
3254 SE MAHALI LN Designer's Address: 7178 windflower pl nw
Port ORCHARD WA 98366 City State Zip seasick WA 98380
CLEAR FORM desi ns@icloud.com
City State Zip Designer's Email a Pd 9
DESIGN PARAMETERS
Treatment Device
0 Glendon ❑ Sand Filter ❑Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU L1 Other
Treatment Level(check all that apply): ❑A 0 B 0 C 0 BL 1 0 BL2 ❑BL3 El E ❑N
Drainfield Type
("Gravity ❑Pressure i 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 3034
Daily Flow:Operating Capacity 360 gpd Length 50' ft
s,
Daily Flow: Design Flow 480 gpd Diameter S 8.i 4 in
Septic Tank Capacity(working) 1200 gal Number ``���'r��, 4
Receiving Soil Type(1-6) 3 Separation /� i,' Ili b 5 etc ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 � •
Orifices
600 ft2 Total ^ _' na
Required Primary Area .:����,��u.•.,;:,;��►:m i,t,
Designed Primary Area 600 ft2 Diameter — -'7-2 S— in
Designed Reserve Area 600 ft2 Spacing in
Trench/Bed Width 3' ft Manifold
Trench/Bed Length 200 ft Schedule/Class na
Elevation Measurements Length ft
Original Drainfield Area Slope 5% % Diameter in
New Slope,If Altered 5% % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 18 in Transport Pipe
from Original Grade Down_stope 15 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 15' ft
Gravel-based Drainfield Required? ❑Yes Eti No Diameter 4' in
Pump Required? 0 Yes E'No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day na
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 0 Timer 0 Elapse Meter 0 Event Counter
Calculated Total Pressure Head Al � dV. turY n ,Pump offComments
MAY 27 2025
MASON COUNTY ENVIRONMENTAL H ALTH
1 RET I Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 221232250030. --
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Fe Test hole locations V Drainfield orientation and layout Reference depth from original grade:
V Soil logs 0 Trench/bed dimensions and !g Septic tank
O Property lines critical distances within layout B Drainfield cover
0 Existing and proposed wells l D-Box]Valve box locations Reference depth from original grade
within 100 ft of property V Septic tank/pump chamber and restrictive strata:
1 Measurements to cuts,banks,and locations Eft Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
fa Location and orientation of Pi Clean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
Ef Location and dimension of V Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
Buildings Q1 Other Information
CI Audible/visual alarm referenced Yes No
P1 Direction of slope indicator tEl Scale of drawing shown on scale 0 Er Design staked out
✓ Waterlines bar 0 0 Recorded Notices attached
0 Roads,easements,driveways, CI Elevation benc �`f'r d relative 0 Waiver(s)attached
parking "elevations of sy si,:' l rst):pow, is 0 0 Pump curve attached
0 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar 1 •.'t� Non-residential justification
yirdI,* ;,„m �'��'t ❑ ❑Waste strength
i .cesiGNER%i 0
❑ Flow
DESIGN AP' 'bik
The undersigned designer must be notified by i ller ime of in .on EfYes 0 No
3—'? • 2e
Signature o signe 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 on-site regulations:
CCYV\ C (77117 --
Environmental Health ecialist 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: c 1-2'7//VO
✓ 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. Revised:4/14/2025
Advantage Perc & Design
Timely-Reasdnable-30 Years of Local Experience
Construction Notes for 4 bedroom Gravity System
-Install 4—50'-trenches installed 1$"deep on high side of trench with a d-box and equal distribution
configuration
-Installer must stakeout 4-50' laterals and contact the designer for approval prior to permit release.
-Install on 5 foot centers.
-must verify and maintain 36" of vertical separation.
-Install level and along contours.
-Install in dry weather only.
-Use 1200 Gallon septic tank
-System designed for typical resideitial waste strength sewage only.
-System designed for 480 Gallons Pier Day
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4 MAY 2 7 2025
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