HomeMy WebLinkAboutSWG2025-00170 - SWG Application / Design - 5/6/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
A 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: SWG2025-00170
APPLICANT PEEBLES REVOCABLE LIVING TRUST Phone:
GEORGE J PEEBLES & DONNA J
Address: MARK T PEEBLES SUCCESSOR TRUSTEE VANCOUVER, WA 98662
OWNER PEEBLES REVOCABLE LIVING TRUST Phone:
GEORGE J PEEBLES & DONNA J
Address: MARK T PEEBLES SUCCESSOR TRUSTEE VANCOUVER, WA 98662
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
SEPTIC INSTALLER TJ GOOS* Phone: 360-490-0217
Address: 150 E MARISA PL SHELTON, WA 98584
Site Address: 21 N Quinault PI
Primary Parcel Number: 423185100075
Permit Description: new 2br sfr - pressure trench
Permit Submitted Date: 05/06/2025
Permit Issued Date: 06/04/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/29/2028 (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.
4
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 DATERECENED: 0/ a� ,2025
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en,IP,.. AMOUNiRECE RECEIVED CO (/)
- ; Public Health & Human Services 82� � _ o N
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 ��� _) -S — ��I 7O
415 N.6th Street-Shelton,WA 98584 v
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE m
Adam Peebles �/�/� (360)607-6996 c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE \�` 7-
18638 NE 65th St. %.1911‘.��% Vancouver WA 98662 n 03SITE ADDRESS-STREET•CITY,ZIP CODE (� �0k) C
21 N. Quinault PI. U �co - oodsport WA 98548 114,..
NAME OF DESIGNER �
N I;� `••. PHONE I N
Dale L. Tahja ‘ + (360) 463-8023
NAME OF INSTALLER PHONE v Os)
T.J. Goos 1,-k (360) 490-0217
PERMIT TYPE(select one) DRINKING WATER SOURCE
RESIDENTIAL OSS b_COMMUNITY OSS in:COMMERCIAL OSS b.'PRIVATE INDIVIDUAL WELL b7 PRIVATE TWO-PARTY WELL Z 03
TYPE OF WORK(select one) 1'PUBLIC WATER SYSTEM Lake Cushman Water Co.
E-NEW CONSTRUCTION/UPGRADES ffREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR
SUBMITTALS Cl SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
Ii DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? O I
5WAIVER(S)(IF APPLICABLE) 2 0.18acre IDYES p NO 0 t
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go to Hoodsport, left on Hwy 119, left on Mt. Church Dr., left on Quinault PI., first driveway I o
on the left.
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WITH MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED TH TEST HOLE NUMBERS. 01
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes) i
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME S• E ID COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS A,t, COMMENTS/CONDITIONS
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LICENSED DESIGNERJr 1
. ^ RECORD DRAWING AND INSTALLATION REPORT
SOIL COD
V=VERY G=GRAVELLY S=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
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pKIS e4TOR S NATURE DATE APPLICATION EXPIRATION DATE FICATION APPROVED/ISSUED BY DATE
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THIS ORM SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
1 . i
DESIGN FORM—PAGE ONE Assessor's Parcel Number y ` 3 — \ — z�a 15_
A design will be reviewed when 3 copies of each of the following are submitted:
'I 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 2025-00170 Designer's Name: Dale L.Tahja
Applicant's Name: Adam Peeles Designer's Phone Number: (360)463-8023
Mailing Address:
18638 NE 65th St. Designer's Address: 2450 W. Deegan Rd.W.
Vancouver WA 98662 City State Zip Shelton WA 98584
City State Zip Designer's Email daletahja@gmail.eom
DESIGN PARAMETERS -`.
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU Ll Other
Treatment Level(check all that apply): ❑A ❑B ❑ C ❑ BL1 ❑BL2 ❑BL3E Cl N
Drainfield Type
elit Gravity ,(L-Pressure ErTrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class Sch.40
Daily Flow: Operating Capacity 180 gpd Length 27 ft
Daily Flow:Design Flow 240 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,000 gal Number 5
Receiving Soil Type(1-6) 4 Separation 6 ft
Receiving Soil Appl. Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices
Designed Primary Area 400 ft2 Diameter 1/8 in
Designed Reserve Area 400 ft2 Spacing 48 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 135 ft Schedule/Class Sch.40
Elevation Measurements Length 60 ft
Original Drainfield Area Slope 4 % Diameter 1.25 in
New Slope,If Altered 4 % Preferred manifold configuration used? El Yes ErNo
Depth of Excavation Up-slope 10 in Transport Pipe
from Original Grade Down-slope 8 in Schedule/Class Sch.40
Designed Vertical Separation 24 in Length 20 ft
Gravel-based Drainfield Required? 0 Yes E1 No Diameter 1.25 in
Pump Required? E(Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
i Duff.in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 7 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 18 gpm le Timer Pf Elapse Meter Ilif Event Counter
Calculated Total Pressure Head 16 ft If Ts : p , . ;,,, off 5 hrs.57.5 min.
Comments .i
JUN 0 3 2025 .
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MASON COUNTY ENVIRONMENTAL HEALTH
J B W Revised:4/14/2025
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 51\3 -- 3` — 0 a1 S
Permit Number: SWG 2025-00170
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
d Test hole locations Ea Drainfield orientation and layout Reference depth from original grade:
d Soil logs Ef Trench/bed dimensions and l Septic tank
El Property lines critical distances within layout la Drainfield cover
H Existing and proposed wells fg D-BoxNalve box locations Reference depth from original grade
within 100 ft of property <g Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks, and locations li' Laterals, trench bed,top and
surface water and critical areas Fr Observation port location bottom
H Location and orientation of V Clean-out location 0 Curtain drain collector
curtain drain and all absorption Ej Manifold placement ❑ Sand augmentation
components IIrT Orifice placement Other cross-section detail:
® Location and dimension of g Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
lel Buildings 0 Audible/visual alarm referenced Yes No
El Direction of slope indicator El Scale of drawing shown on scale u 0 Design staked out
V Waterlines bar 0 0 Recorded Notices attached
V Roads, easements,driveways, 0 Elevation benchmark and relative 0 0 Waiver(s)attached
parking ele io o m o onents Cd' 0 Pump curve attached
P1 North arrow and scale drawing P P O V E ❑ 0 Evaluation of failure
shown on scale bar on-residential justification
J U N 0 3 2025 ,■ ❑ Waste strength
0 ❑ Flow
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a DESIGN AMA)L
The undersigned designer must be notified by instal er at time of installation !Yes 0 No -
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Signature of Designer Date , 1
•The undersigned has reviewed this design on behalf of Mason County Public Health and det-;�': to it j
compliance with state and local on-site regulations: ' M;°" N 1`,.o
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- 'R�nmental Health Specialist Date Z�\ ;SbMI f J 0 ��
CAUTION: DESIGNG AP"Approved"
'R dOVAL IS VALID ONLY Public
UbNDEiRaTHE FOLLOWING CONDITI II +ti```'
The design is
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 2 4 —��
✓ 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,
j 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
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Liberty Pumps 280 - 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
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Installation/Maintenance
Pressure 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. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 4ft. Centers. Install the orifices pointing straight up ( 12:00 o'
clock).
7. Divert all storm water run-off away from septic system components.
8. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
9. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
11.Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.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.
17. Locate all utilities prior to starting installation.
18.A Final Inspection and Record Drawing fee will be charged upon completion of the
installation.
19. The installer will notfy the designer,Dale Tahja.(360)463-8023, 48 hours prior to the
start of the installation. f
20. An additional re-design fee may be charged if t:es are requested from the applicant
after the original design is approved. ,�� t, APPROVE f
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LICENSED DESIGNER 1