HomeMy WebLinkAboutSWG2025-00185 - SWG Application / Design - 5/20/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
L SHELTON:360-427-9670,EXT 400
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: SWG2025-00185
APPLICANT CHAMBERS THOMAS C Phone: 206-669-5250
Address: 5377 SE ARCADIA RD SHELTON, WA 98584
OWNER CHAMBERS THOMAS C Phone: 206-669-5250
Address: 5377 SE ARCADIA RD SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
SEPTIC INSTALLER MANKE EXCAVATING LLC Phone: (360)490-0791
Address: 1909 PATTERSON ROAD SHELTON, WA 98584
Site Address: 4620 W Shelton Matlock Rd
Primary Parcel Number: 420222100030
Permit Description: New 3-bedroom gravity system with Class B vertical separation
waiver
Permit Submitted Date: 05/20/2025
Permit Issued Date: 06/17/2025
Issued By: David Anderson
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 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 DATERECENED: ^
AIL, _V)(�/) c uDi
AMOUNT RECEIVED: RECEIVED BY
Public Health & Human Services ( . .5— CO m
Environmental Health 360-427-9670,ext.400 or 360-2754467,ext.400 N O
415 N.6th Street-Shelton,WA 98584 S W G )O S OC L �LJ O A
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE r
Tom Chambers (206) 669-5250 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE C
5377 SE Arcadia Rd. Shelton WA 98584 °m°
SITE ADDRESS-STREET,CITY,ZIP CODE
4620 VV. Shelton Matlock Rd. Shelton WA 98584 14'
NAME OF DESIGNER PHONE I N
Dale L. Tahja (360) 463-8023
NAME OF INSTALLER PHONE C.) I C)
Manke Excavating LLC (360) 490-0791 < I
PERMIT TYPE(select one) DRINKING WATER SOURCE N
g RESIDENTIAL OSS 17 COMMUNITY OSS 5COMMERCIAL OSS PRIVATE INDIVIDUAL WELL ffi PRIVATE TWO-PARTY WELL Z N.)TYPE OF WORK(select one) � k�.;PUBLIC WATER SYSTEM CI TABLE
4
NEW CONSTRUCTION I UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) TABLE X REPAIR I N'
i SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
REDESIGN FORM(REQUIRED) 6SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER4/1/2025? I --
gWAIVER(S)(IF APPLICABLE) 3 8.82acre 0 YES p NO n
O
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go out Shelton Matlock Rd 4.6 miles, property on the right. Walk around locked gate, drain I o
field site 260ft. from the gate.
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4 O I
MAY 2 0 2025 I✓ I co
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. BY: I
OFFICIAL USE ONLY BELOW THIS LINE
0 UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT 0 OTHER: — 0
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COMMENTS/CONDITIONS i /
I'NcSPEC70/R�SOIL LOGS C rry pc j —;ct.* CZ / 1l
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�� .,, I Tle5f qf6( Lt. f " JQ
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Est CO gig" w( inorf till
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
7, V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPE OR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICAT PROVED/ISSUED BY DATE
M.11.16 7 s, S(z z(Zo? 6//7( u
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
.
DESIGN FORM—PAGE ONE Assessor's Parcel Number. ,4, — � — (�
:an .b
A design will be reviewed when 3 copies of each of the following arc 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 2025-00185 Designer's Name: Dale L.Tahja
Applicant's Name: Tom Chambers Designer's Phone Number: (360)463-8023
Mailing Address: 5377 SE Arcadia Rd. Designer's Address: 2450 W. Deegan Rd.W.
Shelton WA 98584 City State Zip Shelton WA 98584
City State Zip Designer's Email daletahja@gmail.com
a, - DESIGN PARAMETERS:
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter ❑ATU I.7 Other
Treatment Level(check all that apply): 0 A 0 B 0 C 0 BLl 0 BL2 0 BL3 El E n N
Drainfield Type �Z,�
Er Gravity 0 Pressure I 'Trench 0 Bed El .ub Surf p v�
Septic Tank/Drainfield Specifications Laterals ikc- 91
Number of Bedrooms 3 Schedule/Class 2729 - C�jG�O O`s
Daily Flow: Operating Capacity 270 , gpd Length 67 ft
Daily Flow:Design Flow 360 - gpd Diameter 4 in
Septic Tank Capacity(working) 1,200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 10-42 ft
Receiving Soil Appl.Rate 0.6 " gpd/ft2 Orifices
Required Primary Area 600 - ft2 Total Number of Orifices 2729 Perf. Pipe
Designed Primary Area 600 ft2 Diameter N/A in
Designed Reserve Area 600 ' ft2 Spacing N/A in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 - ft Schedule/Class 3034 -
Elevation Measurements Length 40 ft
Original Drainfield Area Slope 8 % Diameter 4 in
New Slope,If Altered 8 % Preferred manifold configuration used? 0 Yes EN()
Depth of Excavation Up-slope 30 in Transport Pipe
from Original Grade Down-slope 27 in Schedule/Class 3034
Designed Vertical Separation 18 in Length 100 ft
Gravel-based Drainfield Required? 0 Yes e No Diameter 4 in
Pump Required? 0 Yes P'No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
Diff.in Elevation Between Pump&Uppermost Orifice N/A ft Dose quantity N/A gal
Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) N/A gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head Gravity gpm 0 Timer 0 Elapse Meter 0 Event Counter
Calculated Total Pressure Head N/A ft If Timer: Pump on N/A ,Pump off N/A
Comments
Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number, Lk 6 a - 1 -• O
Permit Number: SWG`)� - CO'-
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations RT Drainfield orientation and layout Reference depth from original grade:
d Soil logs Lot Trench/bed dimensions and Lot Septic tank
O Property lines critical distances within layout la Drainfield cover
RI® Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property E' Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,and locations ' Laterals,trench/bed,top and
surface water and critical areas iff Observation port location bottom
IE Location and orientation of 6'1 Clean-out location 0 Curtain drain collector
curtain drain and all absorption Et Manifold placement 0 Sand augmentation
components Ea Orifice placement Other cross-section detail:
El Location and dimension of �vj Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
0 Buildings g Other Information
0 Audible/visual alarm referenced Yes No
L1 Direction of slope indicator 1E1 Scale of drawing shown on scale E 0 Design staked out
PS Waterlines bar 0 0 Recorded Notices attached
O Roads, easements,driveways, p Elevation benchmark and relative E 0 Waiver(s) attached
parking elevations of system components 0 0 Pump curve attached
IE North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified `
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invta rat time of installation El Yes 0 �
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Signature of Designer ! 414SQJ , ?025
• 0471,
The undersigned has reviewed this design on behalf of Mason County Public Health and detgrnutisrtit E-' w
compliance with state and local on-site regulations: ' =-��z F
(22 /l/7/ /V Z; moTO~ Luj
Environmental Health Specialist Date d .. 12 n !
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDI 9,i , v
✓ The design is stamped"Approved"by Mason County Public Health. (''- q � ''
/
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: l Z/2d 7 D
✓ 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
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i LICENSED DESIGNER ► 1pk
Installation/Maintenance
Gravity 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. Divert all storm water run-off away from septic system components.
4. No curtain (french) drains allowed within 10ft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.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.
11.Locate all utilities prior to starting installation.
12.A Final Inspection and Record Drawing fee will be charged upon completion of the
septic system installation.
13.The installer will notify the designer, Dale Tahja(360) 463-8023, at least 48 hours prior
to the start of the septic system installation.
14.An additional re-design fee may be charged if changes are requested from the applicant
after the original design is approved.
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