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HomeMy WebLinkAboutSWG2025-00227 - SWG Application / Design - 6/6/2025 584eiMASONCOUNTY 415 N 6TH STREET,SHELT967 ,E 98584SHELTON: ,S 42 TON, ,EXT 400 nt 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: SWG2025-00227 COVrvi APPLICANT ANDRES ET UX MATEO TOMAS Phone: Address: 221 E COUGAR LN S SHELTON, WA 98584 OWNER ANDRES ET UX MATEO TOMAS Phone: Address: 221 E COUGAR LN S SHELTON, WA 98584 SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023 Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584 Site Address: 1031 E PHILLIPS LAKE LOOP RD Primary Parcel Number: 220055100070 Permit Description: New 4bd ATU to pressure trench Permit Submitted Date: 06/16/2025 Permit Issued Date: 07/01/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/26/2028 (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 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. 7 Must comply with all Planning regulations regarding RV usage on lot. 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. OFFICIAL USE ONLY eln." .. MASON COUNTY DAIIREamc k. - , - II _ `' C N AMOUNT RECEIVED:4 S WINED BY: ,/1 0 • COm Public Health & Human Services Ian Environmental Health 360-427-9670,ext 400 or 360-275-4467,ext.400 /� n Cl) 415 N.6th Street-Shelton,WA 98584 S WG LO /� _ I`�1 O X ��/ Z U) ON-SITE SEWAGE SYSTEM APPLICATION r. APPLICANT (r t PHONE m m Mateo Tomas (�-� (360) 801-3561 Z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE O 3 221 E. Cougar Ln S o Shelton WA 98584 - m SITE ADDRESS-STREET,CITY,ZIP CODE WI x 1031 E. Phillips Lake Loop Rd.@=D zShelton WA 98584 N ea NAME OF DESIGNER `i-n- 1 PHONE tV Dale L. Tahja L m (360)463-8023 NAME OF INSTALLER PHONE CI CI R 5 Ic) PERMIT TYPE(select one) DRINKING WATER SOURCE O Of RESIDENTIAL OSS rl COMMUNITY OSS l COMMERCIAL OSS WI PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I 0' TYPE OF WORK(select one) a PUBLIC WATER SYSTEM r iii NEW CONSTRUCTION/UPGRADES 5-REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR N I Cal SUBMITTALS ❑ SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE Ca 1 DESIGN FORM(REQUIRED) W'I SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? O I LJ WAIVER(S)(IF APPLICABLE) 4 0.93acre — 0 YES Q NO T DIRECTIONS TO SITE AND SITE CONDITIONS:(ox.locked gate) CI Go to Phillips Lake public boat launch. Go on Phillips Lake Lp. Rd. to property on the left. I o o Io Vim 0 SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE AGGED WITH TEST HOLE NUMBERS. I FL O OFFICIAL USE ONLY BELOW THIS LINE — — — — ------- IPGRA�Ug DE FAILURE SOURCE(for reporting purposes) ic _ o ._ ��.�.kl 0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE 0 COMPLAINT ❑OTHER: �:,• . INSPECTOR SOIL LOGS COMMENTS/CONDITIONS r ✓ `r , /.1 1 0 0 0 ...5\ fici OS L 46 ....c_i ( i _� 1 -y�O 0111 9 o z ckk\ .11-\-1) 4: 11^1\32A-7V ‘‘., -3,,,six , \4, RECORD DRAWING AND INSTALLATION REPORT H SOIL CODES: V=VERY G=GRAVELLY S=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE '` (/*S G/z_ z _f 1(( 12 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSRE Revised:4/14/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 0 0 5 — 5 1 — 0 0 0 7 0 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: 1I"X 17" PARCEL IDENTIFICATION "' Permit Number: SWG 2025-00227 Designer's Name: Dale L.Tahia Applicant's Name: Mateo Tomas Designer's Phone Number: (360)463-8023 Mailing Address: 221 E.Cougar Ln. S. 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 k DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter ©A1U NuWater BNR-soo Li Other Treatment Level(check all that apply): p A p B 0 C 0 BL1 C]BL2 0 BL3 ❑E 0 N Drainfield Type ❑ Gravity fir Pressure liTrench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 4 Schedule/Class Sch. 40 Daily Flow:Operating Capacity 360 gpd Length 45 ft Daily Flow:Design Flow 480 gpd Diameter 1.25 in Septic Tank Capacity(working) NuWater BNR-500 gal Number 6 Receiving Soil Type(1-6) 4 Separation 5 ft Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices Required Primary Area 800 ft2 Total Number of Orifices 72 Designed Primary Area 800 ft2 Diameter 1/8 in Designed Reserve Area 800 ft2 Spacing 48 in Trench/Bed Width 3 ft Manifold Trench/Bed Length 270 ft Schedule/Class Sch. 40 Elevation Measurements Length 80 ft Original Drainfield Area Slope 5 % Diameter 1.25 in New Slope, If Altered 4 % Preferred manifold configuration used? 0 Yes gNo Depth of Excavation Up-slope .7ll (1 in Transport Pipe from Original Grade Down_slopc Y I Schedule/Class Sch. 40 Designed Vertical Separation 12 in Length 10 ft Gravel-based Drainfield Required? 0 Yes F6 No Diameter 2 in Pump Required? it Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 4 Diff. in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 90 gal Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1.200 gal Uppermost Orifice Fie Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 34 gpm Elf Timer Fil Elapse Meter 64 Event Counter Calculated Total Pressure Head 16 ft If Timer: Pump on 2.6 min. ,pump off 5 hrs.57.4 min. Comments Revised:4/14/2025 DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 0 0 5 — 5 1 -- 0 0 0 7 0 Permit Number: SWG 2025-00227 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 1 Test hole locations Ei1 Drainfield orientation and layout Reference depth from original grade: IA Soil logs lig Trench/bed dimensions and if Septic tank lig Property lines critical distances within layout lifDrainfield cover VI Existing and proposed wells Eg D-Box/Valve box locations Reference depth from original grade within 100 ft of property lif Septic tank/pump chamber and restrictive strata: 6i'! Measurements to cuts, banks, and locations fif Laterals, trench bed,top and surface water and critical areas Eil Observation port location bottom 6I Location and orientation of 64 Clean-out location 0 Curtain drain collector curtain drain and all absorption Fg Manifold placement 0 Sand augmentation components Q( Orifice placement Other cross-section detail: O Location and dimension ofFe [� Observation ports/clean-outs primary system and reserve area Lateral placement with distance to edge of bed Other Information 11 Buildings Ftf Audible/visual alarm referenced Yes No g Direction of slope indicator 21 Scale of drawing shown on scale d 0 Designstaked out 1 Waterlines bar 0 0 Recorded Notices attached 1 Roads, easements,driveways, p Elevation benchmark and relative 0 0 Waiver(s)attached parking elevations of system components RI ❑ Pump curve attached FA 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 be notified by insta et-at time of installation 56 Yes 0 No - ;)''.--.\— C\;\,\P\' c Signature of Designer Date , i _ cr ; - The undersigned has reviewed this design on behalf of Mason County Public Health and dete y.:•• e-in 1 compliance with state and local on-site regulations: 4. = %.w�, t iXE 1 *.ris .7) m N / •) Environmental Health Sp ialist Date �%4 � o w U CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDI :hi %4-, J $ s/ The design is stamped"Approved"by Mason County Public Health. / %%- j ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 6 ` 7c(28 „\, ✓ 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 . Mason County WA GIS Web Map 5510002: 2200 5100060 1081 E PHfL/ \ LIPS LAKE LOOP RD • •4 0055 0002' _ 2200551000069 2005'=999 f 2200 1008 t 2005510005', I / 41 1 103.1:E PHILLIt), LAKE LOOP RD 5 f 00551i •057 I \ 220055/001 - r 1011 E PHILLIPS LAKE LOOP RD R r r 100055 • 2 e f----='" APPROVED 2 5 : ..----l' JUL 01 2025 MAST COUNTY ENVIRONMENTAL HEALTH 1009 E PHtLUP LAKE LOOP RD RET ,,�'" • 22 055100072 ( 220055100073 6/15/2025, 12:37:39 PM VV't- C-C-TO-V- K-D-- 1:767 0 0.01 0.01 0.02 mi 0 County Boundary i L, ' . ' .r f • . I r 1 0 0.01 0.02 0.04 km No Filled ,Z,C)( J— \5 l-- $0 ° Site Address (Zoom in to 1:3,000) So soes:Ess.HERE.Garmin,Iresnnap.Increment P Corp.,GEBCO,USGS. FAO.NPS,NRCAN.GeoBeee,IGN.Itadesser NI.Ordnance Survey,Esrl U Tax Parcels (Zoom in to 1:30,000) tit.Eed China(Hong Kong),rot contributors,and the GIS User Community — Contours 5 ft Mason County WA GIS web Map Appamnion Mason County disdains accuracy,reliability.or timeliness of website info,not was for losses from rearms on I.turnips//wkvrmasanoo i rwe•govndsdalme.phP Ci 1 02 • IP - . ' Y ,. -7, • ill f 0 A. . iiimmilmi., :::: . . -.SI . N.,. . ,,fil: • '''' 1 ct..,, , ..,tj • .1111111111r, : . ...,. 1 : , .,...:. . e .x ,,,,,.,f.t t . • I - i CV A :' " i 1, '. ..• ------•--i.:...,..-- •••:-.:,1.-•,.•,....- •.,. ()1 10.4 ' I I 111111 ! r )U 11; . _Ig g i OA iii,4y f ►. ' -----• `,....� >.11ii ,.a °,2 mow'„ 4. ►, :, �,,� - : _ � APPROVED At k ' MASON COUNTY ENVIRONMENTAL HEALTH RET 1. , i i co� g z1 N - LL a g 4 ,iiiii i Cal.API\ . C g ' I '1/I Nim. zZocai m a W mOa W c1.--J 1 m L-11 t, } �� u O.47,.. ! i Q N Z 1 I o oW 9 APR VELt 4 m 1 2 J U L 0 1 2025 Z LL L.i6 MASON COUNTY ENVIRONMENTAL Kitg W RET W N Z ~ � ' - .-. :C) 1 P R 1 1 LL I mW Fir" /1---- ,g , H O i Z 111 Y J Q t CI i CI P a s 2 C' 1 i L r { �� of i — — ——-- j Q it=l' 06 09- m .0 •, x CI ,-1.---..r.--....0 ( 3' \ Z i LL J i -- Media Gallery X Liberty Pumps 280- 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non- Automatic) Performance Curve: 280-Series t • ' ti ' 1 111 ` Trr , + r t s t t 25 1._!- . Illark -- -f.4.-�-- ' .___ Ito , ,• + ..ems....__ ,. U. 20 I I ! ! / ) 111111111g411411111 1-1-1 V ill ' �_. or ( i � S ! ' 1 amine.a.w.T 7 f-t-r-44-4-4- ! IlAi +4- : 1- --r-t- t }- 0 1._ 1 _L.L.LL Li r ; i ,--1---r., -I t 1 i 1 1 .i , t ....,_ . 0 5 10152025 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute APPROVED JUL 01 2025 MASON COUNTY ENVIRONMENTAL HEALTH RET 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 (with orifice shields)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 10ft. 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. The Designer may have additional charges for redesign work and Final Inspection. 19. The installer must notify the designer- Dale L. Tahja—(360)463-8023) at least 48 hours prior to installation. 07.4 # APPROVED < .� `' +r JUL 01 2025 0.9417 tf MASON COJNTY ENVIRONMENTAL HEALTH 510021 �h RET • *' Dale L.Tahh i LICENSED DESI �. �V► "��������a��� f f ''.• ----- ____.-- ";"--- „....,-..,0 ,r.„....." o ri/ _f4,. I) . ' 0.% • • ‘., ii (1':::-.----'(•,-) )0 • 5 „. (, , ‘) 0 gir4k,ikk x 6i C2-^ 1.0 Li i f _I? r ,i.:,. * ' . 0 W_.,E4tik.44Vt)k_ .4 ' (1 .°4'''''''' LA 0 0) -4 , •_416!.....irai. 14 yz.i. 4„..4..t.c, _. , ...., ' II g; 2,.„. 47"--.:* • ,.....„3 • ,3,,, , c) > :•''0, .... "" c t 73 • rrl 0.. c•-•45% 11 . ci Cla c=) e5C . . .. r•rl crt w_ri • C2 z - • --4 x-- 1--. • . • 4 - • -17---, • .714 0 . ! lir .......„, ,,.... \ ...._ , :.a... .....\\ ., 1110— ., . ...r" . • 1 ... \,i•• 41111/4•\iy ? \ ,,.., 4r - ..) . 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