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HomeMy WebLinkAboutSWG2024-00284 - SWG Application / Design - 7/15/2025 415 N 6TH STREET,SHELTON,WA 98584 01111. MASON: COUNTY SHELTON:360-427-9670,EXT 400 BELFAIIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2025-00284 APPLICANT HOPE PANDORA I Phone: 360-536-5098 Address: 4455 NW SHELLEY DR SILVERDALE, WA 98383 OWNER HOPE PANDORA I Phone: 360-536-5098 Address: 4455 NW SHELLEY DR SILVERDALE, WA 98383 SEPTIC INSTALLER DARYL HEMLEY* Phone: 253-857-3241 Address: PO BOX 305 BURLEY, WA 98322 SEPTIC DESIGNER Lawrence Purdum Phone: 2535099922 Address: PO Box 801 Gig Harbor, WA 98335 Site Address: 422 E OLDE LYME RD Primary Parcel Number: 321275300207 Permit Description: Upgrade to TLB for Building Permit Permit Submitted Date: 07/15/2025 Permit Issued Date: 07/17/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/15/2028 (based on date of inspection) Type of Work Other Components being Replaced: Other Surfacing Sewage? No Existing Failure? No Shoreline? Yes Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Public Water System Additional Details: Add Nuwater BNR500 and convert ST to PT Permit Conditions: 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 4 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/OR 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. MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 M . �' BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 6 The reserve designated is a Table 10 reserve for a Shoreline Low-Impact Expansion proposal. When the reserve is installed in the future, waterline may need to be relocated to meet setbacks to new drain field. 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/OR 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. I OFFICIAL USE ONLY \\ MASON COUNTY DATE RECEIVED: f yf--/�J (/ I ' \J C// ) D ret1"7 COMMUNITY SERVICES L c `� AMOUNT RECEIVED: ( � RECEIVED BY CO (n �� Vy� o rn J- N Public Health(Community Health/Environmental Health) C w 415 N.6th Street-Shelton. orn.WA 8584 e■t 400 SWG /f�E — "�,� I (� 415 N.6th Street-Shelton WA 985a4 'G/ (`/j`/) (;/J L_,+/ 73 Q Z 65 ON-SITE SEWAGE TANK ONLY APPLICATION a n m n APPLICANT PHONE r PANDORA HOPE 360-536-5098 D c MAILING ADDRESS-STREET,CITY,STATE,7IP CODE m 4455 NW SHELLEY DRIVE rn r SITE ADDRESS-STREET,CITY,ZIP CODE 422 E OLDE LYME RD m NAME OF DESIGNER PHONE 7:11N APEX SEPTIC DESIGN 253-509-2579 o NAME OF INSTALLER PHONE DARYL @ RON HEMLEY SEPTIC INSTALLATION 360-710-9820 < I N TYPE OF WORK(select one) DRINKING WATER SOURCE E NEW CONSTRUCTION/UPGRADES ❑ 0REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0PRIVATE TWO-PARTY WELL Z I COMPONENT(S)TO BE REPLACED/INSTALLED ElPUBLIC WATER SYSTEM LAKE LIMERICK-WFI 44150T t El SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I � A OTHER g1Awi^T"► NV,' O 2 8712 SOFT W I (A OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST 0 I ElSURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 0 O SUBMITTALS 0 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS O PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) ❑ 10FT+DRINKING WATER SUPPLY LINES I C) ❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) El 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST f I 0 ❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES O WELLS WITHIN 100FT El WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... N.) I 0 O DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ❑ NORTH ARROW 0 SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) FROM HWY 3, TAKE A LEFT ONTO E MASON LAKE RD. APPROX 2.7 MILES, TURN RIGHT ONTO E OLDE LYME RD, 0.4 MILES THE PROPERTY IS ON THE RIGHT. OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING BUILDING PERMIT El HOME SALE ❑COMPLAINT 0 OTHER: COMMENTS/CONDITIONS II 01)0Yrit-CLe, 41) 11,6 4r 5 vo pviiiii 4-- SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION :SSUEDAPPROVED/ Y DATE 111 �( ° 6A1100/1 I1 1L THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 7 __ 5 3 __ 0 0 2 0 7 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 '1 Scaled plot plan,including all applicable items on checklist. '1 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: II"X 17" PARCEL IDENTIFICATION Permit Number: SWG 2625 - 002..A1 Designer's Name: Lawrence Purdum Applicant's Name: Pandora Hope Designer's Phone Number: 253-509-2579 Mailing Address: 4455 NW Shelly Drive Designer's Address: PO Box 801 Silverdale, WA 98383 Gig Harbor, WA 98335 City State Zip City State Zip DESIGN PARAMETERS Treatment Device 0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: ®Aerobic Unit Make/ModelNuWater BRN500 0 Disinfection Unit Make/Model Other: Drainfield Type 0 Gravity L Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class N/A Daily Flow: Operating Capacity 240 gpd Length N/A ft Daily Flow: Design Flow 180 gpd Diameter N/A in Septic Tank Capacity N/A gal Number N/A Receiving Soil Type(1-6) N/A Separation N/A ft Receiving Soil Appl. Rate N/A gpd/ft2 Orifices Required Primary Area N/A ft2 Total Number of Orifices N/A Designed Primary Area N/A ft2 Diameter N/A — in Designed Reserve Area N/A ft2 Spacing N/A in Trench/Bed Width N/A ft Manifold Trench/Bed Length N/A ft Schedule/Class N/A Elevation Measurements Length N/A ft Original Drainfield Area Slope N/A % Diameter N/A in New Slope,If Altered N/A % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope N/A in Transport Pipe from Original Grade Dow,_slope N/A in Schedule/Class Schedule 40 Designed Vertical Separation N/A in Length 4 Ft ft Gravelless Chambers Required? 0 Yes 0 No 0 Optional Diameter 2-in in Pump Required? 0 Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 8 Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity 30 gal Orifice 5.5 ft Chamber Capacity 1,000 (existing) gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 16.7 gpm ►iTimer XIElapse Meter XI Event Counter Calculated Total Pressure Head 12.7 ft If Timer: Pump on TBD © setup ,pump off TBD ©setup Comments Tank replacement only DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 2 7 -- 5 3 -- 0 0 2 0 7 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch ❑ Test hole locations ® Drainfield orientation and layout Reference depth from original grade: ❑ Soil logs Ell Trench/bed dimensions and cia Septic tank ® Property lines critical distances within layout 0 Drainfield cover ❑ Existing and proposed wells ® D-Box/Valve box locations Reference depth from original grade within 100 ft of property ® Septic tank/pump chamber and restrictive strata: III Measurements to cuts,banks,and locations 0 Laterals,trench bed,top and surface water and critical areas 0 Observation port location bottom ❑ Location and orientation of ❑ Clean-out location 0 Curtain drain collector curtain drain and all absorption 0 Manifold placement ❑ Sand augmentation components ❑ Orifice placement Other cross-section detail: Location and dimension of 0 Observation 0 Lateral placement with distanceports/clean-outs primary system and reserve area to edge of bed Other Information ® Buildings Q9 Audible/visual alarm referenced Yes No ❑ Direction of slope indicator ® Scale of drawing shown on scale ❑ Design staked out riI Waterlines bar 0 Recorded Notices attached ® Roads,easements,driveways, ® 0 Waiver(s)attached parking ® 0 Pump curve attached ® North arrow and scale drawing 0 1Z9 Evaluation of failure shown on scale bar Non-residential justification O 0 Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation ISJ Yes 0 No 4 j . p _ 7/10/25 Signature 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 on-site regulations: C._11LQ,A4/149<tg(Y/ �fI71Z� Environmental Health Rpecialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped "Approved"by Mason County Public Health.✓ 12 E) The Onsite Sewage Permit has not expired,the Permit Expiration Date is: / b ✓ 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. Updated Date: 12/7/2015 ggidog ! 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