HomeMy WebLinkAboutSWG2025-00191 - SWG Application / Design - 5/21/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
al ': 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: SWG2025-00191
APPLICANT HUSTED MARIAN Phone:
Address: 802 COLONEL WRIGHT RD SHELTON, WA 98584
OWNER HUSTED MARIAN Phone:
Address: 802 COLONEL WRIGHT RD SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 50 E Haskel Hill Rd
Primary Parcel Number: 221264290030
Permit Description: new 2br sfr -gravity w/class b waiver
Permit Submitted Date: 05/21/2025
Permit Issued Date: 07/21/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/12/2028 (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.
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
Ira:. MASON COUNTY DATE RECEIVED: ioss, i
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AMOU CENE). 5 6 RECEIVED BY: W Cl)
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Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 C cn���
415 N.6th Street-Shelton,WA 98584 jI 1�� _ h o 1 n I O
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ON-SITE SEWAGE SYSTEM APPLICATION 3 4
APPLICANT PHONE m m
Marian Husted (805) 835-3432 Z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
802 Colonel Wright Rd. Shelton WA 98584 m
SITE ADDRESS-STREET,CITY,ZIP CODE •
50 E. Haskell Hill Rd. Shelton WA 98584 I N
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NAME OF DESIGNER -- _ i PHONE I N
Dale L. Tahja (360) 463-8023
NAME OF INSTALLER PHONE v
T.J. Goos (360) 490-0217
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PERMIT TYPE(select ono) DRINKING WATER SOURCE �;
RESIDENTIAL OSS (COMMUNITY OSS ;l 'COMMERCIAL OSS l!7 PRIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z I
TYPE OF WORK(select one) PUBLIC WATER SYSTEM I
f NEW CONSTRUCTION/UPGRADES EREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I -P
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
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DESIGN FORM(REQUIRED) gSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? 1-
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'WAIVER(S)(IF APPLICABLE) 2 3.7 acres ❑ YES p NO 0 I I
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go onto Harstine Island, left on Island Drive North, left on Haskell Hill Rd. right on second I o
drive, immediate right into property.
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I O
OFFICIAL USE ONLY BELOW THIS LINE ---
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE CI COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS =
(13 5 L .111. .J•• u j 0 _i
'29 d.&411.1::. .3s 6/ON Ig'("A l;
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SOIL CODES:
RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
1 S ECTOR SIGNATURE I DATE APPLICATION EXPIRATION DATE APP TION APPROVED/ISSUED BY DATE
✓�� -(Z �S (0 -c� - L-� 7'Zi 2
IS lit ' MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
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DESIGN FORM—PAGE ONE Assessor's Parcel Number.���� — " `� — _1 v
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: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 2025-00191 Designer's Name: Dale L.Tahja
Applicant's Name: Marian Husted Designer's Phone Number: (360)463-8023
Mailing Address: 802 Colonal Wright 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
DESIGN PARAMETTERsS
Treatment Device .
❑ Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU a Other
Treatment Level(check all that apply): ❑ A ❑B ❑ C ❑ BL1 0 BL2 0 BL3 pi E O N 4- $/�
Drainfield Type 'QeC•, `y10
LgGravity 0 Pressure Er Trench 0 Bed 0 Sub Dnp•a
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Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 2729
Daily Flow: Operating Capacity 180 gpd Length 45 ft
Daily Flow:Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1,000 gal Number 3
Receiving Soil Type(1-6) 4 Separation 12 ft
Receiving Soil Appl.Rate 0•6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices 2729 Perf. Pipe
Designed Primary Area 400 ft2 Diameter N/A in
Designed Reserve Area 400 ft2 Spacing N/A in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 135 ft Schedule/Class 3034
Elevation Measurements Length 40 ft
Original Drainfield Area Slope 15 % Diameter 4 in
New Slope,If Altered 13 % Preferred manifold configuration used? 0 Yes fffNo
Depth of Excavation Up-slope 24 in Transport Pipe
from Original Grade Down_slope 19 in Schedule/Class 3034
Designed Vertical Separation 18 in Length 20 ft
Gravel-based Drainfield Required? 0 Yes el No Diameter 4 in
Pump Required? 0 Yes E'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 NIA ft If Timer: o "` vu4cot..,:;A N/A
Comments kw ..,4-"i
JUL 2 1 2025kb
MASON COUNTY ENVIRONMENTAL HEALTH
JBI Revised:4/14/2025
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Assessors Parcel Number c� is — �I •-��D3 to
DESIGN FORM—PAGE TWO �
Permit Number: SWG 2025-00191
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
PJ Test hole locations 53 Drainfield orientation and layout Reference depth from original grade:
10 Soil logs Lot Trench/bed dimensions and {o( Septic tank
g Property lines critical distances within layout la' Drainfield cover
L( D-Box/Valve box locations
g Existing and proposed wells Reference depth from original grade
within 100 ft of property L1 Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks, and locations Q Laterals,trench/bed,top and
surface water and critical areas I?3 Observation port location bottom
Fr Location and orientation of 10 Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components 63 Orifice placement Other cross-section detail:
IFI Location and dimension of Lvf Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
E'l Buildings 0 Audible/visual alarm referenced Yes No
10 Direction of slope indicator Q Scale of drawing shown on scale Er 0 Design staked out
EI Waterlines bar 0 0 Recorded Notices attached
L! Roads,easements,driveways, El Elevation benchmar • 4 e c ri 0 Waiver(s) attached
parking ele 'olpitilin f ❑ Pump curve attached❑ Evaluation of failure�� � �'
g North arrow and scale drawing
shown on scale bar JUL 2 1 2025 on-residential justification
.Cl 0 Waste strength
q7 gc7N COUNTY ENVIRONMENTAL HE b 0 Flow
DESIGN APAL
The undersigned designer must be notified Ans, r t time of installation E1 Yes 0 No
Signature of Designer Date j
The undersigned has reviewed this design on behalf of Mason County Public Health and determin- ....':, . n.: z $
compliance with state and local on- ite regulations: `01 o.a,,, v ,!_' j
En - o tal Health Specialist Date `‘t‘t ;S }U/T"4f t
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDI ;I ZA •,1,0 ;
✓ The design is stamped"Approved"by Mason County Public Health. (et.
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✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: —a �� '�.� ,..��
✓ 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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MASON COUNTY ENVIRON" :'
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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 l Oft. 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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