HomeMy WebLinkAboutSWG2025-00260 - SWG Application / Design - 7/1/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
J` SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00260
APPLICANT KNUTZEN ET UX JOHN R Phone:
Address: JERI D ANSORGE-KNUTZEN TAHUYA, WA 98588
OWNER KNUTZEN ET UX JOHN R Phone:
Address: JERI D ANSORGE-KNUTZEN TAHUYA, WA 98588
SEPTIC DESIGNER Dave Ghylin - Dave's Septic Service Inc. Phone: 360-710-2449
Address: PO BOX 301 SEABECK, WA 98380
Site Address: 1826 NE Tee Lake Rd
Primary Parcel Number: 323353190041
Permit Description: 2BR ADU -Pressure w/Class B Waiver
Permit Submitted Date: 07/01/2025
Permit Issued Date: 08/28/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/10/2028 (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 Desiner/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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED:
,ir - :. MASON COUNTY L 7 - Cl - 20 z 3 a
.It. COMMUNITY SERVICES AMOUNT RECEIVE : � RECEIVED BY: CO Cn
,M. 0 m
\�`3� ?- S Public Health(Community Health/Environmental Health) C W
7,,1�.�•y4' 360-427-9670,ext 400 o 467.ext.400
415 N.6th Street•Shelton,WA 98584 S W G 2UZS �
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ON-SITE SE SYSTEM APPLICATION z
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APPLICANT m
John Knutzen 360-850-2421 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE p g
1826 NE Tee Lake RD Tahuya WA 98588 rn
SITE ADDRESS-STREET,CITY,ZIP CODE Pr.1PZI
1826 NE Tee Lake RD LPFOF1EHONE
Tahuya WA 98588 c^'
NAME OF DESIGNER �-/ PHONE I N
Dave Ghylin a 360-710-2449
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NAME OF INSTALLER PHONE v I CO
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PERMITDRINKING WATER SOURCE
TYPE(select one) to
Pi RESIDENTIAL OSS rl COMMUNITY OSS r COMMERCIAL OSS El PRIVATE INDIVIDUAL WELL M-PRIVATE TWO-PARTY WELL Z 101
TYPE OF WORK(select one) a PUBLIC WATER SYSTEM
r
NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I GJ
SUBMITTALSCO
t 0 SURFACING SEWAGE 0 EXISTING FAILURE El SHORELINE
MI
In DESIGN FORM(REQUIRED) M SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I —'
PrWAIVER(S)(IF APPLICABLE) 2 13 Acres 0 I I
DIRECTIONS TO SITE AND SITE CONDITIONS (ex.locked gate)
Please call owner before showing up due to the size and location of the proposed site. I o
Follow the ribbons West off of NE Tee Lake RD up a paved driveway and through a tree 0 r I o
farm. -+
* I .4"
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
3Y 5L
32- "
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSP OR SIGNATURE DATE APPLICATION EXPIRATION DATE AP !CATION APPROVED/ISSUED BY DATE
It/fiC,JA �, 2—r 7—�� �/OAR, (�, L g -�S"
T S Fe •MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12 7/2015
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 3 3 5 — 3 1 — 9 0 0 4 1
A design will be reviewed when 3 copies of each of the following are submitted:
'1 Completed design form that has been signed and dated. '1 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: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 2.07, - GOZ(eO Designer's Name: Dave Ghylin
Applicant's Name: John Knutzen Designer's Phone Number: 360-710-2449
Mailing Address: 1826 NE Tee Lake RD Designer's Address: PO Box 301
Tahuya WA 98588 Seabeds WA 98380
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity VI Pressure L92rTrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 40
Daily Flow:Operating Capacity 480 gpd Length 55' ft
Daily Flow:Design Flow 480 gpd Diameter 1" in
Septic Tank Capacity(working) 1200 gal Number 5
Receiving Soil Type(1-6) 4 Se an 6' ft
Receiving Soil Appl.Rate .6 gpd/ft R V i4 'Orifices
,`1_.
Required Primary Area 800 & otal b r of Orifices 70
z 8 2025
Designed Primary Area 800 MAS eter 1/8" in
Gl 1,NTYENVIRONMENTAL •
hE��;
Designed Reserve Area 1,375 ft2 Spacing T 4' in
Trench/Bed Width 3' ft JBW Manifold
Trench/Bed Length 55' ft Schedule/Class 40
Elevation Measurements Length 30' ft
Original Drainfield Area Slope 10-15% % Diameter 1" in
New Slope,If Altered N/A % Preferred manifold configuration used? 0 Yes Iii'No
Depth of Excavation up-slope 16" in Transport Pipe
from Original Grade Down-slope 14" in Schedule/Class 40
Designed Vertical Separation 18" in Length 155' ft
Gravelless Chambers Required? 0 Yes 0 No l(Optional Diameter 2" in
Pump Required? Eff Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 12
Diff. in Elevation Between Pump&Uppermost Orifice -20' ft Dose quantity 40 gal
Drainfield Squirt Height/Selected Residual(head) 5' ft Chamber Capacity(flood) 1000 __ ___ gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 30.6 gpm EiTimer liElapse Meter lir Event Counter
Calculated Total Pressure Head 24.4 ft If Timer: Pump on 78 sec ,Pump off 2 hrs
Comments
Designer will perform a draw down and set the timer once system is built.
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 3 3 5 — 3 1 -- 9 0 0 4 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Test hole locations lifDrainfield orientation and layout Reference depth from original grade:
61 Soil logs g Trench/bed dimensions and g Septic tank
0 Property lines critical distances within layout L 1 Drainfield cover
0 Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations lg Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
❑ Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption & Manifold placement 0 Sand augmentation
components 6if Orifice placement Other cross-section detail:
0 Location and dimension of Observation
primary system and reserve area It Lateral placement with distance ports/clean-outs
to edge of bed
El Buildings Other Information
g Audible/visual alarm referenced Yes No
Pi Direction of slope indicator
g Scale of drawing shown on scale ❑ gtf Design staked out
6g Waterlines bar 0 g Recorded Notices attached
0 Roads,easements,driveways, g 0 Waiver(s)attached
parking P p R V E g ❑ Pump curve attached
11
lid North arrow and scale drawing O Q( failure
shown on scale bar AUG 2 $42025 Non-residentialEvaluation justification
ASON COUNTY ENVIRONMENTAL HEALTH ❑ liff Waste strength
J1131At ❑ gFlow
DESIGN APPROVAL
The undersigned designer must be not' ed by installer at time of installation Eli Yes 0 No
I- 6 36--ZC.
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: .
Jg_.,e___NLtick —2 g" . 5-
Eni.iroveivl Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
I The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: /" / (!- I
✓ 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
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Dave's Septic Services, Inc.
P.O. Box 301
Seabeck, WA 98380
(360) 710-2449
Customer Information:
Date: 4/21/25
Applicants Name: John Knutzen
Tax ID #: 32335-31-90041
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Pump Selection for a Pressurized System-Single Family Residence Project
Parameters
Discharge Assembly Size 1.50 inches 300 1 I .l � �
I PF3015 i _
Transport Length 155 feet MI I
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Transport Pipe Class 40
Transport Line Size 2.00 inches — I '
Distributing Valve Model None
Max Elevation Lift 10 feet 250 I I
Manifold Length 30 feet
Manifold Pipe Class 40 pF30101
Manifold Pipe Size 1.00 inches _I ..__ . 1� ,
Number of Laterals per Cell 5 NMI
Lateral Length 55 feet
Lateral Pipe Class 40 „ 200 II III
Lateral Pipe Size 1.00 inches N PF30071
Orifice Size 118 inches " WA
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Orifice Spacing 4 feet 0
Residual Head 5 feet ~ '� I
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Flow Meter None inches co [.
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'Add-on'Friction Losses 0 feet I 150
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Calculations c
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Minimum Flow Rate per Orifice 0.43 gpm 0 PF3005j
Number of Orifices per Zone 70 :3 .. -.
lik
Total Flow Rate per Zone 30.6 gpm F— 100 I
I
Number of Laterals per Zone 5
Flow Differential 1st/Last Orifice 3.8 % I `�iNk
��
Transport Velocity 2.9 fps
Frictional Head Losses III .�,��
Loss through Discharge 2.8 feet 50
Loss in Transport 2.5 feet I I I l I I t
Loss through Valve 0.0 feet ;; : _ ."�
Loss in Manifold 3.6 feet
Loss in Laterals 0.5 feet —U101111 __
Loss through Flowmeter 0.0 feet I I I I
'Add-on'Friction Losses 0.0 feet 00 5 10 15 20 25 30 35 40
Net Discharge(gpm)
Pipe Volumes
Vol of Transport Line 27.0 gals
Vol of Manifold 1.3 gals 0 (,�OrIPumpData �end
Vol of Laterals per Zone 12.3 gals A `. T
Total Volume 40.7 gals PF3005 High Head Effluent Pump ° •-- System Curve:-
30 GPM, 1/2HP �` '
Minimum Pump Requirements 115/230V 10 60Hz,200V 61 ��1- �Q�,� Pump Curve: -
Design Flow Rate 30 6 gpm C A.% ��
PF3007 High Head t mp P��' ���Q Pump Optimal Range:
Total Dynamic Head 24.4 feet 30 GPM,3/4HP GQ���y����
230V 10 60Hz.200/46 z Operating Point:
PF3010 High Head Effluent ppl* Design Point:0
30GPM, 1HP
230V 10 60Hz,200/460V 30 60Hz
%in
l
o PF3015 High Head Effluent Pump
30 GPM, 1-1/2HP
Orenco 230V 10 60Hz,200/230/460V 30 60Hz
General Designer Notes
Owner Name: John Knutzen p P:11
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Reference: 32335-31-90041 G 2% 2025
���� GOUNS� NIRONMENSA.1
#1 -Soil logs have been dug on this site and are the responssionitty of the,the ANty owner or owner's agent to
have these soil logs buried after the inspection process has been completed.
#2—If during the construction process, soil conditions are found that may lead to premature failure of the
system, construction shall stop immediately and the designer shall be notified. Such soil conditions may
include but not limited to ground water, surface water, fill material, clay soil,bedrock, or excessively
permeable gravels.
#3 —Any substitutions or deviations from these plans shall be approved by the Health Department or the
designer prior to construction. All changes of the system components shall be documented by the designer
on the final As-built drawing.
#4—Peak design flow is 480 g.p.d., Recommended daily flow should not exceed 384 g.p.d.
or premature failure may occur.
#5 —Backfill sewage disposal system immediately after final inspection process,cover soils should be
loamy sand or better. Seed final cover with grass or shallow rooting ground cover.
#6—Keep all maintenance access lids and ports accessible to ground surface.
#7—Installer should rake the fmished grade smooth and slope it to divert all surface water runoff away from
tank and drainfield areas.
#8—Setbacks from house foundation to drainfields and reserve areas are 10', septic tanks 5' and transport
lines 2' unless otherwise stated within the design.
#9—Driveways and parking areas must stay 5' from drainfield areas. Tanks may be located within parking
area and driveways if approved for this application.
#10—Sewage waste strength should meet the following criteria or be lower Bod-5 = 130-174 mg/1, TSS =
47-71 mg/1, FOG= 10-20 mg/1, PH= 6.5-7.2 with microscopic life forms present.
#11 —Installer must adhere to all manufacturer installation requirements for all products used.
#12—The attached septic design does not represent a survey nor does it purport to show all easements or
encroachments, if any. Designer recommends property lines be located prior to any final installation occurs.
Surveys may be required to accomplish this.
#13 —Property lines and corners have been represented by owner or owner's agent,the designer is not
responsible for errors due to inaccurate measurements from property lines or corners that are inaccurate.
#14—If a curtain drain is required with this design it must meet all Health Department installation
requirements.
#15—Developers, homeowners and installers, installations of on-site sewage disposal system should always
be installed in dry weather conditions. Irreparable soil damage may occur if systems are installed in wet
conditions. Planning the installation of system is very important and should be done as early in the building
development stage as possible. Wet weather conditions have caused delays in final approval dates.
#16—Maintenance is required will all sewage disposal systems. Owners will receive details of this in the
designer manual with the final approval of the application.
#17—Adhere to all designer notes located on design layout page.
#18—If development exceeds 10,000 square feet of impervious surface an engineered drainage plan may
need to be submitted. Options are available to reduce square footage requirements, such as wagon wheel
driveways, contact DCD for further details. Owners are responsible for any fee for redesigns or revisions
that may be needed after BSA submittal not due to designer error.
#19—Low flow water fixtures are recommended within the home to help lower the hydraulic load to the
system.
#20-Watertight components are a must for all onsite sewage systems. Installers are required to ensure all
components are watertight, extreme care should be used during backfilling of these components to prevent
settling and or water intrusion issues. If leaking components are not fixed in a timely manner,the designers
warranty may be void.
#21 —Installation of this design must meet all Health Department regulations and all adopted policies by the
Health Department that may apply. Installer is required to be versed in these regulations, if any questions
contact designer.
#22—All components used must be on State Department of Health approved products list for use with
residential waste.
#23 —Installer must inspect all tanks used at time of delivery and any tanks with defects must be rejected
and not used. When using any existing tank, the installer must due a 24 hour leak test to ensure all tanks
used are watertight.
#24—All plumbing must be routed into the new sewage system that has been designed. It is the property
owners responsibility to show the designer all plumbing stub outs and all gray and black water discharge
points. A plumber may be needed on old homes to ensure that all stub out locations are connected to the
new proposed sewage disposal system. An inside pump basin may be needed in some cases where
plumbing is located in basements and elevations for a gravity discharge cannot be maintained.
#25 —Do not use low profile chambers or the system will be red tagged. All lateral lines must be a
minimum of 6"off the infiltrative surface. Lateral ends must be secured at the cleanout and must be in the
center of the port.
#26—Gravel trenches are recommended, but Arc 36"chambers are allowed.
Specific Designer Notes:
#1-This application is for a new 2- Bedroom ADU
#2-A new pressure system is proposed with 270' of drainfield for a total of four-bedrooms of drainfield.
#3-Any large stumps holes to be filled with sand filter sand.
#4-Extreme caution must be taken on clearing drainfield area. Native soils can't be damaged
Recommended to be done by septic installer. e ;#5-0/Misrequired. ppOiI
,,,.
#6-Adhere to all wavier requirements.
#7-A time dose panel is required. AUG 2 8 2025
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
SL#1- 0-34" Reddish brown fine sandy loam with some gravels to restrictive layer.
Soil type 4.
SL#2- 0-36" Reddish brown fine sandy loam with some gravels to restrictive layer.
Soil type 4.
SL#3- 0-32" Reddish brown fine sandy loam with some gravels to restrictive layer.
Soil type 4.
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SL#4- 0-32" Reddish brown fine sandy loam with some gravels to restrictive layer. ; . '4
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