HomeMy WebLinkAboutSWG2025-00349 - SWG Application / Design / As-Built - 9/4/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
ak: BELFAIR:360-275-4467,EXT 400
f ' Public Health & uman erVICeS ELMA:360 482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2025-00349
APPLICANT BOTTOM FAMILY LIVING REVOCABLE Phone:
TRUST
Address: PO BOX 550 GRAPEVIEW, WA 98546
OWNER BOTTOM FAMILY LIVING REVOCABLE
TRUST Phone:
Address: PO BOX 550 GRAPEVIEW, WA 98546
SEPTIC INSTALLER THAD BAMFORD* Phone: 360-790-2364
Address: 301 WALLACE KNEELAND BLVD STE 224-332 SHELTON, WA 98584
Site Address: 211 E VINEYARD CREST RD
Primary Parcel Number: 121087890065
Permit Description: Replace septic tank
Permit Submitted Date: 09/04/2025
Permit Issued Date: 09/08/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/08/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring
Additional Details: IM-1250
Permit Conditions:
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.
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.
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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
. , ' Scp Q 4 7025
t�t012-f OFFICIAL USE ONLY• DATE RECEIVED:
MASO ::-___ - aq - pq - � u) cn
COMMUNITY SERVICES AA10UNTRECEI ��o RECEIVED BY 41032.
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Public Health(Community Health/Environmental Health) /'' �L\ < (n
41 S N.6 hS70,Street
et Shelf00 r,3 W l 5 ext.400 S W G al)/y` / - CO 3449_ Cl) °
415 N.6th Street Shelton.WA 98584 V V !�
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ON-SITE SEWAGE TANK ONLY APPLICATION
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ILING ADDRESS-STREET,CITY,S TE,ZIP CODE W
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SITE ADDRESS-STR ET,CITY,ZIP CODE 6riaeD .�'V
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NAME OF DESIGNER PHONE
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NAM _74/7.� /'' (f' _ PHONE ! /" - `-,�r y 0 I�,
40,44.44;iii)
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TYPE OF WORK(select one) DRINKING W ERCE N I
❑ NEW CONSTRUCTION/UPGRADES $ EPAIR/REPLACEMENT hiPt PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z r(,
COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM
eEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I ,, / I'N
THER /gi)2 r' 1� *"e-S W II
OTHER DETAILS(select all that apply) TANK S)SETBACK CHECKLIST r 1
0
❑ SURFACING SEWAGE ,EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS 0 I I J
SUBMITTALS 5GFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
pic PLOT PLAN(REQUIRED) ANK CROSS SECTION(REQUIRED) L!J' 10FT+DRINKING WATER SUPPLY LINES I
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) g5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
P
r
PLOT PLAN CHECKLIST Q
PROPERTY LINES AND EASEMENTS $EXISTING/PROPOSED STRUCTURES EXISTING/PROPOSED OSS COMPONENTS AND LINES
g.vv
ELLS WITHIN 100FT 0 WATER SUPPLY LINES 1a_DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC...
❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS fxNORTH ARROW 0 SCALE BAR I`\—^`
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate)
OFFICIAL USE ONLY BELOW THIS LINE --
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS I CONDITIONS
V.iupV6t,Ce, +cm ____
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 APPROVED'ISSUED BY DATE
.�, ct J `b f20 7A6. I 1 ct[ t-zs
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12..712015
63%
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INFILTRATOR`
septic
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Features&Benefits
• Strong injection molded polypropylene construction
• Lightweight plastic construction and inboard lifting lugs allow
for easy delivery and handling
• Integral heavy-duty green lids that interconnect with EZsnap
risers, Safety Star secondary safety lid system, and pipe riser
solutions
• Structurally reinforced access ports eliminate distortion during
installation and pump-outs
• Reinforced structural ribbing and fiberglass bulkheads offer
additional strength
Can be installed with 6"to 48" (152 to 1,219 mm) of cover
• Can be pumped dry during pump-outs
• Suitable for use as a septic tank, pump tank, or rainwater(non-
potable)tank
• No special water filling requirements are necessary
• The tank may be backfilled with suitable native soil. See
installation instructions for guidance.
�i0
The Infiltrator IM-1250 is a lightweight, strong and durable septic tank. This waterttJ tank del is offered
with Infiltrator's line of custom-fit EZsnap risers and heavy-duty lids. Infiltrator injectick ngfil s provide a
revolutionary improvement in plastic tank design, offering exceptional long-term strengt wa MklVhtness.
TANK CUTAWAY Partition baffle wall 1" `,5% O
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l�
HEAVY DUTY LID CUTAWA'
Reinforced 24" structural
access port
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Structural bulkheads
MID-SEAM CUTAWAY fr
Reinforced water tight INFILTRATOR
mid-seam gasketed water technologies
connection
,IM-1250 General Specifications and Illustrations
The IM-1250 is an injection molded two-piece mid-seam
polypropylene tank. The injection molded design of
thelM-1250 allows for a mid-seam joint that has precise LIFTING STRAP(TYP.) LIFTING LUG(TYP.) RISER CONNECTION(TYP.)
dimensions for accepting an engineered EPDM gasket. „ t ,;. '1.; t r, r
The engineered mid-seam joint accepts a continuous s K/,,
loop EPDM gasket. Infiltrator s EPDM gasket design s i.. 61.7
utilizes technologyand materials from the sanitary (.:' c —'®\+---'' Sr;-. [1,567]
_ �{ - ;r EXTERIOR
sewer pipe industry to deliver a reliable watertight seal. i _._. _ 'y x WIDTH
The two-piece design is permanently fastened using -` !, .I.;,,1 L ,,,{ , r ,.,_v 1:. > '
a system of molded-in alignment dowels and locking - - . 152.3[3,868]
seam clips. The IM-1250 is assembled and sold through EXTERIOR LENGTH
a network of certified Infiltrator distributors.
TOP VIEW
Must be backfilled and installed in
L "ir'I accordance with the Infiltrator IM-and
I Fyn =s CM-Series Septic Tank General OUTLET PIPE
(TYP.)
• • •�• Installation Instructions.For shallow
f Li ground water conditions reference
�• IN/ILT•ATOR e•
i.I- •6 the Infiltrator IM-and CM-Series Tank 54.6
•.4 [1,387]
L— •En: Buoyancy Control Guidance. = EXT
TERIOR
• „
• sEAM CLIP
Please visit www.infiltratorwater.com (TYP)
or scan OR code for the latest LIFTING STRAP • ,
SCAN M E information. (TYR)
IM-1250 END VIEW .
Working Capacity 1,278 GAL(4,839 L) I a 10
-ABS 0 24.0(610 ACCESS PORT 0 4(102]
Total Capacity 1,480 GAL(5,602 L) INL Et WITH LOCKING LID(2) 10.01254)FREEBOARD PVC OR ABS
.• OUTLET TEE
Airspace 16.30% I NLT�.r 1 r.l .A RS.3P%CtE I 1 . I ,' .. t,.' 6:UT
_
Length 154" (3,911 mm) 1' I6 ' _ _ 0.2 Is)WALL
THICKNESS
1 Width 61.7" (1,567 mm) ! • PER CODE . 44.0
1
1,1181 PER CODE
Length-to-Width Ratio 2.8: 1 12FI E�111xG i�ss - DEPTH I i
I Height 54.6' (1,387 mm) su(crYP.) II r'
Liquid Level 44"(1,118 mm)
Invert Drop 3"(76 mm) { SIDE VIEW
Fiberglass Supports 4 e '
CONTINUOUS
Compartments 1 or 2 TANK TOP ELASTOMERIC
I-4ALF , GASKET
Maximum Burial Depth 48"(1,219 mm)
Minimum Burial Depth 6"(152 mm) • •/: SEAM
pz) CLIP
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Maximum Pipe Diameter 4"(102 mm) %7�ll1G
I Weight 405 lbs(184 kg) AP R rywE`a Nr EL � ,
1 P V TANK BOTTOM
HALF
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4 Business Park RoadSEP 082025 P.O.Box 768 MID-HEIGHT SEAM SECTION
s6o57 Saybrook.
.Fax 860 577-7001 MASON COUNTY ENVIRONMENTAL HEALTH
1-800-221-4436
INFILTRATOR www.inflltratarwater.com RET
waiter`,echI olOgies intoeinfiitratorwater.com
For U.S.Patents information visit www.infiltratorwater.comrpatents.Other patents pending.Infiltrator,0uick4 and EZflow are registered trademarks of Infiltrator Water Technologies.Infiltrator Water Technologies is a
whollycwned subsidiary.of Advanced Drainage Systems,Inc.(ADS).
rGi 2024 Infiltrator Water Technologies,LLC. Not responsible for any typographic errors.Printed in U.SA. lld 125 0124
Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436