HomeMy WebLinkAboutSWG2025-00329 - SWG Application / Design - 8/18/2025 r► "
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
L BELFAIR:360-275-4467,EXT 400
f. Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00329 Cud,,,
APPLICANT GUZMAN ABNER & MICHELLE R Phone:
Address: PO BOX 699 SHELTON, WA 98584
OWNER GUZMAN ABNER & MICHELLE R Phone:
Address: PO BOX 699 SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
SEPTIC INSTALLER TJ GOOS* Phone: 360-490-0217
Address: 150 E MARISA PL SHELTON, WA 98584
Site Address: 581 E AYCLIFFE DR
Primary Parcel Number: 321275000119
Permit Description: Repair 2bd pressure trench
Permit Submitted Date: 08/18/2025
Permit Issued Date: 09/11/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/10/2026 (based on date of inspection)
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.
2 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.
4 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
5 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
6 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
7 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.
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
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
8 Installer to use Class A mitigation for tank to waterline setback if the waterline cannot be
relocated to meet 10ft setback. Drain field to meet 10ft setback. Sleeve waterline if within
10ft of sewer transport line.
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
MASON COUNTY DATERECENED: 6 g i so a5
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AMOUNT RECENEQy ^�� RECEIVED BY: diGe
Public Health & Human Services (-1'�(fD UX o m
Environmental Health 0-427-9670,ext.400 or 360-275-4467,ext.400 ^ O�r _ ����� N 0
���415 N.6th Street-Shelton,WA 98584 Q-, './1 O A
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ON-SITE SEWAGE SYSTEM APPLICATION v a
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APPLICANT PHONE m
Abner Guzman (360)229-0949 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE Lv,L nCD C
P.O. Box 699 Shelton WA 98584 (D m
SITE ADDRESS-STREET,CITY,ZIP CODE Q I—
581 E. Aycliffe Dr. JZ c Shelton WA 98584 3 1 W
NAME OF DESIGNER ~ PHONE 0Dale L. Tahja � j bir (360)463-8023
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Q NAME OF INSTALLER �� ' PHONE 0 I
T.J. Goos (360) 490-0217 Z
PERMIT TYPE(select one) 11344�t DRINKING WATER SOURCE y I N
RESIDENTIAL OSS 5COMMUNITY OSS biCOMMERC AL OSS 5 PRIVATE INDIVIDUAL WELL S PRIVATE TWO-PARTY WELL Z ,y
TYPE OF WORK(select one) PUBLIC WATER SYSTEM Lake Gmendc water System
I
.,`NEW CONSTRUCTION/UPGRADES gREPAIR I REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR
SUBMITTALS 0 SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE
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❑✓ DESIGN FORM(REQUIRED) Q SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? ‘..0
I O
❑ WAIVER(S)(IF APPLICABLE) 2 0.31 acre EYES ENO n I I
O
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go out to Lake Limerick, stay on Mason Lake Rd., turn left on Muirkirk Way, right on Aycliffe I o
Dr., first driveway on the left.
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(D ISITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. CO
OFFICIAL USE ONLY BELOW THIS LINE — — — — — — ---
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT 0 OTHER: i11. V
INSPECTOR SOIL LOGS COMMENTS!CONDITIONS —` —��GM x tl
-\\-\\%, 0 /32_. S 1-
3Z'c- 1\ • . _ ,T/ r g J 0
1-:W7,/ -- D (3 as L .
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.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE A (CATION APPROVED/ISSUED BY DATE
GO IT C k.o17 c cX 9(IIt-S
THIS FORM MAY B SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 7 — 5 0 — 0 0 1 1 9
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 ,20'Y5- 603,3-,Cf Designer's Name: Dale L.Tahja
Applicant's Name: Abner Guzman Designer's Phone Number: (360)463-8023
Mailing Address:
P.O. Box 699 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 PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Other
Treatment Level(check all that apply): 0 A ❑B ❑C ❑BL1 ❑BL2 ❑BL3 O E Cl N
Drainfield Type
0 Gravity li Pressure It 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class Sch.40
Daily Flow:Operating Capacity 180 gpd Length 16,16,34,34.34 ft
Daily Flow:Design Flow 240 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 gal Number 5
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices 35
Designed Primary Area 400 ft2 Diameter 1/8 in
Designed Reserve Area 600 ft2 Spacing 48 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 134 ft Schedule/Class Sch. 40
Elevation Measurements Length 70 ft
Original Drainfield Area Slope 0 % Diameter 1.25 in
New Slope,If Altered 0 % Preferred manifold configuration used? 0 Yes 91No
Depth of Excavation Up-slope KAI( tel )L CA Transport Pipe
from Original Grade Dow„-slope 6 in Schedule/Class Sch. 40
Designed Vertical Separation 24 in Length 30 ft
Gravel-based Drainfield Required? 0 Yes Cl No ✓ Diameter 2 in
Pump Required? Ili Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Duff in Elevation Between Pump& Uppermost Orifice 8 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice II Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 18 gpm ll1 Timer El Elapse Meter g Event Counter
Calculated Total Pressure Head 18 ft x imec: Pump n 2.5�min. ,pump off 5 hrs.57.5 min.
Comments �vf E LJ
SEP 1 1 2025
MAS(1N cauviit14R.o ME*hkl tf.A•trrIl
RET Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 2 7 — 5 0 -- 0 0 1 1 9
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Fti Test hole locations 6d Drainfield orientation and layout Reference depth from original grade:
iii Soil logs 66 Trench/bed dimensions and Eio.i Septic tank
Property lines critical distances within layout 6d Drainfield cover
6l Existing and proposed wells lif D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 66 Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,and locations 11' Laterals,trench/bed,top and
surface water and critical areas 64 Observation port location bottom
10 Location and orientation of 6Z1 Clean-out location 0 Curtain drain collector
curtain drain and all absorption Et Manifold placement 0 Sand augmentation
components Etii Orifice placement Other cross-section detail:
Iii Location and dimension of Ell Lateral placement with distance Cif Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
0 Buildings RI Audible/visual alarm referenced Yes No
6Zi Direction of slope indicator RI Scale of drawing shown on scale EI 0 Design staked out
BS Waterlines bar 0 0 Recorded Notices attached
Eli Roads,easements,driveways, El Elevation benchmark and relative 0 0 Waiver(s)attached
parking elevations of system components 57i 0 Pump curve attached
6i North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer ust be notified ins Jgr at time of installation[1 Yes
�, 0 No
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Signature of Designer Date ✓'
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The undersigned has reviewed this design on behalf of Mason County Public Health and determin n ,—Zb
compliance with state and local on-site regulations: �•.�Q`s coON ' . t N ,()
Of) Gt I (1 )W-- aia.
Environmental H lth Specialist Date``��a b' � ; $ o `n �,^
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITI i• % A,( U
✓ The design is stamped"Approved"by Mason County Public Health. � hot-2,6 �`�l,/✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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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1)Extra protection of integrity of tank la)Waterproof surface barrier applied to concrete tank consistent with Manual of
and joints Concrete Practice ACI 515.1R.Flexible rubber boots or compression seals meeting ASTM C •
1644,or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to
provide flexibility in case of tank settlement while still maintaining a watertight seal.
2)Performance testing of tank 2a)Concrete tank tested for water-tightness consistent with ASTM C 1227.
3)Accessibility of tank for ease of 3a)Access openings at or above finished grade with lockable lids or secured to prevent
operation and maintenance unauthorized entry.
4)Extra protection of integrity of 4a)Water line installed in casing of at least Schedule 40 PVC within 10 feet of the tank.
water line Water lines are uniformly supported by pressure-grouting annular space with sand-cement
grout or bentonite,or casing spacers or skids installed consistent with AWWA PVC Pipe
Design and Installation Manual M23-7-2.
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APPROVED
1 SEP 1 1 2025 X - .r e,�\-. ' �.\-,' .t \(-4.\�er
MASON COUNTY ENVIRONMENTAL HEALTH
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Media Gallery X
Liberty Pumps 280- 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
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Performance Curve: 280-Series I
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APPROVED
SEP 11 2025
MASON COUNTY ENVIRONMENTAL HEALTH
RET
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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 I Oft. 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.
.`�, APPROVED
Y
1 1 2025
MASON COUNTYSEP ENVIRONMENTAL HEALTH
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• Dale L.Tame
of LICENSED DESIGNER
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