HomeMy WebLinkAboutSWG2025-00325 - SWG Application / Design - 8/13/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360427-9670,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: SWG2025-00325
APPLICANT Hunter, Adam Phone: 360 753-1226
Address: 2201 93rd Ave SW Olympia, WA 98512
CONTRACTOR HOUSE BROS CONSTRUCTION Phone: 360-495-4156
Address: PO BOX 1820 MCCLEARY, WA 98557
OWNER Curtis & Peggy Peoples Phone: 678-575-2118
Address: 171 SE Ashley Rd SHELTON, WA 98584
Site Address: 48 W Blakely Dr
Primary Parcel Number: 519085000111
Permit Description: Repair-2BR glendon
Permit Submitted Date: 08/13/2025
Permit Issued Date: 09/10/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 03/09/2026 (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.
ONLA,, tt
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: �UJ(()' ) r _ 20a5
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Environmental Health 360-427-9670,ext.400 or 360-27S-4467,ext.400 ^ <
415 N.6th Street - Shelton,WA 98584 SWG D�/{� Qb 3,5 O '
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION 3 z
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APPLICANT C' PHONE M
DAVID JOVANOVICH �CLnn `.) 3604701707 z
MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE /r�� h E
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PO BOX 1820 �G o' MCCLEARY WA 98557 ITI
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SITE ADDRESS-STREET,CITY.ZIP CODE : .�
48 W BLAKELY DR ELMA WA 98541
NAME OF DESIGNER 'T PHONE I Q
ADAM HUNTER p 3607531256 I 01
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NAME OF INSTALLER PHONE v O
HOUSE BROTHERS 3604701707 < I o
PERMIT TYPE(select one) DRINKING WATER SOURCE O
C C
Lf7 RESIDENTIAL OSS LJ COMMUNITY OSS ILJ COMMERCIAL OSS 3 PRIVATE INDIVIDUAL WELL 6'PRIVATE TWO-PARTY WELL z
TYPE OF WORK(select one) a PUBLIC WATER SYSTEM
5"NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) TABLE X REPAIR
SUBMITTALS r2I SURFACING SEWAGE El EXISTING FAILURE 0 SHORELINE co
C
I� DESIGN FORM(REQUIRED) I l SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/20257 r0
I
EWAIVER(S)(IF APPLICABLE) 1 0.24 El YES
El NO X
, DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
STAR LAKE DR TO A LEFT ON STAR LAKE DR TO A LEFT ON BLAKELY DR TO SITE ON I
THE RIGHT o
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
0 --2o c
20
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 TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
T Frr- # AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 519085000111 -- --
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. '1 Scaled layout sketch,including all applicable items on checklist.
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: I 1"X 1 7"
PARCEL IDENTIFICATION
Permit Number: SWG 40,a6- [xj 3 o s5 Designer's Name: ADAM HUNTER
Applicant's Name: DAVID JOVANOVICH Designer's Phone Number: 3607531226
Mailing Address:
PO BOX 1820 Designer's Address: PO BOX 162
MCCLEARY WA 98557 City State Zip OLYMPIA WA 98507
City State Zip Designer's Email JHANDASSOCIATES@HOTMAIL.COM
DESIGN PARAMETERS
a-(� /w3( Treatment Device
El Glendon ❑ Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter El ATU ❑Other
Treatment Level(check all that apply): J A J B .J C J BL 1 J BL2 J BL3 I E I N
Drainfield Type GLENDON
0 Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 1 Schedule/Class GLENDON
Daily Flow: Operating Capacity 2'1D ` 8. gpd Length GLENDON ft
Daily Flow: Design Flow 2 10 `4'2( gpd Diameter GLENDON in
Septic Tank Capacity(working) 1000 gal Number GLENDON
Receiving Soil Type(1-6) 4 Separation GLENDON ft
Receiving Soil Appl. Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices GLENDON
Designed Primary Area 400 ft2 Diameter GLENDON in
Designed Reserve Area 400 ft2 Spacing GLENDON in
Trench/Bed Width GLENDON ft Manifold
Trench/Bed Length GLENDON ft Schedule/Class 40
Elevation Measurements Length 19 ft
Original Drainfield Area Slope 5 % Diameter 1 in
New Slope,If Altered N/A % Preferred manifold configuration used? I 'Ycs 0 No
Depth of Excavation Up-slope GLENDON in Transport Pipe
from Original Grade Down-slope GLENDON in Schedule/Class 40
Designed Vertical Separation 12 in Length 70 ft
Gravel-based Drainfield Required? 0 Yes EfNo Diameter 1 in
Pump Required? M'Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day GLENDON
Diff. in Elevation Between Pump&Uppermost Orifice 8 ft Dose quantity GLENDON gal
Drainfield Squirt Height/Selected Residual(head) GLENOGN ft Chamber Capacity(flood) 1000 gal
Uppermost Orifice Higher 0 Lower than Pump Shutoff Pump controls:Please check thosittoe required.
Capacity @ Total Pressure Head PER GLENDON gpm d Timer G7'Elapse Meter ' Event Counter
Calculated Total Pressure Head PER GLENDON ft If Time Pup ', '; a ff GLENDON
Comments l Q
SEP 08 2025 :,, ,
MASON COUNTY ENVIRONMENTAL HEAL'-
,J BW Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 519085000111 -- --
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
9' Test hole locations 9' Drainfield orientation and layout Reference depth from original grade:
9' Soil logs l' Trench/bed dimensions and El Septic tank
0' Property lines critical distances within layout a Drainfield cover
0' Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 9' Septic tank/pump chamber and restrictive strata:
a Measurements to cuts,banks,and locations ®' Laterals, trench/bed, top and
surface water and critical areas Ed Observation port location bottom
0' Location and orientation of 9' Clean-out location 9' Curtain drain collector
curtain drain and all absorption Q( Manifold placement a Sand augmentation
components Ed Orifice placement Other cross-section detail:
Location and dimension of 9' Lateral placement with distance 9' Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
1 Buildings Q( Audible/visual alarm referenced Yes No
Direction of slope indicator 6' Scale of drawing shown on scale Er 0 Design staked out
12' Waterlines bar 0 0 Recorded Notices attached
0' Roads, easements,driveways, 0 Elevation benchmark and relative 0 ❑ Waiver(s)attached
parking leptpS 9`s .item components g 0 Pump curve attached
h� f t 0 0 Evaluation of failure
� North arrow and scale drawing '�� �' �.
shown on scale bar "L�~
;,, Non-residential justification
SEP 1 pii: ❑ ❑ Waste strength
hiflASON COUNTY FNviRUfv 0 ❑ Flow
hACN7qq��������Lr,
DES1,PROVAI:
The undersigned designer ust . A• i le. by installer at time of installation C'Yes 0 No
it a 8/13/25
v;.tur= of Designer Date
The undersigned has reviewed thi• .esign on behalf of Mason County Public Health and determined it to be in
compliance with state and local on :ite regulations:
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
✓ 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
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL#: 519085000111
DATE SUBMITTED: 8/13/2025 LEGAL/LOT#: STAR LAKE#1
LOT 111
SUBMITTED BY: ADAM HUNTER
APPLICANT: HOUSE BROTHERS
ADDRESS:
I.CALCULATIONS
NUMBER OF BEDROOMS= 1
RESIDENTIAL GPD FLOW = 240
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= 0.6 GPD/FT2
REDUCTION =LEAVE BLANK IF NO REDUCTION TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 400 FT2
TRENCH LENGTH OR BED CONFIG. = PER GLENDON
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE = 1000GAL.-CONCRETE
NEW OR EXISTING= NEW
III. DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM = NIA
ROCK DEPTH BELOW PIPE = NIA
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIAL/SEASONAL SATURATION = NIA
FILL DEPTH = N/A
TRENCH WIDTH = NIA
0 ItP pPi 0 2102 E D
fis 8/13/250
ALTH
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