HomeMy WebLinkAboutSWG2025-00366 - SWG Application / Design - 9/11/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
.I L 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: SWG2025-00366
APPLICANT Caliber Septic Design Phone: 3605097900
Address: 165 NW Tupelo Way Poulsbo, WA 98370
OWNER DATUS ET AL NATHAN JAMES Phone: 360.801.6958
Address: HAYLIE MARIE PRATER BELFAIR, WA 98528
SEPTIC DESIGNER RICHARD BAZZELL* Phone: 360-509-7900
Address: 165 NW TUPELO WAY POULSBO, WA 98370
Site Address: 120 NE DAVEY JONES PL
Primary Parcel Number: 123305000047
Permit Description: Repair 3bd gravity bed
Permit Submitted Date: 09/11/2025
Permit Issued Date: 09/19/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/17/2026 (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.
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: /] - I 12Q,�5
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AMOUNT RECENEI RECEIVED BY: t�W y�— Public Health & Human Services /[\ co m
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Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 /� <
415 N.6th Street -Shelton,WA 98584 SWG „/O — O 0 340 O 0
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m
Nathan Datus 360.801 .6958 z
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MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE K
120 NE Davey Jones Place, Belfair, WA 98528 CD N CO
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SITE ADDRESS-STREET,CITY,ZIP CODE 1===,
Same as mailing address [ I I
NAME OF DESIGNER PHONE L5 1 I N
Caliber Septic Design - Richard Bazzell 360.509.7900 �n
NAME OF INSTALLER PHONE C`,7 in
o I CA)
To Be Determined — <_
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PERMIT TYPE(select one) DRINKING WATER SOURCE O
C
R-RESIDENTIAL OSS I ' COMMUNITY OSS ff COMMERCIAL OSS n PRIVATE INDIVIDUAL WELL n PRIVATE TWO-PARTY WELL Z I O
1g PUBLIC WATER SYSTEM Beards Cove 05100E
TYPE OF WORK(select one) I
6 NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ElCOTABLE X REPAIR I C31
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINECO
Q DESIGN FORM(REQUIRED) 0 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? Or I O
0 WAIVER(S)(IF APPLICABLE) 3 0.23 ac DYES ENO n I I
O
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
See design for driving directions and a local vicinity map. I o
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4, I -i -
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
1-4k1 . 0 /I.3 ti S , CSi-oi
1.\\--t: p_(o t,m.S tao -c �
1 �-
fo s$il c - ram+t -
cUi -' cL2ti 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 EXPI TION DATE APPLICATION APPROVED/ISSUED BY DATE
Ain 'ln la, 0 'I k-`(
THIS FORM MAY BE S NNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 1 2 3 3 0 5 0 0 0 0 4 7
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 coals - 003(p4 Designer's Name: Richard Bazzell
Applicant's Name: Nathan Datus Designer's Phone Number: 360-509-7900
Mailing Address: 120 NE Davey Jones PI Designer's Address: 165 NW Tupelo Way
Belfair WA 98528 City State Zip Poulsbo WA 98370
City State Zip Designer's Email richard@calibersepticdesign.com
DESIGN PARAMETERS
Treatment Device
0 Glendon ❑ Sand Filter ❑ Mound ❑ Sand Lined Drainfield 0 Recirculating Filter ❑ATU ❑Other
Treatment Level(check all that apply): ❑ A ❑ B ❑C ❑ BL 1 ❑ BL2 0 BL3 IKE ❑N
Drainfield Type
ieGravity 0 Pressure 0 Trench Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 40/3034
Daily Flow: Operating Capacity 360 gpd Length 45 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1200(existing) gal Number 3
Receiving Soil Type(1-6) 3 Separation 3 O.0 ft
Receiving Soil Appl. Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices n/a
Designed Primary Area 450 ft2 Diameter n/a in
Designed Reserve Area N/A ft2 Spacing n/a in
Trench/Bed Width 10 ft Manifold
Trench/Bed Length 45 ft Schedule/Class n/a
Length n/a ft
Elevation Measurements Len g
Original Drainfield Area Slope 0-2 % Diameter n/a in
New Slope,If Altered n/a % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 21.25-36 in Transport Pipe
from Original Grade Down-slope 19-33.75 in Schedule/Class 40/3034
Designed Vertical Separation 36 in Length 28 ft
Gravel-based Drainfield Required? 0 Yes Et No Diameter 4 in
Pump Required? 0 Yes Er No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day n/a
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 n/a gpm 0 Timer 0 Elapse Meter 0 Event Counter
Calculated Total Pressure Head n/a ft If Timer: Pump on n/a ,Pump off n/a
Comments
This design proposes to utilize the existing septic tank (certified water tight by installer) and replace the
dispersal component with a new 10' x 45' gravity bed.
Revised: 6/11/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number 1 12 13 13 I 0 15 I 0 I 0 I 0 I 0 14 17
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
le Test hole locations V Drainfield orientation and layout Reference depth from original grade:
V Soil logs Er Trench/bed dimensions and V Septic tank
V Property lines critical distances within layout Ili Drainfield cover
le Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade j
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations 0 Laterals,trench/bed,top and
surface water and critical areas le Observation port location bottom
❑ Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
er Location and dimension of 0 Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
Buildings g Other Information
IFI 0 Audible/visual alarm referenced Yes No
ey Direction of slope indicator l Scale of drawing shown on scale le 0 Design staked out
V Waterlines bar 0 0 Recorded Notices attached
19 Roads,easements,driveways, R' Elevation benchmark and relative 0 0 Waiver(s)attached
parking elevations of system components 0 0 Pump curve attached
tEl North arrow an'. ale drawing 0 0 Evaluation of failure
shown on scalp. .f Non-residential justification
0 'Waste strength
ftj,
0 Er Flow
1 fir: 4 ^ ;.11t DESIGN APPROVAL
r rEtYes 0 No
The unde��;-ed 8pb �r �;�'` be notified by installer at time of installation
' 21037128 0 it � -- - 09.09.2025
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i LICENSED DESIGNER 't :nature of Designer Date
v.% ♦% at% A.% % wa
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:
Ct I l.'t rz-c
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. O((n I'2_‘,
✓ 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: 6/11/2025
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