HomeMy WebLinkAboutSWG2025-00327 - SWG Application / Design - 8/16/2025 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: SWG2025-00327
APPLICANT Zimny, Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
OWNER WHITMAN DIANNA J Phone:
Address: 2715 LOCKER RD SE PORT ORCHARD, WA 98366
SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 310 NE RIVERSIDE PL
Primary Parcel Number: 123201003350
Permit Description: Repair/upgrade to 3bd gravity trench
Permit Submitted Date: 08/16/2025
Permit Issued Date: 09/18/2025
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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
6141-1N6
- --- OFFICIAL USE ONLY —
‘ 4t1‘ MASON COUNTY DATI : og - i �- �5
Public Health & Human ServicesAMOUNT �� o 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 _ 1 / 3 R.-4 g- 2
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1:R FORM ON-SITE SEWAGE SYSTEM APPLICATION v n
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APPLICANT PHONE I
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Dianna Whitman z
MAILING ADDRESS-STREET CITY.STATE.ZIP CODE —J „ i g
2715 LOCKER RD SE, PORT ORCHARD WA L 11 co
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SITE ADDF ESS STREET,CITY,ZIP CODE C, •I i
310 NE Riverside PI, Belfair wa 98524 c _ 1 I
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NAME OF )ESIGNER PHONE N
Jim Zimny 360-516-7287 'L`-: 'D , 1 I r\,)
NAME OF NSTALLER PHONE n Q I
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PERMIT TYPE(select one) DRINKING WATER SOURCE ---- • 5 I 1 J
0
Irr RESIDENTIAL OSS f1 COMMUNITY OSS fl COMMERCIAL OSS PA' PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
TYPE OF'NJRK(select one) \ ❑ PUBLIC WATER SYSTEM_ __ _ r/
fl NEW CONSTRUCTIO /UPGRADE REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I __-
SUBMITTf.LS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
Q✓ DESIGN FORM(REQUIRED) ✓❑SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE LOT CREATED AFTER 4/1/2025/ r I
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❑ WJiIVER(S)(IF APPLICABLE)
3 5.02 EYES ✓❑NO n
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DIRECTIONS TO SITE AND SITE CONDITIONS (er locked gate,
From Belfair travel 1.3 miles to NE Riverside PI, Take RT , Travel .3 miles and take the IVY
drive was labeled 310 Riverside PI. As you travel up the driveway the test holes are on the O.left marked with Pink Ribbons. o I u\)
I(11
SITE NUS''BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED I4ITH TEST HOLE NUMBERS I 0
- --- . - OFFICIAL USE ONLY BELOW THIS LINE ---
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOI.UNTARY ❑MAINTENANCF/PUMPING ❑BUILDING PFRMIT' OW-IMF OW-IMF SAI F ❑COMPLAINT ❑OTHER'
INSPECTOR SOIL LOGS CiI�VA/S�4.'(0 COMMENTS/CONDITIONS
��`F.-- ).v, cia irks 04 frolirs 0,71.1-o.\-aorli .ckl
Tit-7 o - ryvs0 ( No -h: b -
-NS ' Q v� OOP
A-
(tese-i\L•) 03 ►- ►0+e_ tarir
RECORD DRAWING AND INSTALLATION REPORT
SOIL COC ES'
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R-ROOTS REQUIRED FOR FINAL APPROVAL
I Nam-' OTC R GIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED'ISSUED BY DATE
1111t2 6riIs-t66 et/( f7
THIS FORK MAY BE SCANNED 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 2 0 1 0 0 3 3 5 0
A design will be reviewed when 3 conies 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. '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 a62- - Do3X1 Designer's Name: Jim Zimny
Applicant's Name: Dianna Whitman Designer's Phone Number: 360-516-7287
Mailing Address:
715 LOCKER RD SE Designer's Address: 7178 Windflower plow
PORT ORCHARD WA 98366 City State Zip Seabeck WA 98380
CLEA• FORM APDdesigns@icloud.com
City State Zip Designer's Email
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 0 B 0 C 0 BLl 0 BL2 ❑ BL3 trE 0 N
Drainfield Type
ll rGravity 0 Pressure i'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length 50 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity (working) 1200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 5' CTC ft
Receiving Soil Appl. Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices NA
Designed Primary Area 450 ft2 Diameter �ar t in
Designed Reserve Area 450 r
ft2 Spacing 1'��- �t in
Trench/Eed Width 150 ft .,9 1tZri Manifold
Trench/Bed Length 3 ft Schedule/%o 20223033 y. `".,tr,+ NA
Elevation Measurements Length ;;� L,cEJ, o s ER + ft
Original Drainfield Area Slope 15 % Diameter _ '�"`%"f& in
New Slope,If Altered 15 % Preferred manifold cor►figtfration used? 0 Yes 0 No
Depth of Excavation Up-slope 17 in Transport Pipe
from Original Grade Down-slope 11 in Schedule/Class 3034
Designee.Vertical Separation 36 in Length 25 ft
Gravel-based Drainfield Required? 0 Yes C1 No Diameter 4 in
Pump Required? 0 Yes P'No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity A P P D
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) Sre�. is 2025 gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those re ur
Capacity @ Total Pressure Head gpm 0 Timer 0 ElWitilgtQP NTY ENVIEQ Mikiltiolditia
Calculated Total Pressure Head ft If Timer: Pump on ,Pump oRET
Commerts
Revised:6/11/2025
'DESIGN FORM—PAGE TWO Assessor's Parcel Number: 1 2 3 2 01 U U 3 3 5 U I
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
le Test hole locations iie Drainfield orientation and layout Reference depth from original grade:
of Soil logs V Trench/bed dimensions and lid Septic tank
✓ Property lines critical distances within layout V Drainfield cover
❑ Existing and proposed wells of D-Box/Valve box locations Reference depth from original grade
within 100 ft of property le Septic tank/pump chamber and restrictive strata:
er Measurements to cuts,banks,and locations er Laterals,trench/bed,top and
,urface water and critical areas er Observation port location bottom
V :Location and orientation of V 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:
fib Location and dimension of Lateral placement with distance er Observation ports/clean-outs
.)rimary system and reserve area to edge of bed Other Information
✓ Buildings 0 Audible/visual alarm referenced Yes No
er Direction of slope indicator V Scale of drawing shown on scale 0 ErDesign staked out
e Waterlines bar 0 0 Recorded Notices attached
er Roads,easements,driveways, ✓ Elevation benchm..:* and relative 0 0 Waiver(s)attached
Parking elevations of sys in '),mponents 0 0 Pump curve attached
ef North arrow and scale drawing ;.P q'yi 0 0 Evaluation of failure
shown on scale bar �`
�°' y„► Non-residential justification
:�4 ., ', mf..� 0 0 Waste strength
er .O,zm„ 1�t4 0 0 Flow
i o Jwnu.N4.,74mry
LICLNS[Y) )L!CN R •
DESIGN ig
The undersigned designer must be noti I d by installer at time of installation erYes 0 No
C /- e
Sign re f 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:
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped "Approved"by Mason County Public Health. / III f_
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: �j�
✓ 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
I
Advantage Perc & Design
Tirnely•Reasonab 'e•3O Years of Local Experience
Construction Notes for 3 bedroom Gravity bed System
-Install 3 -50' infiltrator laterals on 5 'centers ( Rock and Pipe may be substituted)
17" maximum trench depth on high side of trench with a d-box and equal distribution configuration
-must verify and maintain 36" of vertical separation.
-Install level and along contours.
-Install in dry weather only.
-properly abandon the existing 1000-gallon septic tank and install a new Use 1200 Gallon septic tank
with locking lid risers to the surface of the ground
-System designed for typical residential waste strength sewage only.
-System designed for 360 Gallons Per Day
0 1 7 +L
LIC E SIGNER
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APPROVED
20
MASON COUNTYSEP ENVIRONMENTAL HEALTH
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4 Advantage Perc&design APDdesigns@icloud.com (360) 516-7287
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