HomeMy WebLinkAboutSWG2025-00288 - SWG Application / Design - 7/23/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
Al": 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
On-Site Sewage System Permit: SWG2025-00288
APPLICANT Zimny, Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
OWNER CHRYSALIS REAL ESTATE SOLUTION Phone: 425 503 6121
LLC
Address: 21530 NE 29TH ST SAMMAMISH, WA 98074
Site Address: 1301 NE Tahuya River Dr
Primary Parcel Number: 222067590231
Permit Description: New 3BR SFR -Gravity
Permit Submitted Date: 07/23/2025
Permit Issued Date: 09/30/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/12/2028 (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— -
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415 N.6th Street- Shelton,WA 98584 V�l_)o !✓ U C-TJC�(/] Q 73
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT iCNC r
CHRYSALIS REAL ESTATE SOLUTION LLC, 360-874-4699 z
MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE g
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21530 NE 29TH ST SAMMAMISH WA 98074 L • g3
SITE ADDRESS-STREET.CITY.ZIP CODE I
1301 Tayhuya River Dr, Belfair wa 98524 `~'
NAME OF DESIGNER PHONE I �1,�,
Jim Zimny 360-516-7287 1
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NAME OF INSTALLER PHONE -- I N
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PERMIT TYPE(select one) DRINKING WATER SOURCE OO
Ft RESIDENTIAL OSS f COMMUNITY OSS rl COMMERCIAL OSS CY PRIVATE INDIVIDUAL WELL b PRIVATE TWO-PARTY WELL Z I C1
o PUBLIC WATER SYSTEM r
TYPE OF VvORK(select one)
NEW CONSTRUCTION/UPGRADES ¶1 REPAIR/REPLACEMENT OTHER DETAILS(select all that eppty) 0 TABLE X REPAIR Ii
SUt3MITTALs 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W
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lJ DESIGN FORM(REQUIRED) Q SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/20257 O I 0 WAIVER(S)(IF APPLICABLE) 3 2 acres DYES ONO n t
DIRECTIONS TO SITE AND SITE CONDITIONS (et kxked gate/
From Belfair take Northshore rd 3.6 miles to Ne Belfaair Tahuya Rd and take rt. Follow 3.8 1 0
miles to NE tahuya River Dr. Follow for 1.2 miles to the site on left. Marked with Pink
Ribbons
follow pink ribbons from driveway to test holes. I W
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 repotting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT El OTHER.
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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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
IN CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE A TION APPROVED/ISSUED BY DATE
WI\diet-A2---25 cC.e t2, .... ..< 1 j3kkii °/..319-2.c
THIS FORM 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: 2 2 2 0 6 7 5 9 0 2 3 1
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: I I"X 17
PARCEL IDENTIFICATION
Designer's Name: JIM ZIMNY
Permit Number: SWG G�' waQg 360-516-7287
CHRYSALIS REAL ESTATE SOLUTION LLC. Designer's Phone Number:
Applicant's Name: 7178 WINDFLOWER PL NW
Mailing Address: 21530 NE 29TH ST Designer's Address: i
SAMMAMISH WA 98074 City State Zip
SEABECK WA98380
CLEAR FORM APDDESIGNSC�?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): ❑A 0 B 0 C 0 BLl 0 BL2 0 BL3 efE 0 N
Drainfield Type
IR/Gravity ❑Pressure DiTrench 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 40 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1250 gal Number 5
Receiving Soil Type(1-6)
4 0 n� es 5' CTC ft
Receiving Soil Appl. Rate 0.6 / S j Orifices
600 T �f0 , ,;'► na
Required Primary Area ���� !�
Designed Primacy Area 600 "I�iamet�; C C���jA1.'rI
4�1in
Designed Reserve Area 600 gnSp 1 CO ctt tpj ov•of �. •le in
Trench/Bed Width 3 ft „% "i •�old
�1 ;' na
Trench/Bed Length 200 ft Schedule/Cla - °LICE e .
GAF
Elevation Measurements Length 7 2-tr ft
Original Drainfield Area Slope 7 % Diameter in
New Slope,If Altered 7 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation I1p-slope Si i Z in Transport Pipe
from Original Grade Down-slope ye Q in Schedule/Class 3034
Designed Vertical Separation 36 in Length 80 ft
Gravel-based Drainfield Required? 0 Yes 0 No Diameter 4 in
Pump Required? 0 Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between Pump& Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm 0 Timer 0 Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on ,Pump off
Comments At° Prer3jA IN etil-r V;/K4 , 'ad ' /ytilty k wf Ai CO f4 4-0 kit
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Doa,.00d•4/1 111111G
' DESIGN FORM-PAGE TWO Assessor's Parcel Number: 2 2 2 0 6 7 5 9 0 2 3 1
Permit Number: SWG
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DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
se Test hole locations le Drainfield orientation and layout Reference depth from original grade:
of Soil logs Er Trench/bed dimensions and Er Septic tank
Er Property lines critical distances within layout it Drainfield cover
it D-RoxNalve box locations
lr Existing and proposed wells Reference depth from original grade
within 100 ft of property lid Septic tank/pump chamber and restrictive strata:
{Z( Measurements to cuts,banks,and locations le Laterals,trench/bed,top and
surface water and critical areas i ' Observation port location bottom
I ' Location and orientation of Er Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components ❑ Orifice placement Other cross-section detail:
ef Location and dimension of Lateral placement with distance Er Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
er Buildings 0 Audible/visual alarm referenced Yes No
' Direction of slope indicator ' Scale of drawing shown on scale 0 'Design staked out
fitr Waterlines bar 0 0 Recorded Notices attached
' Roads,easements,driveways. V Elevation benchm.;.$and relative 0 0 Waiver(s)attached
parking elevations of syst;'1 !',, ponents 0 ❑ Pump curve attached
Et A�� 0 ❑ Evaluation of failure
North arrow and scale drawn 4:1,, �r '��
shown on s a .y ; I
�� Non-residential justification
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%� '� ❑ Waste stren h
" x y �s', 0 strength
"'- 0 ❑ Flow
3 p 2025 i•rF .• r' wNER
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The under ��ied designee notified by i r at ti of installation FrYes 0 No
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Signature o esiiner , 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 -si e gulations:
Env r.gr al Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped "Approved"by Mason County Public Health. -...)._gr
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 16' 12
✓ 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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MASON COUNTY ENVIRONMENTA�; "' J L HEALTH
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Advantage Perc & Design
Tlmoly•Pr,,lconable•30 Years of Local Experience
Construction Notes for Gravity 3 Bedroom System:
Equal Distribution w/Graveless Chambers (pipe and Rock may be substituted)
Install 5—40' Laterals w/6 hole d-box.
Install on 5' foot centers.
Sleeve driveway crossing with A' Sch 40 piping
Install 9-" deep on low side of trench maintain 36" of vertical separation
Install level and along contours.
Install in dry weather only.
Use 1250-Gallon septic
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
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