HomeMy WebLinkAboutSWG2025-00302 - SWG Application / Design - 7/20/2025 eM- •: MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
-1�—' Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00302
APPLICANT HAYES ALICIA& SAMUEL Phone:
Address: 3689 SAGE BRUSH LN NW BREMERTON, WA 98312
OWNER HAYES ALICIA & SAMUEL Phone:
Address: 3689 SAGE BRUSH LN NW BREMERTON, WA 98312
SEPTIC DESIGNER BOB PAYSSE* Phone: 360-507-1498
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
Site Address: 311 E Emerald Lake Dr W
Primary Parcel Number: 321245200025
Permit Description: 2BR Oscar X02 with waiver to 75
Permit Submitted Date: 07/30/2025
Permit Issued Date: 09/25/2025
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/04/2028 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
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MASON COUNTY DATE RECEIVED: ��` 30-
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AMOUNT RECEIVED- RECEIVED BY
Public Health & Human Services 051 CO U
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 C U)
415 N.6th Street -Shelton,WA 98584 S W G /-�� - CO ^^` U) ❑
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zON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT F-ONE m
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SAM HAYES z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE K
3689 SAGE BRUSH LN NW BREMERTON WA 98312 m
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SITE ADDRESS-STREET.CITY ZIP CODE
311 EMERALD LAKE DR wl
-� SHELTON WA 98584 G'NAME OF DESIGNER � PHONE
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ROBERT H. PAYSSE 360-426-1803
NAME OF INSTALLER J U L 3 0 70M , PHONE v I —
TBD
PERMIT TYPE(select one) p DRINKINGIWATER SOURCE - I N
IY1 RESIDENTIAL OSS COMMUNITY 053��COM
RM CIAL033 3 PRIVATE INDIVIDUAL WELL I�PRIVATE TWO-PARTY WELL 0
{p
TYPE OF WORK(select one) PUBLIC WATER SYSTEM EMERALD LAKE WS I
w, NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I CP
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
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( DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER4/1/2025? O I N
WWAIVER(S)(IF APPLICABLE) 2 0.27 ❑ YES El NO
NO � I
O DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate)
9 N. HWY 3. LEFT ON MASON LAKE RD. TOWARDS EMERALD LAKE. TURN RIGHT I o
INTO EMERALD LAKE DEV. ON EMERALD LAKE DRIVE. TAKE FIRST RIGHT ONTO r I
EMERALD LAKE DRIVE WEST. CONTINUE TO END OF ROAD AND SITE ADDRESS ON o
LEFT (311). PDI SIGN POSTED I N
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I 01
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ❑COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS(CONDITIONS
C L /)J1/6)4 10 L \ Ali Q f
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SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR
tISIGNATURE DATE APPLICATION EXPIRATION DATE (f)� AP TION APPPR/O�VED/ISSUED BY DATE
t 46-:227-25 5-2.7 '•-•
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iT IS MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
,
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 4 — 5 2 — 0 0 0 2 5
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.
'1 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 2025—--00302 Designer's Name: ROBERT H.PAYSSE
Applicant's Name: SAM HAYES Designer's Phone Number: 360-426-1803
Mailing Address:
3689 SAGE BRUSH LN NW Designer's Address: 3083 E MASON BENSON RD
BREMERTON WA 98312 City State Zip GRAPEVIEW WA 98546
City State Zip Designer's Email pioneerdigging@yahoo com
r DESIGN PARAMETERS
e'J\SI ON °II 3I2S Treatment Device
❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU OSCAR X02 U Other
Treatment Level(check all that apply): D A 0 B 0 C 0 BL I 0 BL2 0 BL3 El E 0 N
Drainfield Type
❑Gravity 0 Pressure 0 Trench ■ ' 0 Sub Surface Drip
Septic Tank/Drainfield Specifications 7 / ►ater
Number of Bedrooms 2 Schedule/Clas. ec) ER MNFR
N
Daily Flow:Operating Capacity 180 gpd Length �Q N - ft
Daily Flow:Design Flow 240 gpd Diameter \! ( - in
Septic Tank Capacity(working) OSCAR X02 gal Number -
Receiving Soil Type(1-6) 4 Separati• C1) - ft
? Receiving Soil Appl. Rate 0.6 gpd/ft2 t rifices
Required Primary Area 400 ft2 Total Number of On -- m PER MNFR
Designed Primary Area 420 ft2 Diameter - in
Designed Reserve Area 420 ft2 Spacing - in
Trench/Bed Width 14 ft Manifold
Trench/Bed Length 30 ft Schedule/Class PER MNFR
Elevation Measurements Length - ft
Original Drainfield Area Slope 24 % Diameter - in
New Slope,If Altered 24 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope - in Transport Pipe
from Original Grade poN,,_slope - in Schedule/Class PER MNFR
Designed Vertical Separation 24+ in Length - ft
Gravel-based Drainfield Required? 0 Yes g No Diameter - in
Pump Required? g Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day PER MNFR
Diff. in Elevation Between Pump&Uppermost Orifice 12 ft Dose quantity PER MNFR gal
Drainfield Squirt Height/Selected Residual(head) - ft Chamber Capacity(flood) OSCAR X02 gal
Uppermost Orifice Ei6 Higher 0 Lower than Pump Shutoff Pump controls:Please check thos re re
PER MNFR Timer I t nter
Capacity @ Total Pressure Head gpm `.
PER MNFRTimer: Pumpon rv""P ,Pumpoff PE , :-
Calculated Total Pressure Head ft
If SEP 2 5 2025
Comments
MASON COUNTY ENVIRONMENTAL HEALTH
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Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 2 4 — 5 2 -- 0 0 0 2 5
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
El Test hole locations WE Drainfield orientation and layout Reference depth from original grade:
g Soil logs g Trench/bed dimensions and g Septic tank
g Property lines critical distances within layout 121 Drainfield cover
g Existing and proposed wells lig D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
g Measurements to cuts,banks,and locations 121 Laterals,trench/bed,top and
surface water and critical areas 6d Observation port location bottom
g Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption lig Manifold placement 0 Sand augmentation
components g Orifice placement Other cross-section detail:
g Location and dimension of Lateral placement with distance i Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
66 Buildings g Audible/visual alarm referenced Yes No
iii Direction of slope indicator J Scale of drawing shown on scale d 0 Design staked out
g Waterlines bar 0 g Recorded Notices attached
g Roads,easements,driveways, p Elevation benchmark and relative E1 0 Waiver(s)attached
parking elevations of system components g 0 Pump curve attached
g North arrow and scale drawing 0 t1 Evaluation of failure
shown on scale bar Non-residential justification
❑ g Waste strength
❑ I3'Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation Et Yes 0 No
peetvAt (i- q( 1 si-2-S
Signature of Des' ner 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- ' regulations.
kli6' 0-26-25
Env' on:�: I ealth Specialist Date
CAUTION: DESIGN APPRO AL 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: '(�
d —2.7_�'
✓ 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 Maso ptp h.
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An Installation Fee is required. SEP 2 5 1= '
This form may be scanned and available for public view on the Mason l�Tb Sil CliMsezd:4T14/2025
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FUTURE WATERLINE
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PROPOSED 2 BEDROOM OSCAR X02 PER
HOME LOCATION MANUFACTURER
<vj INSTRUCTIONS
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AN ASBUILT/INSTALL SIGNOFF FEE WILL MASON COUNTY ENVIRONMENTAL HEALTH
BE CHARGED AT TIME OF INSTALLATION `��p�
PIONEER DIGGING, LNG CUSTOMER: SAM HAYEs TEST HOLE I: TEST HOLE 2: TEST HOLE 3:
:)32GV. 1�32CaQ. U24G 1.
PARCEL# 32124-52-00025 32+1 11. 32+Tll.l. 2-1+ I ILL
SEPTIC DESIGNS ADDRFSS: 3v EMERALD LK DR W ROOIS @ 32 ROOTS @ 32 ROOFS @ 24
3083 E MASON BENSON RD. CRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE °DCWMsat nes IS DESIGN
NOT A SURVEY.REFERENCES INCLUDE V/T/COUNITY PROVIDED
PATS OR SURVEYS.FIELD MEASUREMENTS ANO COUNTY GIS.DESIGN INTENDED FOR SEPTIC
OFFICE-360-426-1803 FAX-360-427-2353SITE PT C A { 0' DEPARTMENT/AGENCY
ONLY PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER
SI I I I I: PLAN SCALE I�=3 V DEPARTMENT/AGENCY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS
PROPOSED 2 BEDROOM *INSTALL
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INSTRUCTIONS
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CUSTOMER: SAM HAYES TEST HOLE I: TEST HOLE 2: l EST HOLE 3:
PIONEER DIGGING, INC. PARCEL 32124-5200025 3+,TIL. 03+'��1. �++ L
SEPTIC DESIGNS ADDRFSS: 311 EMERALD LK DR W ROOTS @ 32 ROOTS @ 32 ROOTS @ 24
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DISCLMI BL fiR E NOT A SURVEY.REFERENCES INCLUDE-APPLICANTICOUNTY PROVIDED
3083 E MASON BENSON RD. GRAPEVIEW,NA.A 98546 DESIGNER: ROBERT H.PAYSSE PLATS ORSL/NEYS.FIELDMFASUREI.ENT$ANDCOUNTYGIS.DESIGN INTENDED FOR SEPTIC
OFFICE-36(}426 I803 FAX 360 427-235310' PURPOSES oGE PROPOSED DEVNOT REP AaY sE sBACKS To onER
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//_ OS5OCOILS
INSPECTION PORT
W/SLIP CAP
ASTM C-33 SAND
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PREPARED SOIL SURFACE
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MANUFACTURER INSTRUCTIONS
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EXPVneS MASON COUNTY ENVIRONMENTAL HEALT-
AN ASBUILT/INSTALL SIGNOFF FEE WILL J 131,5
BE CHARGED AT TIME OF INSTALLATION
INC. CUSTOMER: SAM HAYFS TEST HOLE I: TEST HOLE 2: TEST HOLE 3:
PIONEER DIGGING,
0-32 GSL 32+ LL 0-24 G.A.
PARCEL# 32124-52-00025 32+TILL IL 24+'il 1.
SEPTIC DESIGNS ADDRESS: 311 EMERALD LK DR.W ROOTS @ 32 ROOTS @ 32 ROOTS @ 24
3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER: ROBERT I-L PAYSSE PDISCLAIMER LAYS RSU THIS II NOT A SURVEY.REFERENCES INCLUDE:APPLICADESIGNI TE}KMTY PROVIDED
PUTS OR SURVEYS.FIELD LIF.SI IUPLCNTSAND COUNTY ENS DESIGN INTENDED FOR SEPTIC
OFFICE 36(}4261803 FAX 360 427 2353 OILY PROPOSED EP SUBJECT MAY BE
: [ DEPARTMENT/AGENCY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS
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SUBMITTAL DATA SHEET
Thermoplastic
Reinforced Thermoplastic motor bracket and discharge with built-in guide bearing.This 1/2 HP pump has a stainless
steel top bearing and motor coupling.These are assembled with our A.Y. McDonald stainless steel motors.Two wire
single phase models include pump, motor, and 10' lead.
This four inch submersible is supplied with grounded leads meeting the National Electrical Code(N.E.C.)specifications.
The performance curve below will assist you in choosing the pump that meets your needs. A
MODELS I E-30 GPM
00 _
E - 30 GPM B
300 I SHUTOFF HEAD
W + , 53 P.S.I.
W
. HP 1/2 122 FT. •,
200 --� �
1 l--
W --
_
—
100 —1/2 HP•�4 STAGES ^
.
Simplex 0 5 10 15 20 25 30 35 40
Duplex 0 10 20 30 40 50 60 70 60
Fourplex 0 20 40 60 80 100 120 140 160
FLOW GPM
Specifications
Model HP Material Volts Phase A B Wt.
LOT-30 1/2 Plastic 115 1 I 10.94 9.53 23
yyQ�M.ins
M•
Donald
SUBMITTAL INFORMATION
- Stainless steel pump shell and pump shaft - Powered by A.Y.McDonald submersible motors 1/2 HP.
- Reinforced Thermoplastic diffusers and impellers - 1 1/4"FNPT Discharge
- Thermoplastic intake screen and cable guard
NO-LEAD:The weighted average of the wetted surface of this no-lead product contacted by consumable water contains less than one quarter of one
percent(0.25%)lead.
Lowridge Onsite Technologies,Inc. Toll Free:1-877-476-8823 dave@lowridgetech.com
P.O.Box 1179 Fax: 1-425-335-3622 oscaronsite.com
Lake Stevens,WA 98258 '4I
A.Y.McDonald considers the information on this assembly drawing correct when published. ndPp ioPail�bl ty,lllblud g s ci c .`-subject to change without notice.
Submitted by: SEP 2 5 2025 V t/2022
MASON COUNTY ENVIRONMENTAL HEALTH
Installation & System Notes
1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,
transport line, drainfield, and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2. This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state, county, and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer,or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities (ex. water,gas, electric) prior to
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6. All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers (ex. ATU, Glendons,) may have other requirements not listed within this design.
7. All electrical wiring shall be done by a licensed electrician or homeowner(if allowed) and must be permitted through Labor
and Industries. Designer not responsible for electrical permitting or other electrical specific code requirements.
8. The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain 10ft to waterlines with all septic components. If less than 10ft is required,sleeving in sch. 40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18" above sewage line with one of the lines sleeved in sch.
40 pvc 10ft in each direction of crossing.
10. This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11. Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and 10ft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or
may not meet other requirements.
13. All onsite septic systems require regular maintenance to verify satisfactory operation. The system owner/operator is
responsible for the continuous operation and maintenance of the system per WAC 246-2 mar der Iota a n ;. nce
information, refer to Mason County Public Health Homeowner's Manual,which should b¢r cei c afti ' II io I.
3 x. il
14. System owner should be cautious of landscaping around septic components. Root irft', on SEP 2 50 l
can cause premature failure of the drainfield area. In addition, bushes and trees shoulcfie pt y
away from lids and other septic maintenance points. MASON COUNTY ENVIRONMENTAL HEALTh
J
15. Changes made at time of installation may impact designer calculations, pump sizing,and e"\
compliance w/county and state requirements. Contact designer prior to install w/any � t
proposed variations from design. Changes may result in additional fees and permitting. '�u a ,
PIONEER DIGGING, INC. CUSTO,�IER: SAM F1AYEs c t
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PARCEL#:3212452-00025 6. RceEt H3VIYSSE ?mot';
SEPTIC DESIGNS ADDRESS: 3ll EMERALD LK DR W ' ' ' ' '.F k
3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE EXPIRES
OFFICE-3611-426-I803 FAX-36l)-427-2353 :=,I 1 FFT: NOTES SCALE NA