HomeMy WebLinkAboutSWG2025-00334 - SWG Application / Design - 8/22/2025 rn, MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
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: SWG2025-00334
APPLICANT ULEOTSO LLC -Karen & Rahsaan Phone:
Arellano
Address: 403 16TH AVE E F SEATTLE, WA 98112
OWNER ULEOTSO LLC -Karen & Rahsaan Phone:
Arellano
Address: 403 16TH AVE E F SEATTLE, WA 98112
SEPTIC DESIGNER BOB PAYSSE* Phone: 360-507-1498
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
SEPTIC INSTALLER TBD Phone:
Address: 123 XXX XX, XX. 00000
Site Address: 581 E Murray Rd N
Primary Parcel Number: 121072490052
Permit Description: New SFR 2-bedroom gravity system with Class B waiver
Permit Submitted Date: 08/22/2025
Permit Issued Date: 10/06/2025
Issued By: David Anderson
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/19/2028 (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.
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.
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
I BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
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
Ass, MASON COUNTY DATE RECEIVED: -
,_ (^ _d� C >
1,16 AMOUNT RECEIVED, (�/�l Y�!L's .` RECEIVED BY: 03 Cn
Public Health & Human Services 655 o m
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 6' Ccn
415 N.6th Street-Shelton,WA 98584 S W G '/�J 0,3'^�/' _ Oo 33 4 5 x
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ON-SITE SEWAGE SYSTEM APPLICATION
A L .
PPICANT --.CL m m
ULEOTSO, LLC - KAREN & RAHSAAN A 'ELLANO z
c
MAILING ADDRESS-STREET.CITY STATE.ZIP CODE g
403 16TH AVE E F ,N SEATTLE WA 98112 m
33
SITE ADDRESS-STREET,CITY,ZIP CODE
581 E MURRAY RD (���, � N
`� GRAPEVIEW WA 98546
NAME OF DESIGNER ' INGWATERSOURCE
PHONE
ROBERTH. PAYSS 360-426-1803NAME OFINSTALLERPHONETBD
PERMIT TYPE(select one)
RESIDENTIAL OSS COMMUNITY OSS _ 'RCIAL OSS g-PRIVATE INDIVIDUAL WELL n-PRIVATE TWO-PARTY WELL Z I
TYPE OF WORK(select one) PUBLIC WATER SYSTEM I
M-NEW CONSTRUCTION I UPGRADES b REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR IN)
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
DESIGN FORM(REQUIRED) 01 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? Or I -
Lt�WA1VER(S)(IF APPLICABLE) 2 4.9 ElYES El NO
NO � I CO
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate)
N. HWY 3. RIGHT ON GRAPEVIEW LOOP RD. LEFT ON MURRAY RD. CONTINUE TO 1 O
LEFT ON FRONTIER RD. SITE IS ON THE LEFT. o lc
Icn
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I IV
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER.
INSPECTOR SOIL LOI=S COMMENTS I CONDITIONS
TOi:c, 32. 4S1- (rYp - Y) '
Re i-a4- 3z`` t-( l
"Tt4z: o, 3i' 6t5c. (Tyree
Rcs3- co 32*t w( &of gilt/
SOIL CODES: RECORD DRAIMNG AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSPECTO IGNATURyi
DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
X/ /fl 7d 7S
VIVA) 7r
—__--- in i° /W075-
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
h
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 1 2 1 0 7 — 2 4 — 9 0 0 5 2
A design will be reviewed when 3 copies of each of the following are submitted:
'1 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 �0 Z> -0033 t Designer's Name: ROBERT H.PAYSSE
ULEOTSO,LLC Designer's Phone Number: 360-426-1803 Applicant's Name:
Mailing Address: 403 16TH AVE E F Designer's Address: 3083 E MASON BENSON RD
SEATTLE WA 98112 City State Zip GRAPEVIEW WA 98546
City State Zip Designer's Email pioneerdigging@yahoo.com
DESIGN PARAMETERS- rc' ., `;7.t.
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU U Other
Treatment Level(check all that apply): ❑A ❑B ❑C ❑ BLl ❑BL2 ❑BL3 71 E ❑N
Drainfield Type
It�Gravity 0 Pressure I 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 / Schedule/Class 2729 PERF
Daily Flow:Operating Capacity 180 ' gpd Length 27 - ft
Daily Flow: Design Flow 240 ' gpd Diameter 4 ' in
Septic Tank Capacity(working) 1200 - gal Number 5 '
Receiving Soil Type(1-6) 4 - Separation 9+ ft
Receiving Soil Appl. Rate 0.6 . gpd/ft2 Orifices
Required Primary Area 400 c ft2 Total Number of Orifices -
Designed Primary Area 405 ft2 Diameter - in
Designed Reserve Area 405 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 135 / ft Schedule/Class 3034 ,
Elevation Measurements Length 50 ft
Original Drainfield Area Slope 5 % Diameter 4 in
New Slope,If Altered 5 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 12 in Transport Pipe
from Original Grade Down-slope 10 in Schedule/Class 3034
Designed Vertical Separation 18+ in Length 15 ft
Gravel-based Drainfield Required? El Yes 0 No Diameter 4 in
Pump Required? 0 Yes IlZfNo 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 CIHigher 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
Revised:4/14/2025
, DESIGN FORM—PAGE TWO Assessor's Parcel Number: 1 2 1 0 7 -- 2 4 -- 9 0 0 5 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
lid Test hole locations 10 Drainfield orientation and layout Reference depth from original grade:
B1 Soil logs g Trench/bed dimensions and iI Septic tank
g Property lines critical distances within layout i' Drainfield cover
g Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property lid Septic tank/pump chamber and restrictive strata:
10 Measurements to cuts, banks,and locations
121 Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
121 Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components g Orifice placement Other cross-section detail:
Location and dimension of g Lateral placement with distance 61 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
10 Buildings g Audible/visual alarm referenced Yes No
Direction of slope indicator 1 Scale of drawing shown on scale g d 0 Design staked out
g Waterlines bar 0 g Recorded Notices attached
g Roads,easements,driveways, p Elevation benchmark and relative Gtf ❑ Waiver(s)attached
parking elevations of system components 0 l Pump curve attached
g North arrow and scale drawing 0 if Evaluation of failure
shown on scale bar Non-residential justification
❑ it Waste strength
o af Flow
DESIGN APPROVAL
The undersigned designer must be notified by inst ller at time of installation g Yes 0 No
ar(RA* (-t- Asp- g (-2-24 --7.
Signature of Designer Date �p
Piri:,
of Mason County Public Health and determined i o be in ® '
The undersigned has reviewed this design on behalf aso o ty
compliance with state and local on-site regulations: itfgsov� et 062
111 to (6'/ ' ' ' oav 02S
Environmental Health Special st ` / Date J3'444,ivviRo /1147
q A[H
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved" by Mason County Public Health. 7/ ���C_ _ ,�
✓ 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
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PIONEER. DIGGING, INC. PAR fOIV1k R: uLEOTSO,LLC TEST HOLE I: TEST HOLE 2: TEST HOLE 3:
PARCEL# 12107 2490052 trio c lmot, 0-3 (Si. r;
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SEPTIC DESIGNS ADDRESS: 581 E MURRAY RD RI\)I S-30 ROO I S-32
3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE /COUNTY PROVIDED
p � MUEASSpPP`�TSORSYsIIELLNODEAS NE EY.REFERENCES
COUNTYGI DESIGN INTENDED FOR SEPTIC
OFFICE 3EX�42612303 FAX"3611427"2373 C s
HEET: SITE PLAN SCALE 1 =100' PURPOSES ONLY PROPOSED DEVELOPIENT MAY BE SUBJECT TO OTHER
DEPARTMENT/AGENCY REVIEW.DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS
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BE CHARGED AT TIME OF INSTALLATION EXPIRES
PIONEER DIGGING, INC. CUSTOMER: ULEOTSO,LLC PARCEL-:12107 2490052 T LS 11IOLE I: TEST HOLE 2: TEST HOLE 3:
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SEPTIC DESIGNS ADDRESS: 581 E MURRAY RD RJJ1S-30 ROOTS-32
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DESIGNER: ROBERT H.PAYSSE DI$CLAI"E TH II NOT A SURVEY.REFERENCES INCLUDE APPLICANT/COUNTY PROVIDED
3083 E.MASON BENSJN RD. GRAPEVIEW,WA 98546 PUTS OR SURVEYS FIELD MEASUREMENTS Ng R COUNTY DES+GNINTENDEDFSEPTIC
OFFICE36l}42618113 FAX 360 427 2353 C DEPARTMENT/AGENCY TO OTHER
REVIEW DESIGNERPURPOSES ONLY PROPOSED D NOT RESPONSIBLE FOR SETBACKS LOPMENT MAY BE TUNRELA UNRELATED TO
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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 loft to waterlines with all septic components. If less than loft 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 loft 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 246-272A. For operation and maintenance
information, refer to Mason County Public Health Homeowner's Manual,which should be received after installation approval.
14.System owner should be cautious of landscaping around septic components. Root intrusion
can cause premature failure of the drainfield area. In addition, bushes and trees should be kept
away from lids and other septic maintenance points.
15. Changes made at time of installation may impact designer calculations, pump sizing,and
compliance w/county and state requirements. Contact designer prior to install w/any
proposed variations from design. Changes may result in additional fees and permitting. 4"•�F .,;s^,
•
PIONEER DIGGING, INC, CUSTOMI lt: 1 n-FOTSO,LLC
PARCEL$ 12107'2490052 •
RCEERT N3�PAYSSE
SEPTIC DESK,NS ADDRESS: 581 E MURRAY RD •••` ''F
3083 E MASON BENSON RD. GRAPEVIEW,WA 9854G DESIGNER: ROBERT H.PAYSSE EXPIRES
OFFICE-360-426-1803 FAX-360-427-2353 SHEET: NOTES SCALE NA