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HomeMy WebLinkAboutSWG2025-00347 - SWG Application / Design - 9/3/2025 rn" .: MASON COUNTY 415 N 6TH 84 STREET,SHELTON,WA 985 SHELTON:360 427-9670,EXT 84 BELFAIR:360-275-44267 EXT 400 --J' Public Health & Human Services ELMA:360 482-5269,EXT 400 -_/"' FAX:360-427-7787 On-Site Sewage System Permit: SWG2025-00347 APPLICANT HUSTON JACK A & RENEE M Phone: 360-490-0370 Address: 1320 SE ARCADIA RD SHELTON, WA 98584 OWNER HUSTON JACK A & RENEE M Phone: 360-490-0370 Address: 1320 SE ARCADIA RD SHELTON, WA 98584 SEPTIC DESIGNER DWIGHT SIMPSON Phone: 360-490-1111 Address: 3441 E Johns Prairie Rd SHELTON, WA 98584 SEPTIC INSTALLER JACK HUSTON* Phone: 360-358-8868 Address: 1320 SE ARCADIA RD SHELTON, WA 98584 Site Address: UNKNOWN Primary Parcel Number: 320282490113 Permit Description: New SFR 4-bedroom pressure system Permit Submitted Date: 09/03/2025 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: 09/16/2028 (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 Drainfield 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/environmentallonsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY��� DATE RECEIVED: /`� O� - // ) C D �A�®� �o� U O-- ✓ C U) 55/ RECEVED BY: a /� c rm 0.1 r� AMOUNTRECBVED:� /✓1 rn C Public Health & Human Services 0 Environmental Health 360-427-9670,ext.400 or 360-275 4467,ext.400 S W G n 6 - 003j 1 O 2 415 N.6th Street Shelton,WA 98584 'per `� Z Q' OE SYSTEM APPLICATION > ON-SITE SEWA rn m PHONE r APPLICANT 3(.0 490-0310 z C MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE r73 n1 ' LO E IN rut,II) :a Rci S SITE ADDRESS-STREET,CITY,ZIP CODE ` ' I� VPHONE Ir NAME OF DESIGNER I -. . O 3. ^325 U' 3I O ,J I'' I '[� l \7 1111k O LU J 6 o l a VW�q \ .-7� I PHONE NAME NAME OF INSTALLER , I li 14 �'l 1,• 4°°o-0 -,v — • ��► Q L`� J : DRINKING WATER SOURCE 6 roc054 6 ❑ PERMIT TYPE(select one) ;N PRIVATE INDIVIDUAL WELL ■ PRIVATE TWO- •RTY WEL Z InQ lot RESIDENTIAL OSS ❑ COMMUNITY OSS COMMERCIAL OSS 0. PUBLIC WATER SYSTEM �" TYPE OF WORK(select one) I f� X REPAIR Or NEW CONSTRUCTION/UPGRADES b.REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE El SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE W SUBMITTALS r ,® DESIGN FORM(REQUIRED) te SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4f1f2025? 14 1 V Ilk 1`2 NQ _D 0 WAIVER(S)(IF APPLICABLE) 1 DIRECTIONS TO SITE AND,S-IITEICONDMONS:(ex.locked gate) �w �„01 Ww rt vt' W� �v� h �._/ I O �'f'CI,.ti ia. ►7d '�"O S E l Z a II l��-/1 �4 • r Sr C�c1 0 �ove,w o r Iof SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 0 OTHER: __ - -INSPECTOR SOIL LOGS %"{ COMMENTS/CONDITIONS ����` WI Trite- 13"-V(z 1.M 5 I rr, I3-16 „ V(1t4taS ( •yII3) I TµL:0- tg �v4tAGIIj 143- kir k k ft (d >o7 . N- I :0- 15 1" v6,t n 4 j.c �i �wf�li+r �60% „hi 15 ,32 V�,r�ce1►5f 32 s WN S SSA- of it RECORD DRAWING AND INSTALLATION REPORT S'/. REQUIRED FOR FINAL APPROVAL. SOIL CODES: DATE .S /' V=VERY G=GRAVELLY S=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTSAPPLICATION OR FINA APPROVED/ISSUED BY ( INSPECTO SIGNATURE DATE APPLICATION EXPIRATION DATE 1016 izo f� ?/16(ZdZg Revised:6(3/2025 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE ii t { I DESIGN FORM-PAGE ONE Assessor's Parcel Number: `3 f Z 0 z 1 c I?1`1 J Q 'ID I ( ( 3 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 "X 17" //�� � PARCEL IDENTIFICATION Permit Number: SWG 75`0 LIT l T Designer's Name: . _ t SO A -TWA( + Designer's Phone Number: -3(30 k i]-((1 Applicant's Name: n�.Q, p�1eti�;;���.��p,l� Mailing Address: 1.3 . SL i idol K4• Designer's Address: 344 i e• Q Z S 1'& t t Tel City State Zip QtL Wilt `[-fri8 City State Zip Designer's Email ��� S r`P DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 • 8er Treatment Level(check all that apply): 0 A 0 B 0 C 0 BLl 0 BL2 0 BL3 0 E 0 N Drainfield Type 4 ❑Gravity `tikPressure litTrench 0 Bed a Sub S cg D� ° Septic TanklDrainfield Specifications Laterals RkccF/ 20?s Number of Bedrooms �c YClass 4-0 CFO Daily Flow: Operating Capacity '3ta 0 gpd Length + ft Daily Flow: Design Flow 4 6O gpd Diameter ( 1/ in Septic Tank Capacity(working) ZOO gal Number (C Receiving Soil Type(1-6) Separation i l 5- ft Receiving Soil Appl. Rate - (p gpd/ft2 Orifices Required Primary Area f5 C)-0 ft2 Total Number of Orifices Designed Primary Area 81 Q ft2 Diameter er in Designed Reserve Area 00 ft2 Spacing (c90 in Trench/Bed Width 3 ft Manifold Trench/Bed Length 'Z 70 ft Sc edu ,/Class err) Elevation Measurements Length 2 ft Original Drainfield Area Slope IF % Diameter 'Z. in New Slope,If Altered 1' % Preferred manifold configuration used? 21 Yes 0 No Depth of Excavation Up-slope iii in Transport Pipe from Original Grade Down-slope (o in Sc a iI1 .lass 4-0 Designed Vertical Separation ZII- in Length fl0 ft Gravel-based Drainfield Required? ti Yes 0 No Diameter 2 in Pump Required'? Yes 0 No Dosing and P mp Chamber Pump/Siphon Specifications �,/i • Number of doses/day Diff. in Elevation Between Pump&Uppermost Orifice ` - ft Dose quantity 0 gal Drainfield Squirt Height/Selected Residual(head) .Z ft Chamber Capacity(flood) (1 ZOO gal Uppermost Orifice IIHigher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 3Z. gpm /ID Tinier 4D Elapse Meter Xi Event Counter Calculated Total Pressure Head I 0 ft If Timer; Pump on 2.i``hn 4`O5w,Pump off ( 4 iS- Comments V ift'Q1 ( :S / Revised:6/11/2025 iM ''++- . DESIGN FORM—PAGE TWO Assessor's Parcel Number Z O 2� T 9 a! i 3 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 1#d Test hole locations 0 Drainfield orientation and layout Reference depth from original grade: Iiil Soil logs 0 Trench/bed dimensions and Septic tank lil Property lines critical distances within layout Iv Drainfield cover 0 D-Box/Valve box locations IN and proposed wellsReference depth from original grade within 100 ft of property 0 Septic tank/pump chamber and restrictive strata: 444,Measurements to cuts,banks,and locations L$ Laterals,trench/bed,top and surface water and critical areas 0 Observation port location bottom RI Location and orientation of 0 Clean-out location Ift Curtain drain collector Gtiftain-iikaia.ancl all absorption ❑ Manifold placement Sand augmentation components ❑ Orifice placement Other cross-section detail: ili Location and dimension of ;r;A Lateral placement with distance l Observation ports/clean-outs primary system and reserve area to edge of bed Other Information 1 ] Buildings Q Audible/visual alarm referenced Yes No ei Direction of slope indicator @ Scale of drawing shown on scale V.1 0 Design staked out p Waterlines bar 0 0 Recorded Notices attached ® Roads,easements,driveways, Elevation benchmark and relative ❑ 0 Waiver(s)attached parking elevations of system components '® 0 Pump curve attached Sin North arrow and scale drawing 0 [$Evaluation of failure shown on scale bar Non-residential justification ❑ 0 Waste strength ❑ ❑ Flow DESIGN APPROVAL A The undersigned designer must be otifi y installer at time of installation�]Yes 0 No ''tt�;..• ` P--°11t ignature of esigner Date Ili• 1 .: O6r� The undersigned has reviewed this design on behalf of Mason County Public Health and dete''i !��y, - ���, ` �.jy compliance with state and local on-site regulations: exnReallro zs iA_ 1016 075‘ , Environmental Health Specialist Date oGtil� �6 (28 CAUTI ON: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION :p a ��� ry,�� ✓ The design is stamped"Approved"by Mason County Public Health. (./o/Z0 ,y� ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: �yFq� ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. ^S� 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 • 2 3/ A/en///f-/ Ha v,C u,e) ( 6,xirj / (A(Aye,ve ?ro OS!-d w ar I i v V 3 p I Po ssiVe- 4)Se/4en/ hi° are- RQWf,et war ' To ► to Ac"kci I loc.c� ;ohc. 5‘ INA;n c, C.)( ►Z? 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