HomeMy WebLinkAboutSWG2025-00348 - SWG Application / Design - 9/3/2025 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHELTON:360-2754467.EXT 400
J 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: SWG2025-00348
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: 320282490112
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 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.govlhealth/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY DATE RECENED ^/] _ O�i ��
(09c Cn
O'i AMOUNT RECENED; �// RECENED BY: 0.,�, ^ co m
Public Health & Human Services
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Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 ��� �D�_ - a03143 o C
415 N.6th Street-Shelton,WA 98584 Z u)
ON-SITE SEWAGE SYSTEM APPLICATION >c xi
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APPLICANT �ys PHONE I
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE e-' ���� com
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SITE ADDRESS-STREET,CITY.ZIP CODE t- I W
PHONE I°
NAME OF DESIGNER n(, O ( �
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NAME OF INSTALLER J PHONE
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3 cock 1\v�s V `� IN V DRINKING WATER SOURCE Q
PERMITRM TYPE(select one) B) �� lOO
In RESIDENTIAL OSS fi COMMUNI COMMERCIAL OSS aPRIVATE INDIVIDUAL WELL PRIV_ E TWO-PARTY W Z r
a PUBLIC WATER SYSTEM I
IN TYPE OF WORK(select one)
W.NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR
0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CDSUBMITTALS r
SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 411/2025? O r
0EDESIGN FORM(REQUIRED)/ IDES eNO
WAIVER(S)(IF APPLICABLE) I,-CO
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locker!gate) I I O
1r,rc .,. 1Zc�. 4-o G3E DIO. Follow �r‘vew #o y +m
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S r A s 51 , i s 04:" c Lt w)e s4- 04- . erc\ 0C o I--
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE OCOMPLAINT ❑OTHER:
COMMENTS/CONDITIONS
INSPECTOR SOIL LOGS
Tft3 . a- 79 i7S4 (Type n�f �
1�5� 44- 19"
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rtttt: d-32'"'4Sc L( AdaSof ,Md 5
2S5f of 3t 4 wt 'of 4 44l
rso -31" 651.
r d441
�� a r 3 RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: FOR FINAL APPROVAL.
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIREDT OR FINAL A/ISSUED. DATE
INSPE IGNATURE DATE APPLICATION EXPIRATION DATE APPLICA ������
f// /zzs V7(00 Z S
T IS RM 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: ,3 I Z 0 Z aJZk 91014 -I 1 SZJ
A design will be reviewed when 3 copies of each of the following are submitted:
V Completed design form that has been signed and dated. Y Scaled layout sketch,including all applicable items on checklist.
Scaled plot plan,including all applicable items on checklist. V 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"
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PARCEL IDENTIFICATION
Permit Number: SWG 20l5-00 3"/I1 g Designer's Name: -OW 11)L-k- cZen,$o:n
Applicant's Name: l Designer's Phone Number: 13 to 0 4-q O--((j
�t c;;c,�C.t F.k�Q� Avis i�h `
Mailing Address: +`3'Z,O�E kfc4,0. IC.C(; Designer's Address: 3 e1 ( E l-atNoS-fak'r&, RA
hL wA etg� City State Zip <i t�i cn W Pt CleZi
City State Zip Designer's Email
DESIGN PARAMETERS
Treatment Device
❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Othe
Treatment Level(check all that apply): ❑A ❑B ❑ C ❑BL1 ❑BL2 ❑ BL3 ❑E ❑N
Drainfield Type f' 4
e ub Surf
❑ Gravity �I Pressure Trench 0 Bed � ��
Septic Tank/Drainfield Specifications Laterals FOz. �0
Number of Bedrooms 4 the u e lass 40 /GFQ �`f
Daily Flow:Operating Capacity 3 j(o0 gpd Length 4 ft
Daily Flow: Design Flow '1)0 gpd Diameter ( i/4 in
Septic Tank Capacity(working) i szo.0 gal Number (.Q
Receiving Soil Type(1-6) t- Separation C--J a ft
Receiving Soil Appl.Rate .Co gpd/ft2 Orifices
Required Primary Area 00 ft2 Total Number of Orifices s4
Designed Primary Area ?.0 ft2 Diameter 3!(UP in
Designed Reserve Area S 00 ft2 Spacing (p p in
Trench/Bed Width '3 ft Manifold
Trench/Bed Length 2.1 c, ft Schedul lia& 40
Elevation Measurements Length `L ft
Original Drainfield Area Slope 3 % Diameter Z in
New Slope,If Altered 3 % Preferred manifold configuration used? )1 Yes 0 No
Depth of Excavation Up-slo ."7 in Transport Pipe
from Original Grade Down-slope D in Schedule/Class 40
Designed Vertical Separation 211_ in Length SO ft
Gravel-based Drainfield Required? A Yes 0 No Diameter 1.- in
Pump Required? X1 Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff. in Elevation Between Pump&Uppermost Orifice 4 ft Dose quantity 90 gal
Drainfield Squirt Height/Selected Residual(head) z ft Chamber Capacity(flood) a 1 I-LO 0 gal
Uppermost Orifice/4 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 3Z Pm Jdt Timer XI Elapse Meter 4 Event Counter
Calculated Total Pressure Head !0 ft If Timer: Pump on'2 hart)4j6 52C,Pump offrr (.0 /
Comments V\III I.tt e LtS'TA1
Revised:6/1 1/2025
illDESIGN FORM—PAGE TWO Assessor's Parcel Number.3��. a 7 , ,Z `i';R ,o 1 I r
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
21 Test hole locations ] Drainfield orientation and layout Reference depth from original grade:
51 Soil logs ®' Trenchfdimensions and Ea Septic tank
I1 Property lines critical distances within layout 66 Drainfield cover
Ei3 Existing and proposed wells El Valve box locations Reference depth from original grade
within 100 ft of property -1S3 Septic tank/pump chamber and restrictive strata:
ql Measurements to cuts,banks,and locations
63 Laterals,trench bed,top and
surface water and critical areas tl Observation port location bottom
A Location and orientation of ] Clean-out location tfaiCurtain drain collector
all absorption t3 Manifold placement Sand augmentation
components ® Orifice placement Other cross-section detail:
tij Location and dimension of Lateral placement with distance Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
IN Buildings IS Audible/visual alarm referenced Yes No
P9 Direction of slope indicator M Scale of drawing shown on scale rl 0 Design staked out
i1 Waterlines bar 0 0 Recorded Notices attached
ail Roads,easements,driveways, ' Elevation benchmark and relative 0 0 Waiver(s)attached
parking elevations of system components El 0 Pump curve attached
1E1 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
11
The undersigned designer must be notifie y installer at time of installation `�1 Yes ❑ No // .
9.
mot. ���Q -Z /// �.,
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gnature o esigner Date �11/ �.' `• ; ,�+4,,
The undersigned has reviewed this design on behalf of Mason County Public Health and d-1t��'% ;•,fiii ,-, ';°�i: '•/�i`2$
compliance with state and local on-site regulations: t� ....::.e%%f LAP%oaro'
EXP*12E811104r t
irli.Z Io/6/re, 75
Environmental Health Specialist Date Z,
,,, OCT�6 �.
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING COlai`�I, ION. 2025
✓ The design is stamped"Approved"by Mason County Public Health. ������rrNi
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 7/4( z? 0,/4 Nf`IFN);L y
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. FAS TN
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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