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HomeMy WebLinkAboutSWG2025-00346 - SWG Application / Design - 9/3/2025Or 101811I 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 "^l o FAX:360-427-7787 On-Site Sewage System Permit: SWG2025-00346 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: 320282490111 New SFR 4-bedroom pressure system with primary and reserve Permit Description: drainfield on parcel 320282490112 (AFN:2231367) 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. 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. als: 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 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 MASON COUNTY DATE RECEIVED: /may — 03 -Q 0 ,vT�, c CO AMOUNT RECEN RECENED BY: Public Health & Human Services fl 66.6 v CO Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 Cl) 415 N.6th Street-Shelton,WA 98584 SW G a - 00 3� 0 o Z U) ON-SITE SEWAGE SYSTEM APPLICATION > m 0 APPLICANT PHONE I- 70.c + ,nk_f, Nus--nr. 3(00 490- o3'10 Z c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE M 1 131n SC Arc KCL 14 SkaI4'6r' 'i A_ i co - co SITE ADDRESS-STREET,CITY,ZIP CODE [:V :J. :: 1 I W NAME OF DESIGNER ( PHONE IrJ 1Jw;�1�.. S'4w.?Sort 1Ir. !i0.3' KQ2,S j 3too 10—11 + NAME OF INSTALLER PHONE la JMI< qu XKh I 31A 410 -0 3-)0 n4 PERMIT TYPE(select one) DRINKING WATER SOURCE Cl) �TtT s y_ � Jw RESIDENTIAL OSS 11 COMMUNITY OSS Fl COMMERCIAL OSS PRIVATE INDIVIDUAL WELL ■ PRIVA TWO-P RTY WEL I Z I°3 ❑ PUBLIC WATER SYSTEM TYPE OF WORK(select one) ____ ___ _ I I 101 NEW CONSTRUCTION/UPGRADES "e REPAIR/REPLACEMENT OTHER DETAILS(select all Mat apply) 0 TABLE X REPAIR IN SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W El DESIGN FORM(REQUIRED) Igl SEPTIC DESIGN(REQUIRED) BEDROO S LOT SIZE WAS LOT CREATED AFTER 4/1/2025? r ❑ WAIVER(S)(IF APPLICABLE) 21,' K 3.2. New YES NO C ) ^ DIRECTIONS TO SITiE AND SITE CONDITIONS:(ex.locked gate) ' I p �+ l4rc.o d icy. PRA.. *b SE 13ZO .FoUlow ct ivewol -o(4 So..14' t'r I0 0 P N5 i�0.t ` . clo A!'bwn(� -4,nCL - W2S-. Zh-Y ieilok S'tGf�.ivl 4( b I-- s S i • 15 OA !OS cAA kiA 3-LO 2,814 et O 1 12.. ¢„ no Ciln. SO c-c? I— 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 0 BUILDING PERMIT El HOME SALE ['COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS r s: o, 3.1 {eC,g� (rrft 4() Re6f4'{ 3f t. w/ Pift(4M/. 454014- 37" wi Pali co 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. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE AP ATION APPROVED/ISSUED BY DATE ith......_ 914 70ZT 7/I ( j /04/10IS THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025 rmrirb DESIGN FORM—PAGE ONE Assessor's Parcel Number: 1312 10 17.412 T 9 I(° j '< if 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: 11"X 17" PARCEL IDENTIFICATION Permit Number: SWG a -0p34(1 � a Designer's Name: CN65‘.ni- SlnySv v‘ Applicant's Name: -1 0.a.+-1 i.,t;.. [kvAS4-0" Designer's Phone Number: ' DO 41 O^W Mailing Address: 13 La c C- ctic.e.cl I cc ,I- Designer's Address: 3 44 ( e. 1'o'vt ?f�,f W, tl1.l 4-O•� 9 WA i�-r84 City State Zip ff ch 1`l-+0v. W A' ti# 1191 City State Zip Designer's Email dtu4k-J S'sh'eSa ot® tr,4(.tom^ DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 I.per Treatment Level(check all that apply): 0 A ❑ B 0 C 0 BLI 0 BL2 0 BL3 0 E 0 N Drainfield Type `r(<o ❑ Gravity `4 Pressure Trench 0 Bed '.Syk Surf et Dr> P r9 Septic Tank/Drainfield Specifications Laterals �� , 0c`> �p� Number of Bedrooms 4- SchedujClass `t FO `f Daily Flow:Operating Capacity 3 6 0 gpd Length LK ft Daily Flow: Design Flow itli0 gpd Diameter ( V4 i Septic Tank Capacity(working) 1 -00 ' gal Number Go Receiving Soil Type(1-6) ` Separation G-1 Z. ft Receiving Soil Appl. Rate , b gpd/ft2 Orifices Required Primary Area ?O p ft2 Total Number of Orifices ,j4 Designed Primary Area cj 10 ft2 Diameter 3//(f in Designed Reserve Area 4f100 ft2 Spacing (170 in Trench/Bed Width 3 ft Manifold Trench/Bed Length 2,7 0 " ft Schedule Class qo Elevation Measurements Length Z ft Original Drainfield Area Slope 3 % Diameter Z in New Slope,If Altered 3 % Preferred manifold configuration used? kJ Yes 0 No Depth of Excavation Up-slope '? in Transport Pipe from Original Grade Down-slope (", in Schedule lass 4-o Designed Vertical Separation Zer in Length St ft Gravel-based Drainfield Required? 153,Yes 0 No Diameter a in Pump Required? $1 Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications �/ Number of doses/day l Duff. in Elevation Between Pump&Uppermost Orifice4 ft Dose quantity 9 0 gal Drainfield Squirt Height/Selected Residual(head) .Z ft Chamber Capacity(flood) I 17D0 gal Uppermost Orifice 0 Higher jig Lower than Pump Shutoff Pump controls:Please check tho a required. Capacity @ Total Pressure Head .2 gpm fid Timer WI Elapse Meter %@] Event Counter Calculated Total Pressure Head 14 I© ft If Timer: Pump on2,kvti A ,4 ,,Pump off 6. krs, Comments V'( r Y ®T,icM/ Revised:6/11/2025 DESIGN FORM—PAGE TWO Assessor's Parcel Number:3 Z 01 17 I�S j 2 14Cl 0 ( I I i Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Pr Test hole locations El Drainfield orientation and layout Reference depth from original grade: El Soil logs ® Trench/bed dimensions and EIPB Septic tank 'l Property lines critical distances within layout ill Drainfield cover IN Existing and proposed wells l BkofitrxIValve box locations Reference depth from original grade within 100 ft of property 13 Septic tank/pump chamber and restrictive strata: Measurements to cuts,banks,and locations El Laterals,trench bed,top and surface water and critical areas ® Observation port location bottom El Location and orientation of 1S] Clean-out location a Curtain drain collector all absorption V] Manifold placement ►�' Sand augmentation components bil Orifice placement Other cross-section detail: El Location and dimension of 6gLateral placement with distance 15] Observation ports/clean-outs primary system and reserve area to edge of bed ® Buildings Other Information t Audible/visual alarm referenced Yes No NJ Direction of slope indicator l Scale of drawing shown on scale ® 0 Design staked out IP Waterlines bar 0 0 Recorded Notices attached Fill Roads,easements,driveways, l Elevation benchmark and relative 0 0 Waiver(s)attached parking elevations of system components $1 0 Pump curve attached Il North arrow and scale drawing 0 cl Evaluation of failure shown on scale bar Non-residential justification ❑ 0 Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be notified b staller at time of installation Yes 0 No r 1 _ 9 `_ Q",P Signature of Des gner Date kr of The undersigned has reviewed this design on behalf of Mason County Public Health and determi i 2 ' sr compliance with state and local on-si egulations: . DWIOHT 1 SIMPSON .r• ' t r2.S 0 a(?075 .. Environmental Health Specialist Date �,' CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWINlr TDITIQN0 2025 ✓ The design is stamped"Approved"by Mason County Public Health. � ,T ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: q1/fj 77'hgeisqzviz, ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. ycAllp, 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 1 36 eaJSI.��e s fAere fri e/1/ A vie i /e t.to( ia` Le co. `„1„\S (i ,4 i e,Q 7A/ sr Pace g /2004 /a tkAL - I II At gabil / S*"---% 1 • 9L. a‘P�` iV 124rc a i/vi l. .r✓ .320282g9Oi// 4 P pit? i / ii4�� ����' o - 6 2025 -1 s''''it'”- .igt. ' s! 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