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HomeMy WebLinkAboutSWG2025-00381 - SWG Application / Design - 9/22/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 a: SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 .. .1'�. FAX:360-427-7787 On-Site Sewage System Permit: SWG2025-00381 APPLICANT JOHNSON-CARPENTER AMY Phone: 360-229-1003 Address: P 0 BOX 3238 SHELTON, WA 98584 SEPTIC DESIGNER JUSTIN RUSSELL* Phone: 360.956.7242 Address: PO BOX 14531 TUMWATER, WA 98511 Site Address: 60 E Fox Ln Primary Parcel Number: 220037600010 Permit Description: 360 GPD Gravity for residential office/shop Permit Submitted Date: 09/22/2025 Permit Issued Date: 10/03/2025 Issued By: Jeff Wilmoth Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system). Permit Expiration Date: 10/03/2028 (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 - MASON CO UUNTY DATE RECEIVED: /�q _ ).3 _ , .� eni, AMOUNT RECEIVE RECEIVED BY: Q,] N �_ Public Health & Human Services 555 alut.le `-e- 0 cn Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 (� 0 415 N.6th Street -Shelton,WA 98584 SWG v�✓ C)0 3 I En 0 Z di ON-SITE WAGE SYSTEM APPLICATION 3 X �Th m 0 PHONE r APPLICANT ..a r AMY CARPENTER [ 360-229-1003 z 0 i C MAILING ADDRESS-STREET,CITY STATE,ZIP CODEal 60 E FOX LANE �sil d N C'-, SHELTON WA 98584 rn .. SITE ADDRESS-STREET,CITY.ZIP CODE S H E LTO N WA 98584 T1 60 E FOX LANE r� �� 1 PHONE LIJ NAME OF DESIGNER �_._r JUSTIN RUSSELL ~-------) �. 360-970-1233 NAME OF INSTALLER PHONE 1] PERMIT TYPE(select one) DRINKING WATER SOURCE 0 C RESIDENTIAL OSS I! COMMUNITY OSS COMMERCIAL OSS n PRIVATE INDIVIDUAL WELL b-PRIVATE TWO-PARTY WELL Z ra PUBLIC WATER SYSTEM TYPE OF WORK(select one) g NEW CONSTRUCTION/UPGRADES I.I C REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR 0 SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE c SUBMITTALS r ❑ DESIGN FORM(REQUIRED) ❑SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? 0 ❑ WAIVER(S)(IF APPLICABLE) 3 6.27 ❑YES ENO n DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) FROM HARSTINE ISLAND BRIDGE, LEFT ON NORTH ISLAND DRIVE, LEFT ON FOX LANE TO SECOND DRIVE ON RIGHT. r —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) 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS I COMMENTS/CONDITIONS , • // (A, r 6 67 (- �.cS RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: REQUIRED FOR FINAL APPROVAL. V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE �1 T IS F66NI MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025 Parcel Number: 2 21010 Assessor's DESIGN FORM—PAGE ONE 3 7 6 0 0 0 1 0 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. '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 t v�ini ���I Permit Number: SWG ��J ^ J IF/ Name: �'Designer's Phone Number: Applicant's Name: Designer's Address: Mailing Address: City State Zip City State Zip Designer's Email DESIGN PARAMETERS Treatment Device 0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Other Treatment Level(check all that apply): ❑A ❑B ❑C ❑ BL 1 ❑ BL2 0 BL3 !e E 0 N Drainfield Type ❑ Sub Surface Drip Gravity 0 Pressure 0 Trench 0 Bed Septic Tank/Drainfield Specifications terals 2/j NA Number of Bedrooms SHOP/OFFICE Schedu �`? 7gar- / ft Daily Flow: Operating Capacity 136 360 gpd N Lengt N Daily Flow: Design Flow 'q('"„ 270 gpd Diam t� (41in l Septic Tank Capacity(working) 1500 gal Num ezD Receiving Soil Type(1-6) 4 Sep t-u J / ft Receiving Soil Appl.Rate .6 gpd/ft2 p Orifices Required Primary Area 600 ft2 Total ui ri1 / Designed Primary Area 630 ft2 Diameter / in Designed Reserve Area 630 ft2 Spacing / in Trench/Bed3 ft Manifold Width 3034 TrenchBed Length 210 ft Schedule/Class Elevation Measurements Length 26 fl Original Drainfield Area Slope 5 % Diameter 4 in New Slope,If Altered % Preferred manifold configuration used? 0 Yes Er No u sloe 24 in Transport Pipe Depth of Excavation Up-slop 3034 from Original Grade Down-slope 22 in Schedule/Class Designed Vertical Separation 36 in Length 158 ft Gravel-based Drainfield Required? 0 Yes e No Diameter 4 in Pump Required? 0 Yes L'No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day NA NA NA gal Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity NA ft Chamber Capacity(flood) NA gal Drainfield Squirt Height/Selected Residual(head) Pump controls:Please check those required. Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Capacity @ Total Pressure Head NA gpm 0 Timer 0 Elapse Meter 0 Event Counter Calculated Total Pressure Head NA ft If Timer: Pump on ,Pump off Comments A" " vE itio1/4 OCT a3 21125 t,.;,: Revised:6/11/2025 MASON COUNTY ENV RO[,v+'tiTAL-`-'"" _ _ Assessor's Parcel Numbert2 2 0 0 3 7 i6 0 0 0 1 1 01 f 'DESIGN FORM—PAGE TWO Permit Number: SWG (9ap.6.- -O U 8,' DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch ❑ Test hole locations 0 Drainfield orientation and layout Reference depth from original grade: ❑ Soil logs 0 Trench/bed dimensions and 0 Septic tank ❑ Property lines critical distances within layout 0 Drainfield cover 0 D-Box/Valve box locations Reference depth from original grade ❑ wiExthin 1g and of proposed wells 0 Septic tank/pump chamber and restrictive strata: within 100 ft of propertyP p p ❑ Measurements to cuts,banks,and locations 0 Laterals, trench/bed,top and surface water and critical areas 0 Observation port location bottom 0 drain collector ❑ Location and orientation of 0 Clean-out location ❑ CurtainSand drain collector curtain drain and all absorption 0 Manifold placement on components 0 Orifice placement Other cross-section detail: ❑ Location and dimension of 0 Observation ports/clean-outs 0 Lateral placement with distance primary system and reserve area to edge of bed Other Information ❑ Buildings 0 Audible/visual alarm referenced Yes No ❑ Direction of slope indicator 0 Scale of drawing shown on scale 0 0 Design staked out ❑ Waterlines bar 0 0 Recorded Notices attached ❑ Roads,easements,driveways, ❑ Elevation benchmark and relative 0 0 Waiver(s) attached 0 0 Pump attached parking elevations of system components 0 0 Evaluati curvev ofa failure ❑ North arrow and scale drawing shown on scale bar Non-residential justification ❑ 0 Waste strength ❑ ❑ Flow DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation Ies 0 No f LZ 2,5-- Signa o Designer ate The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance with state and loc. • site regulat. ns:./ 4i k )P 0)---3 `2-5' f 'nvi o n al Health •-ecialist Date CAUTION: DESIGN AP'ROVAL 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: / Drainfield site conditions have not been altered to adversely affect conditions of design approval. 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