HomeMy WebLinkAboutSWG2023-00467/APPLICATION & DESIGN - SWG Application / Design - 10/22/2025 01714 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 985
SHELTON:360-427-9670,EXT 40
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: SWG2023-00467
APPLICANT LORD NATHAN &JESSICA Phone: 503-866-6456
Address: 1221 NW 126TH ST SEATTLE, WA 98177
OWNER LORD NATHAN &JESSICA Phone: 503-866-6456
Address: 1221 NW 126TH ST SEATTLE, WA 98177
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 590 N Dow Creek Dr
Primary Parcel Number: 422165000055
New 2-bedroom SFR pressure system with sand-lined bed (drainfield
Permit Description: on parcel 422165000056 AFN: 2232210)
Permit Submitted Date: 10/30/2023
Permit Issued Date: 10/22/2025
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/01/2026 (based on date of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drainfield installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
7 Must provide an HMP prior to constructing/placing any structures on the property. Not
required for the septic system as there is no native vegetation.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
--- - OFFICIAL USE ONLY - -
MASON COUNTY DATE RECEIVED: 10/2o/170?3 u) x.
x.
COMMUNITY SERVICES AMOUNT RECEIVED-�} 1?$ RECEIVED BY
CIm
Public Health(Community Health/Environmental Health) R (p
360-427-9670,ex 400 or 3 60-2 7 5-146 7.ext.400 0
--= 415 N.6th Street-Shelton,WA 98584 SWG 2,023 - Oto q47 ° n Z
ON-SITE SEWAGE SYSTEM APPLICATION
m n
APPLICANT PHONE m
I—
JESSICA LORD 503-866-6456 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
1221 N W 126TH ST SEATTLE WA 98177 z
SWEET,SITE ADDRESS-600 DOW CREEK DR HOODSPORT WA 98548 .A
NAME OF DESIGNER PHONE N
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE 0 N
TBD y
PERMIT TYPE(select one) DRINKING WATER SOURCE O
RESIDENTIAL OSS h. COMMUNITY OSS ffCOMMERCIAL OSS ft PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(select one) 1 PUBLIC WATER SYSTEM LAKE CUSHMAN WS
I
W NEW CONSTRUCTION I UPGRADES �1 REPAIR/REPLACEMENT OTHER DETAILS(select ell that apply) 0 TABLE IX REPAIR (JI
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINEco
n DESIGN FORM(REQUIRED) Il SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE ro
0
6-WAIVER(S)(IF APPLICABLE) 2 1 20'X63' 0 o
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
GO TO HOODSPORT, TURN LEFT ONTO CUSHMAN ROAD, TURN LEFT ONTO o
POTLATCH CUSHMAN ROAD, TURN RIGHT ONTO LOWER LAKE ROAD, TURN IGHT 1- 0
ONTO DOW CREEK DR, LO TIS ON THE RIGHT SIDE, HAS RIBBON TIED AROUND --1
THE SOIL LOGS. ai
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. a)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(tor reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT 0 HOME SALE ['COMPLAINT ❑OTHER
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
1N1:0-38 t,F5 ave. vi
35- 64r" v6 (o0S (1yPLi)
-viz: 0-3 7" L FS
39- (Li`t V(-Coo
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.
INSP R SIGNATURE DATE APPLICATION EXPIRATION DATE APPLI ATI N APPROVED)ISSUED BY DATE
<< l1 /7013 [ 1 / Ol Imz6 IO(UfZO?$
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 1 6 5 0 0 0 0 5 6
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. '1 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 2023-00467 Designer's Name: CINDY WAITE
Applicant's Name: JESSICA LORD Designer's Phone Number: 360-701-0205
Mailing Address: 1221 N W 126TH ST Designer's Address: 80 E PICKERING LANE
SEATTLE WA 98177 City State Zip SHELTON WA 98584
City State Zip Designer's Email cindyewaite@msn.com
DESIGN PARAMETERS
1 Treatment Device
❑Glendon 0 Sand Filter 0 Mound ® Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Other
Treatment Level (check all that apply): ❑A feB 0 C ❑ BL 1 frc BL2 0 BL3 ❑ E ❑N
Drainfield Type
❑ Gravity l 'Pressure 0 Trench litBed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 J Schedule/Class SCHEDULE 40
Daily Flow: Operating Capacity 180 / gpd Length 24 ft
Daily Flow: Design Flow 240 ' gpd Diameter 1.25 in
Septic Tank Capacity(working) 1200 gal Number 4
Receiving Soil Type(1-6) 1 Separation 2 ft
Receiving Soil Appl. Rate 1. gpd/ft2 Orifices
Required Primary Area 240 ft2 Total Number of • ices - 48
Designed Primary Area 240 ft2 Diameter 3/16 • in
Designed Reserve Area 240 ft2 Spacing . 44Q- �' 24 in
Trench/Bed Width 10 ft ��.P *I '�� Manifold
Trench/Bed Length 24 J ft Schedu4. , SCHEDULE 40
s�
Elevation Measurements Len' a ov 4WAITE FZ 6 ft
Original Drainfield Area Slope <1 % Di' a er LICEN;,ED DESIGNER 2 in
New Slope, If Altered % Pre erredmar+ :con iguratton used? ❑ Yes G2fNo
Depth of Excavation tip-slope 46(BOTTOME OF SAND) in Transport Pipe
from Original Grade Down-slope 46(BOTTOME OF SAND) in Schedule/Class SCHEDULE 40
Designed Vertical Separation X. t Q6 in Length 20 ft
Gravel-based Drainfield Required? g Yes 0 No Diameter 2 in
Pump Required? £Yes 0 No 1(\'' Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
4 /
Diff. in Elevation Between Pump& Uppermost Orifice 5 ft Dose quantity 45 gal �\ 7
2 Chamber Capacity(flood) 1200 gal t
Drainfield Squirt Height/Selected Residual (head) ft P Y
Uppermost Orifice lit Higher ❑ Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 28.32 gpm It Timer lif Elapse Meter 67' Event Counter
Calculated Total Pressure Head 8.28 ft If Timer: Pump on ,Pump off
Comments
PUMP CONTROLS TO BE SET AT TIME OF INSTALLATION, CONCRETE TANKS REQUIRED.
D...:�oa• 4/I 1 f1(V'
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 4 2 2 1 6 5 0 0 0 0 5 6
Permit Number: SWG 2023-00467
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
of Test hole locations l ' Drainfield orientation and layout Reference depth from original grade:
le Soil logs litf Trench/bed dimensions and
Septic tank
It Property lines critical distances within layout Qf Drainfield cover
Existing and proposed wells wr D-Box/Valve box locations Reference depth from original grade
within 100 ft of property ( Septic tank/pump chamber
and restrictive strata:
gi Measurements to cuts, banks, and locations .fri1a,r ,
11 Laterals, trench/bed, top and
surface water and critical areas ' Observation port location bottom
gf Location and orientation of ' Clean-out location 0 Curtain drain collector
curtain drain and all absorption ili Manifold placement hi Sand augmentation
components
wr Orifice placement Other cross-section detail:
it Location and dimension of it Lateral placement with distance El' Observation ports/clean-outs
primary'system and reserve area
to edge of bed Other Information RTI✓
gf Buildings
i� Audible/visual Alarm referenced Yes No ti3�L t(J
ii Direction of slope indicator eta/ ",ap
Df Scale of drawing shown on scale ' ❑ Design staked out
gi Waterlines bar Er 0 Recorded Notices attached
IX Roads, easements, driveways, Iv Elevation benchmark and relative 0 0 Waiver(s) attached
parking elevations of system components Gir 0 Pump curve attached
cif North arrow and scale drawing ❑ 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notifie by instaLJAA-1-1
ler at time of installation Yes 0 No
z,,-- 5 11 ) 20Z s
Signature f Designer Date CA.)
The undersigned has reviewed this design on behalf of Mason County Public Health and dt to be in
compliance with state and local on-site re lations: !r'W' 0
7(1/ -2 2(00 U oar � ,
Envi onmental ealth Specialist p vcoo, 2?O1s
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CON�)F
✓ The design is stamped"Approved"by Mason County Public Health. `''! v74,y<�4/`
✓ The Onsite Sewage Permit has not expired, the Permit Expiration Date is: // t I / 2C271j
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
d/ ..
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
I
r
/ r
�' p m
3 � a. i (..)
o m S+ O =
l
O , _
., I.
A O O
a. rat• my
g " kr x
N.,/ `,'.••
♦ w O
O
�) _ ,:ti1►`�
• . C G ,' \ S 8 S S
, "\\\\\q) ,•''' \ a
x
• •
I
•
CA 4,it
3 ..---\ uN *
0
S ' ,* 3
�� Is
I
•,
...\ ------ - T ,L- ..
el Ir•
I w
'te � 50 o74 rncn � Wiv -k
-- 4
t.e..._ (i .�
1� Cr � � -1 NNE C 0 d
t �' .p Q '"' O oO DO Q -p IS
ac, \ O CD (� O N O A p` p is
N �'`� Om. O O p N
t z 10 /�.IP' `� tZ N O N cl o ''. c co
c .s 1 Ef cci � 0 6 (D v N p
n `sy i 11 p (D iv
iT,
CD
° - Alo• 0
0.
ai
co X
S'' .V$ 1$$418S O
•v.' ROY = t``• N •v1 4
IC $, $ IGNER
..1 . ' 1 CD
= EXPIRES owe, r
I ---
'"- 7
z
ORIFICE SPACING
2
Lateral# Length Length Orifice # Distance from Distance from end Length#
# (Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 24 288 •
24 12 0.5 1.5 24
2 24 288 24 12
3 24 0.5_ 1.5 24
288 24
4" 24 288 24 12 0.5 1.5 24
0.5 1.5 24
96 48
TRANS LENGTH 20 94
GPM I 28.32
K (2"SCHEDULEN 40) 284.5
FRICTION LOSS 0.280124
Squirt I 2'
Elevation difference 6
I TDH 8.280124
�F
1
: .%
S. MC, <�eh
I. `)v i WAITE
F'1');SIGNER �'
TRENCH CROSS SECTION
t -ill
_. ._.. _......._.. 4-17&....-F;t-' ''/>~.• e
7e 4e „ gr ). ' of ?pi, --ff,
y� r,c4 ,, F SL q i Ps,
i r , 4 Pp)11,61k,
0 A 9\lit,,,„,
lri• Ocr
A
•
DRAINFIELD LAYOUT
i..freil,
" -re-Aecifedle�/�
I 10' is/
"_ 5-
•
.4r
•
.4r a 2
X1=CLEANOUT/OBS PORTS (`f) 18
X2=D BOX'VALVE BOX WAITE
p CI E
LICENSED DESIGNER
•
X3=Check Valves( „ PU 4r74?
L KPIHLS 05
X4=Flow Control Valves (y)
X5=Soil Logs a 42 I4,/ 4G1
MgS0v OCT 2 2025 f�
D q N,�ENTgL HEALTH
/,-- THREADED CAP OR PLUG
P t f rrc_u(-+-
---- 6"PVC
r --- LAST ORIFICE;WITH
ORIFICE SHIELDS IF
ORIFICE ORIENTATION IS
BACKFILL UPWARD
MATERIAL ,>, \�\- 2 /\ \\\is,.\� +
\���/�\\ ,.. �j // //\; g"_24"
o
0844.\ 000 O cr 0 00 O �— PRESSURE LATERAL
PVC HOSE OR �\ \�)°O° 'oa `} 00 o AS SPECIFIED
LONG SWEEP \%moo 'o 4 ogj()0
ELBOW '.\\ -%\ *. o
\ -- \�f \\--�\\;\ �.\�/,\� DRAINBROW PIPE
MIN.
UNDISTURBED SO —/
6"PVC WITH DRAIN
�e -� HOLES; EXTEND TO
• �T F��s °�� BOTTOM OF GRAVEL TO
Tc\ °L ; A MONITOR PONDING
N 0 INFILTRATIVE SURFACE
CIA��, 1
AITE
LICENSED DESIGNER
Exi,Pz s J;• NG/ LEANOUT PORT
(EXAMPLE) , 0
I
eel- 2 2 2025
hASON COUNTY ENVIRONMENTAL HEALTH
DJA
I. '
/2da 6i/ r•1 / 4�✓k
C.� 7
SECURED LID WITH GAS TIGHT SEAL
/
24"DIAMETER
_ ACCESS RISER
FINISH GRADE
/ 1 6_ TO PUMP
CHAMBER
FROM SEWAGE .
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS
SEPTIC TANK
(TYPICAL) ocr22E 2025
3ECUREO)ID WITH GAS TIGHT SEAL MASON COUN
n" NVIRONMCNTAL HEALTH
THREADED UNION DJA
24"DIAMETER
ACCESS RISER
FINISH GRADE F . SERVICE
j + -- VALVE•
FROM SEPTIC I G �L
TANK \ ( mid
if•� TODRAINFIELD
11 1 ! •
'�- EMERGENCY STORAGE if
ANTI SIPHON
VALVE*
HIGH WATER ALARM LEVEL
f
WORKING VOLUME _0 INDEPENDENT
NORMAL TIMER OFF _ FLOAT STEM
.-� �_ FOR FLOAT
Q ENCLOSED PUMP ' MOUNTING
A. SEDIMENT SHROUD* =I CHECK VALVE
Q s *
•
'I'<J SEDIMENTS 'Z.: SUBMERSIBLE
r 51004. eaI CENTRIFUGAL
� GI PUMP
0 * LICE Dl E IGNER PU)�IP�HAMBER
����� j�YPICAw I S." /Aida.Lhi'IRLS USA 1)
*AS NEEDED I
1 24.0 6-.All/41"'11 ! V-:^.4... I :IA•6r
, ,
Ill!efey Pumps
Pump Specifications 10*
250-Series Submersible ,*II-VA\
Surnp / Effluent PumpIii __ or
_ �
LITERS PER MINUTE
0 20 40 60 80 100 120 140 160 180
25 } II 1 I I I
j 7
i
20
6
—`t
5
15 rn
re
w
I—
w w
w 2
LL
Z I r4 ?
o
o
I
—I ...I
< I--
I—I- 10 3
O
- I II ` 4i
of 1
o
��Q- :4 1 Doti 0Cl'of
2,5
oN• 411 0� 4,4Nlr i glV" A
fO I .ase : r•IT _ p• _. - 1
i a D DES GNER 9P.
A�r//
✓` Z��N �� 1 1,1201116 A
EXPIRES 05,10,
\\64
0 10 20 30 40 50
GALLONS PER MINUTE
250_P1 R U17/2018 :C'opyright 20181 iberty Pumps Inc. All rights rescrsed. Specifications subject to change without notice. Ube*
Installation Notes
Sand Augmented Pressure Distribution System:
42216-50-00056 600 Dow Creek Dr
The prepared site plan is not a survey. It's the owner's responsibility to verify property lines,
utility lines (water, sewer, power, phone and gas) prior to installation.
1. Pump controls to be set at time of installation 135 GPD
2. Install system during dry weather with acceptable soil conditions
3. Gravel based drainfield required.
4. Clean C-33 Required
5. Septic and pump tank must be concrete
6. Keep wheeled vehicles off the drainfield area before, during and after installation.
Tracked equipment only,
7. All ground, surface water and roof drains must be diverted away from the septic tanks
and drainfield. Ensure the final grade slopes away from these areas and water doesn't
collect on or around them. Use swales, berms, catch basin and tight lines. curtain drains,
etc. to divert all waters.
8. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the
drainfield
9. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
10. Install access risers on the septic tanks, valve box and ends of laterals.
11. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
12. Lids must form a water and gas tight seal with the access risers
13. Install effluent filter specified in this design at the septic tank outlet.
14. This system must be installed by a Mason County Certified installer.
15. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
16. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is based on 45 gallons per day per capita with two persons per
bedroom. The minimum design flow per bedroom per day is the operating capacity of
ninety gallons multiplied by 1.33. This results in a minimum design flow of one hundred
twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety
gallons per bedroom per day.
17. Install laterals with contour of the ground
18. Install trench bottoms level and always maintain a minim of six inches into native soil
19. Install locator tape on top of all drainfield laterals.
20. Install threaded clean outs at the ends of all laterals (c m ext d to within six
inches of finish grade and be in a valve box as show
21. Install audio/visual alarm ,,,A...4 1- cullJ
•
22. Filter fabric required over drain rock prior to backf . 14' al^ '1\Atends above
the original grade, run the filter fabric at least 2 i dirt e t wall.
e CIN E W ITE'
LI ED DESIGNER
I0
E�t WY-5 JS tU
System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank and pump tank should be pumped every three to five years or as
needed.
3. System owners are responsible for having maintenance performed annually.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owners shall not at any time change or alter settings in the control box.
6. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
7. Keep the flow of sewage at or below the approved design operating capacity.
8. Keep waste strength at residential waste strength parameters.
9. Spread loads of laundry through the week.
10.Do not use excessive bleach or detergents with added whiteners.
11. Do not shower, do laundry and dishwasher at the same time
12.Antibiotics can kill or impair the biological process in the septic tank.
13. Leaky plumbing can hydraulic overload your on-site septic system.
I
1
?<.
/ OF YA3ti (
tr
0441 di cjs
.`, ,U
oCIN , WA! , !�
LICENSE.,)DESIGNER