HomeMy WebLinkAboutSWG2025-00397 - SWG Application / Design - 9/30/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
J L 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: SWG2025-00397
APPLICANT DELANY ET AL KIM Phone: 360-280-2660
Address: DAVID B COCCHI OLYMPIA, WA 98502
OWNER DELANY ET AL KIM Phone: 360-280-2660
Address: DAVID B COCCHI OLYMPIA, WA 98502
SEPTIC DESIGNER JIM HUNTER* Phone: 360-753-1226
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: UNKNOWN
Primary Parcel Number: 320221290023
Permit Description: New 4bd gravity trench
Permit Submitted Date: 09/30/2025
Permit Issued Date: 11/19/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 10/08/2028 (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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
I
OFFICIAL USE ONLY
J MASON COUNTY DATE RECEIVED. /� /; � cn D
���J//�� C-TJ C fO
AMOUNT RECEIVED. RECEIVED BY: co cn
f Public Health & Human Services Dov m
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 U)
415 N.6th Street -Shelton,WA 98584 S V G a5 - bo 3 q Z 2
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION
m n
APPLICANT PHONE I-
KIM DELANY 360-280-2660 cz
MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE /11z W
' 1v' 2629 SCHIRM LOOP RD NW �,` /'�LYMPIA WA 98502 m
V SITE ADDRESS-STREET,CITY,ZIP CODE
r�A{� UNKNOWN IA o SHELTON WA 98584 I No
. NAME OF DESIGNER V PHONE I N
CC ' JIM HUNTER 360 753-1226 N
NAME OF INSTALLER PHONE N)
cJ v I N)
<_ I `°
PERMIT TYPE(select one) ECOMMUNITY Q71 DRINKING WATER SOURCE 5 CD
RESIDENTIAL OSS COMMUNITY OSS I�COMMERCIAL OS f PRIVATE INDIVIDUAL WELL E PRIVATE TWO-PARTY WELL Z I W
TYPE OF WORK(select One)
n.1 PUBLIC WATER SYSTEM r
v-NEW CONSTRUCTION/UPGRADES I5 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
ff DESIGN FORM(REQUIRED) El SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? r I
0
EWAIVER(S)(IF APPLICABLE) 4 4.8 ACg ❑ YES Q NO 0
DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate)
HWY 3, SOUTH ON AGATE, WEST ON CRESTVIEW PAST AGATE LOOP RD TO
DRIVEWAY ON LEFT AT SAW BLADE WITH ADDRESS LABELED "1359" TO END OF r
NEW RD. o
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 ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER.
INSPECTOR SOIL LOGS CO MENTS I CONDITIONS
7: b.60 (i„u/y C1-6 6
Of LCO
c-nV2?. o - 67_ ()LAS f (v Lf- "Ilcict/
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 APP CATION APPROVED/ISSUED BY DATE
'k-175\4,T ,,\try! (ttt 1
tW) (()Viks-
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
i
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 32022-12-90023- --
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. 'I 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"
J ^ � PARCEL IDENTIFICATION' ':
t(/V
Permit Number: SWG Z 00 1 1 Designer's Name: JIM HUNTER
Applicant's Name: KIM DELANYLA Designer's Phone Number: 3607531226
Mailing Address: 2629 SCHIRM LOOP RD NW Designer's Address: PO BOX 162
OLYMPIA WA 98502 City State Zip OLYMPIA WA 98507
City State Zip Designer's Email JHANDASSOCIATES@HOTMAIL.COM
DESIGN PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter Cr ATU L Other
Treatment Level(check all that apply): J A _ : B -1 C I BL1 J BL2 J BL3 J E J N
' Drainfield Type
al Gravity 0 Pressure PTrench 0 Bed EX Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 4-E C,t,t 3c 311
Daily Flow: Operating Capacity 3 U..J gpd Length 55 ft
Daily Flow:Design Flow 46e. gpd Diameter 4 in
Septic Tank Capacity(working) 1250 gal Number 5
Receiving Soil Type(1-6) 4 Separation (..k, ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area J 3 ft2 Total Number of Orifices N/A
Designed Primary Area f s 2 S ft2 Diameter N/A in
Designed Reserve Area 8°0 ft2 Spacing N/A i n
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 275 ft Schedule/Class aS►AA. 3 -
Elevation Measurements Length ft
Original Drainfield Area Slope 3, % Diameter 4 in
New Slope,If Altered 1, I A % Preferred manifold configuration used? E 'Yes 0 No
Depth of Excavation Up slope (4?)4 in Transport Pipe
from Original Grade Down
1 in Schedule/Class _ i\.`—r.0
Designed Vertical Separation 36 in Length ft
Gravel-based Drainfield Required? 0 Yes 0 No Diameter 4 in
Pump Required? l 'Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day N/A
Diff. in Elevation Between Pump&Uppermost Orifice N/A ft Dose quantity N/A gal
Drainfield Squirt Height/Selected Residual(head) NA ft Chamber Capacity(flood) N/A gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head N/A gpm a Timer 0.Elapse Meter Q.Event Counter
Calculated Total Pressure Head N/A ft If Timlk: al ID•il, 411 /' f• R. fit r^' -wi ,-.
Comments ' '' "=
--pi,
REV/ISED NOV 19 2025 i _SEP 3 0 2025 t
On COUNTY ENVIRONMENTA. L�
I3Y R@yised:4/14/9075
DESIGfI FORM—PAGE TWO Assessor's Parcel Number: 32022-12-90023-- --
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations Drainfield orientation and layout Reference depth from original grade:
g Soil logs E7 Trench/bed dimensions and g Septic tank
g Property lines critical distances within layout ®' Drainfield cover
g Existingand proposed wells &' D-Box/Valve box locations
p p Reference depth from original grade
within 100 ft of property E3' Septic tank/pump chamber and restrictive strata:
a Measurements to cuts,banks,and locations ® Laterals,trench bed,top and
surface water and critical areas ' Observation port location bottom
g Location and orientation of EX Clean-out location g Curtain drain collector
curtain drain and all absorption E ' Manifold placement g Sand augmentation
components E3" Orifice placement Other cross-section detail:
g Location and dimension of Er Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
D1 Buildings Other Information
Audible/visual alarm referenced Yes No
g Direction of slope indicator l Scale of drawing shown on scale Er Design❑ staked out
g Waterlines bar 0 0 Recorded Notices attached
g Roads,easements,driveways, 0 Elevation benchmark and relative 0 0 Waiver(s)attached
parking elevations of system components 11 0 Pump curve attached
g North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be noti • a 'me of installation 0 Yes d No
Sign re of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site regulations:
Environmental Health S ecialist Date
CAUTION: DESIGN APPROVAL 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: 1°1
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
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:4/14/2025
PAGE 1
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL#: 32022-12-90023
DATE SUBMITTED: 09/25/25 LEGAL/LOT#: LOT C
SP 3152
SUBMITTED BY: JIM HUNTER
APPLICANT: KIM DELANY
ADDRESS: 2629 SCHIRM LOOP RD NW
OLYMPIA,WA 98502
I.CALCULATIONS
NUMBER OF BEDROOMS= 4
RESIDENTIAL GPD FLOW= 480
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE 0.6 GPD/FT2
REDUCTION=LEAVE BLANK IF NOT USED
DRAINFIELD SIZING
ABSORPTION AREA= 825 FT2
TRENCH LENGTH OR BED CONFIG.= 275
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE= 1250 GAL.CONCRETE
NEW OR EXISTING= NEW
III.DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM= 2'-0"
ROCK DEPTH BELOW PIPE= 0'-9"
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIAL/SEASONAL SATURATION= >3'-0"
FILL DEPTH= 1'-0"
TRENCH WIDTH= 3'-0"
APPROVED
NO V 19 2025
MASON COUNTY ENVIRONMENTAL HY;E,1 i H
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