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HomeMy WebLinkAboutSWG2025-00448 - SWG Application / Design - 12/3/2025 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 On-Site Sewage System Permit: SWG2025-00448 APPLICANT THEILER ET AL MARY ALICE Phone: Address: JOHN MARTIN THEILER; VALERIE JANE SCRIVNER SEATTLE. WA 98118 OWNER THEILER ET AL MARY ALICE Phone: Address: JOHN MARTIN THEILER; VALERIE JANE SCRIVNER SEATTLE. WA 98118 SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023 Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584 SEPTIC INSTALLER TJ GOOS* Phone: 360-490-0217 Address: 150 E MARISA PL SHELTON. WA 98584 Site Address: 11 N Cutthroat PI Primary Parcel Number: 422165200042 Permit Description: New SFR 2-bedroom OSCAR X02 system with OS-50 coils Permit Submitted Date: 11/17/2025 Permit Issued Date: 12/03/2025 Issued By: David Anderson Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system). Permit Expiration Date: 12/01/2028 (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 fliP4 ; MASON COUNTY DATE RECEIVED: nili • .._ W C CO AMOUNT RECEIVED RECEIVED BY: CO":. - Public Health & Human Services .� , / , 0_. `Io Cl)Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 N 0 415 N.6th Street-Shelton,WA 98584 S W G ,zO 045 — (,V(1 v Liy y(y Z di ON-SITE SEWAGE SYSTEM APPLICATION z APPLICANT PHONE m m John Theiler (206)335-0710 r z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE ou E WA ') 00 SITE ADDRESS-STREET,CITY,ZIP CODE \Si C11 N. Cutthroat PL tS%1 Hoodsport WA 98548 s_i p NAME OF DESIGNER O 1515 PHONE 3 N Dale L. Tahja \R\\ ��� 1 (360)463-8023 D I NAME OF INSTALLER &I PHONE v I N T.J. Goos \ (36090-0217 < PERMIT TYPE(select one) V DRINKING WATER SOURCE RESIDENTIAL OSS EICOMMUNITY 0 COMMERCIAL OSS 5 PRIVATE INDIVIDUAL WELL S PRIVATE TWO-PARTY WELL Z I illi PUBLIC WATER SYSTEM Lake Cushman Water Co. TYPE OF WORK(select one) —t I gNEW CONSTRUCTION/UPGRADES EREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR N I CJl SUBMITTALS ❑SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W Q DESIGN FORM(REQUIRED) ❑SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? 0 I N ElWANER(S)(IF APPLICABLE) 2 0.21 acre EYES [NO n I DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate) I I CI 1.6 I Co N i SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I N OFFICIAL USE ONLY BELOW THIS LINE— UPGRADE 1 FAILURE SOURCE(for reportng purposes) I ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: Alp it INSPECTOR SOIL LOGS COMMENTS/CONDITIONS s�(GM W TRI:Q 2511Cs'- (7yic, +� ,� RP)>t .25 Lioaf l v 0,• ; ti C9 i Tltl.0-2,1t �rsl- ,�� ;. J o 6, () - ` 7 n Iif51- cif 71t1 L( -ld\ ., -% -.bM `".1.r,s416( 1 n - �1 w/ 1 TNL( U - S" (v(%,, 4j' / � l - L "0 65 t ru5i-af 20 t w/ir(l . 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 ION APPROVED/,SSUED BY DATE 7'1, - I? /vl! R/ s_ IZ (O17Z02S" 112/0.3(?o75 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE evised:6/3/2025 1 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2- 2 j 2 1 6 5 i 2 1 0 0 0 4 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. '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" • PAR4 L IDENTIFICATION Permit Number: SWG a '- c(0 L4c4 g. Designer's Name: Dale L.Tahla Applicant's Name: John Theiler Designer's Phone Number: (360)464-8023 Mailing Address: 14039 SE 237th PL Designer's Address: 2450 W. Deegan Rd.W. Kent WA 98042 City State Zip Shelton WA 98584 City State Zip Designer's Email daletahja@gmail.com DESIGN PARAMETERS Treatment Device 0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield ' 0 Recirculating Filter 0 ATU 0 Other ®A Treatment Level(check all that apply): tJ B 0 C i pfBL2 0 BL3 0 E 0 N Drainfield Type 4 ❑ Gravity 0 Pressure 0 Trench 0 Bed I"Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class OS-50 coils Daily Flow: Operating Capacity 180 gpd Length 25 ft Daily Flow: Design Flow 240 - gpd Diameter Netafim Bioline in Septic Tank Capacity(working) 1,000 gal Number 4 Receiving Soil Type(1-6) 4 Separation 1 ft Receiving Soil Appl.Rate 40 0.6 pgpdift2 Orifices Required Primary Area 400 ft? Total Number of Orifices 200 Designed Primary Area 400 ft2 Diameter Netafim Bioline in Designed Reserve Area 400 ft2 Spacing 6 in Trench/Bed Width 14 ft Manifold Trench/Bed Length 30 ft Schedule/Class Sch.40 Elevation Measurements Length ft Original Drainfield Area Slope 0 % Diameter 1 in New Slope,If Altered 0 % Preferred manifold configuration used? 0 Yes FI'No Depth of Excavation Up-slope 0 in Transport Pipe from Original Grade nown_slope 0 in Schedule/Class Sch.40 Designed Vertical Separation 14 in Length 5 ft Gravel-based Drainfield Required? 0 Yes E'No Diameter 1 in Pump Required? el Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 360 Diff.in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 0.666 gal Drainfield Squirt Height/Selected Residual(head) dnp ft Chamber Capacity(flood) 1,000 gal Uppermost Orifice el Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 30 gpm ' Timer Fe Elapse Meter V Event Counter Calculated Total Pressure Head 50 ft If Timer: Pump on 0.48 min. ,pump off 3.52 min. Comments Revised: 6/11/2025 DESIGN FORM—PAGE TWO Assessor's Parcel Number: 4 2 2 2 1 6 5 2 0 0 0 4 Permit Number: SWG ACC"' d o y4-0> DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch lid Test hole locations lig Drainfield orientation and layout Reference depth from original grade: er Soil logs Er Trench/bed dimensions and Er Septic tank it Property lines critical distances within layout V Drainfield cover ❑ Existing and proposed wells Er D-Box/Valve box locations Reference depth from original grade within 100 ft of property Er Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks, and locations id' Laterals, trench/bed,top and surface water and critical areas Er Observation port location bottom it Location and orientation of V Clean-out location 0 Curtain drain collector curtain drain and all absorption le Manifold placement Er Sand augmentation components Er Orifice placement Other cross-section detail: 0' Location and dimension of Er Lateral placement with distance 0 Observation ports/clean-outs primary system and reserve area to edge of bed g Other Information iil Buildings Er Audible/visual alarm referenced Yes No Er Direction of slope indicator V Scale of drawing shown on scale Er 0 Design staked out Er Waterlines bar 0 0 Recorded Notices attached Er Roads,easements,driveways, 'Elevation benchmark and relative 0 0 Waiver(s) attached parking elevations of system components V 0 Pump curve attached ill North arrow and scale drawing 0 0 Evaluation of failure shown on scale bar Non-residential justification ❑ ❑ Waste strength ❑ ❑ Flow DESIGN: PROVAL The undersigned designer rrTat,be notifie y ins er at time of installation leYes 0 No -, \,c- \\--\c) -----0 Signature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determi ::�.*`• im compliance with state and local on-si regulations: 4.4"7~'�C z ........5.0.����'N a te �� ,, i 1 7 / ( 7o ?S � Environmental Health 5pecialist :�`t d'..'�-,` '` -to F'n $ a1,-b44 .�,,.s (to) 1 ‘'`l16<� ,. Z S� CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING C S y i %' .i $' ✓ The design is stamped"Approved"by Mason County Public Health. /y �0 '^b _' j ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ` V I ```1�‘# ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.4, 41*b# Please Note: The system must be installed by a certi?foil inlr, 0,, unless prior authorization is obtained from Mason Count ' lid'.;.- alth. An Installation Fee is required. Fq0, This form may be scanned and available for public view on the Mason County Web site. Revised: 6/11/2025 1-- or - �o `c1 C\\e\\ter 1 _ r<t\\. :, \\6- - ,-- - -- , \ '�•C,� �roo.. _ . 1,\, ,_. \- cx\ v :c � \,i. �-, - 4' . , - \�•( . clx:LNyt,.. .- e.._ \c \ A 6./ 1.4 •,1 61 O ' cl— • • 99' \ .1 )(s 21/;?; .4:;.11:7 4% '' 4144) -111 0 4 . . "up i, i r, I� iii •I i �so,c�li O��Q o� ti 1 j �` 4/4 Oy�• Tq. ti I . #1 1 .r4V• ..,0:4- d7 1 Ctticz..4.............., po , 5100214 / V l+ 4 :0 Die 1.Tahja/7 s LICENSED DESIGNER • i met „ •-----' l , , • o I o # • , - C \C •-•\\ .• i .\ Ei -. ._._._. _ ,_..... \\ (....C, kl\\( VI00 . \r". ' • - — . of,pc,4,,t,;:41.)7,5! - _VOtv ,,,. r.CC.VjZ\V• Z.,\,.,& '4F•t-c--;', 7,i 2? A.I 0 ite 4 , At t _,-co-----„---, 51002144k,if, t. . „0,:-. Dale L.VW"( ' • o LICENSED DESIGNER # \\ slikibst.wwwwwlyb..‘..k.ww., \li .7..... Ix:1)k t . C.......z:ie , 1 d , A /6,, / '<-'•/ "KC7- ,S. "'"...- 11) 14./. 4- 41%,6) 0' 1 44/ d . (9/7 , .,.. • -c-P 1 / .t Ili 0 • iji 4iir el i ....,...._ kr # •• e . , R.V" r 4 .7:—. / FC7,1 / _.. / / 05/7 l ' i \ \,..-- • • / Q-V 0) tvck •, of / 4 ° • . 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III A _ A Treatment tank Discharge tank "-so �FC� 6� . • -------• F,y`• <2,1 /1` Bti _ 01 T TgHFq��y ytf' :6•. -Inc.`.,♦t•` .' ♦,./.'. •;x l• J. . n.. • .+.I ti•1-.. `'4I \\LJ_l _ tfrje • 14'% '" �`= �/ © � C•.. `' .1. •r L 1 4. •'. ., .`'.Y.A 9•t,%- 4e:.,,•:"'..''' . . '? •.4cW' • J•'... • A . ‘rt:1-WCAV‘ Wrte- 4t-Aer X ANEJ • .. • . I D (� 9 ,1 ( J/TF 'U( �` i m wq�r Jzo F�j STAp 9T 4po 1.?1414.4 U m �y *5 7 i ,41'. Ai-• . r�. AS, ?) y . g' . t I` N i / / �� '� ./ f 01 . I ( ( ( . i 61 45= I , - °°� \ t —1, f \*\ .11)- ic- loll. At aspycp OFF N. `t A , Gy� O'� f �` ;J 1 vi i' C.12 4 -1 -5 0 - ,,a___ L-9,, 0 0. a., ? 1 -1.3-q .4,.....4 ij s SUBMITTAL DATA SHEET Thermoplastic Reinforced Thermoplastic motor bracket and discharge with built-in guide bearing.This 1/2 HP pump has a stainless -----T steel top bearing and motor coupling.These are assembled with our A.Y.McDonald stainless steel motors.Two wire single phase models include pump, motor,and 10' lead. This four inch submersible is supplied with grounded leads meeting the National Electrical Code(N.E.C.)specifications. 1 A The performance curve below will assist you in choosing the pump that meets your needs. MODELS I E-30 GPM 00 E - 30GPM B as -- : :. . -. `-_ : .-- s_. M L: :-- -4,-.. ...`• . v _+ • 1/211P inn. • 53 P.S.1. -. 2g0 ; ;.---l..-,- , �F-. ....ice_ ... . - ..-1--t-....,-.....;.-- i 0 100 ,.. 4 HP•4 STAGES .._-, .._,.......w 'w` `. ... .77..=:.....-_ r O......... Simplex 0 5 18 15 20 25 38 35 40 4 Bupiex 0 10 xo 30_ 40 58 111 m N l Amplest 1 m 40 so FLOW80 GPM 188 121 ,,7y�io�c 119F�►�3 �0 Specifications oUNryFNiiRO ,2�1f 4 'I/we Modal HP Material volts Pl+a,e A B ,I ✓q 4',tL LOT-30 1/2 . Piastic 115 11 10.94 9.53 ! 23 yF'4/TN, i st Iles Monad SUBMITTAL INFORMATION t - Stainless steel pump shell and pump shaft - Powered by A.Y.McDonald submersible motors 1/2 HP. - Reinforced Thermoplastic diffusers and impellers - 1 1/4"FNPT Discharge - Thermoplastic intake screen and cable guard NO-LEAD:The weighted average of the wetted surface of this no-lead product contacted by consumable water contains less than one quarter of one percent(0.25%)lead. - : Lowridge Onsite Technologies,Inc. Toll Free:1-877-47b-8823 davealowridgetech.com P.O.Box 1179 Fax: 1-425-335-3622 oscaronsite.com . • Lake Stevens,WA 98258 A.Y.McDonald considers the information on this assembly drawing correct when published.Item and option availability,including specifications,are subject to change without notice. Submitted by: 1/2022 • • Installation/Maintenance Oscar — II 1. Install audio/visual high water alarm. 2. Divert all storm water run-off away from septic system components. 3. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and reserve area. 4. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield and reserve area. 5. Have the System maintained in accordance with manufacturer's requirements. 6. All material and workmanship must meet County and State requirements. 7. Deviation from this approved design without prior approval from the Designer and Mason County Health Department will make this design null and void. 8. The prepared Site Plan is not a survey, it is the owner's responsibility to verify property line locations prior to installation. Any discrepancies must be reported to the Designer immediately. 9. Locate all utilities prior to starting installation. 10. A Final Inspection and Record Drawing fee will be charged upon completion of the installation. 11. The installer will notfy the designer, Dale Tahja (360)463-8023, 48 hours prior to the start of the installation. 12. An additional re-design fee may be charged if changes are requested from the applicant after the original design is approved. 13. All water line and sewer line crossings or areas where required separations can not be met, the Washington State Pipeline Separation Design and Installation Standards must be followed. ..' ... Plan View r DF Pressure Rate CeSing Potable Water Line to length or pope-a•minimum 1 i +1. -0UNIy • O3 2025- ——— — �—--� Via 1S Vertical Sepa mo AZ' rtk r D�eNIIq�'yh9FNTq Case 1: New Potable Water 7/t � Burt'Constructed Above Nonpoteble Pipeline Non potable/Sanitary Sewer Reclaimed Water or e✓/ 441 OF VAN Sa AW'S'Sewer bra+ •r ,ttr�►r ,7ar v u New ttonootwi Oalrr + NoM;G<sUW mwt be / e+' Ab ed webu/saMtary Sewer!stone SewwJ / centered ovm lotvr p pe 1 'beet Potable WMLine�r L witn lent,spaced at Ieaat / 5i l":'Q T , t a g/fromrcant/whoa of atm..plpa O Dale a: :, / LICENSED i)E" .AER e•wtr ! _;. ':,_:" `,��' ` v.'ed aece•etlee ` • '�' 0'eirJmum tenpa' �1������'>►�kw�bviigw vwtr :' "Contrdltd O'naMy Fl1 Case 2:Nonpotable Pipeline tr tfiidc'atr«andre*caf108 Constructed Above Potable \ Water lino Casing-minimum Water Main / \ 1s'wl end centered minimum Precut Rated Cooing Parr g from nopo WNe P+perero Condition B-Vertical Pipe Crossing Suggested Construction Detail Pian View