HomeMy WebLinkAboutSWG2023-00455 - SWG Application / Design - 12/17/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
J SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
--1� Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00455
APPLICANT COOPER DAVID A &TERRY L Phone: 360.340.1931
Address: 4826 SE SLEEPY HOLLOW CT PORT ORCHARD, WA 98366
OWNER COOPER DAVID A &TERRY L Phone: 360.340.1931
Address: 4826 SE SLEEPY HOLLOW CT PORT ORCHARD, WA 98366
SEPTIC DESIGNER Zimny,Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck. WA 98380
Site Address: 691 NE Hurd Rd
Primary Parcel Number: 322242390084
Permit Description: New SFR 3-bedroom pressure system
Permit Submitted Date: 10/23/2023
Permit Issued Date: 12/17/2025
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 10/26/2026 (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 Drain field 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.
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
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firNIF COMMUNITY SERVICES AMOUNT
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415 N.6th Street Shelton.WA 98584 SWG �OaJ —�NL)55x
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION Z D
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APPLICANT PHONE
DAVE COOPER 360-340-1931 Z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
4828 SE Sleepy Hollow Ct, Port Orchard WA 98366 ,�.��/(, ���/5/� w
SITE ADDRESS-STREET,CITY,ZIP CODE t)'���`�Mg ll L� I71
691 Hurd RD, Belfair Wa 98528
NAME DESIGNER PHONE 01 OCT 2 3 2023 t
JIM ZIMNY 360 516-7287 I N
BY:
NAME OF INSTALLER PHONE v IN
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PERMIT TYPE(select one) DRINKING WATER SOURCE Q
i�r RESIDENTIAL OSS F—i COMMUNITY OSS Iri COMMERCIAL OSS W7 PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL z
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TYPE OF WORK(select one) PUBLIC WATER SYSTEM
ff NEW CONSTRUCTION/UPGRADES h-REPAIR/REPLACEMENT OTHER DETAILS(select au that apply) ❑ TABLE IX REPAIR I n1
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SUBMITTALS 0 SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE V
R.DESIGN FORM(REQUIRED) 01 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 I W
3 2.5 Acres I
b WAIVER(S)(IF APPLICABLE) 6 I
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate)
From Belfair take Northshore rd 10.7 Miles to Canyon DR and take rt. follow .8 miles to le
Hurd Rd and follow to address on Rd . Lot is on Left Marked with Pink Ribbons. Follow r
pink ribbons to test holes.
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES Mt/Sr BE FLAGGED WITH TEST HOLE NUMBERS kC
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/P(1MPtNG ❑BUILDING PERMIT OHOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS!CONDITIONS
114 1: °— ?Li ' 6 cc Crypt()
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RECORD DRAWNG 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 APPLIC PPROVED/ISSUED BY DATE
7// lU/74/ZO73 1o / Th/ 6 I Z11 1707
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/W2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number 322242390084- —
A design will be reviewed when 3 copies of each of the following are submitted:
''Completed design form that has been signed and dated. '1 Scaled layout sketch,including all applicable items on checklist
'1 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
Designer's Name: Jim Zlmny
Permit Number. SWG �()23- 00 Li S 5
David Cooper 360-516-7287
Applicant's Name: Designer's Phone Number:
Mailing Address: 4826 SE Sleepy Hollow CT Designer's Address: 7178 Windfiower PI NW
Port Orchard WA 98366 Seabeck WA 98380
CLEAR FORM City State Zip—
City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑ Gravity ll 'Pressure itTrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 - Schedule/Class 40
Daily Flow:Operating Capacity 270 ' gpd Length 50 l ft
360
Daily Flow:Design Flow gpd Diameter 1 1/4 ' in
Septic Tank Capacity(working) 1200 • gal Number 4
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required PrimaryArea 600 ' ft2 Total Number of Orifices 52
eq
Designed Primary Area 600 ft2 Diameter Sr' 1/8 in
Designed Reserve Area 600 ` ft2 Spacing �-' Ii.+' 48 in
Trench/Bed Width 3 , ft �' �Fti►, Manifold
Trench/Bed Length 200 ' ft Schedule/ ;3 s o A�� 40
fa " - ' 2 ft
Elevation Measurements Length' �"
1 a_o.DESIGNER
s, 2
in
Original Drainfield Area Slope 10 % Diame � . .sni;L
New Slope,If Altered 10 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation up-slope 8 in Transport Pipe all,from Original Grade Down_siope 6 in Schedule/Class 30-3,Lf L
Designed Vertical Separation 24 , in Length 60' ft
Gravelless Chambers Required? 0 Yes 0 No ITOptional Diameter 2 in
Pump Required? erYes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications / Number of doses/day 6
Diff. in Elevation Between Pump&Uppermost Orifice 20 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual (head) 5 ,ft Chamber Capacity(flood) 1200. gal
Uppermost Orifice 0 Higher 0 Lower than, p Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head LL gpm - terimer elapse Meter ®'Event Counter
Calculated Total Pressure Head 27 ft ' If Timer: Pump on 1 min 10 pip off 4 hrs
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number. 322242390084- —
Permit Number. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
le Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
O Soil logs 0 Trench/bed dimensions and 0 Septic tank
O Property lines critical distances within layout ®' Drainfield cover
0 Existing and proposed wells 1 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
O Measurements to cuts, banks, and locations 0 Laterals,trenchrbed,top and
surface water and critical areas 10 Observation port location bottom
O Location and orientation of Qf Clean-out location V Curtain drain collector
curtain drain and all absorption le Manifold placement 0 Sand augmentation
components Er Orifice placement Other cross-section detail:
O Location and dimension of 10 Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
of Buildings re Audible/visual alarm referenced Yes No
H Direction of slope indicator 0 Scale of drawing shown on scale 0 e Design staked out
0 Waterlines bar 0 0 Recorded Notices attached
O Roads,easements,driveways, itt 0 Er Waiver(s)attached
o
parking o- ++++ Er 0 Pump curve attached
0 North arrow and scale drawing ..,: .;++ 0 0 Evaluation of failure
shown on scale bar s !I. d. N tt Non-residential justification
' I 0 MI Waste strength -�
G El CI Flow
•�:�DES S IGNER
'AP'ROVAL
The undersigned designer must be noti d y installer at time of installation , Yes 0 No
Sig f 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-si , -tulations: ,.'90
s�f 1- it /110 71 co F�,
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Envir.nmental Health Specialist Date yG4 �f
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITI&`::4,
if The design is stamped"Approved"by Mason County Public Health. / `,54
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: f 0/z6( O ?
✓ 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.
Updated Date: 12/7/2015
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Construction Notes for Pressure Distribution 3 Bedroom System:
Pressure Distribution w/graveless chambers (Rock and pipe may be substituted)
Install 4—50' Laterals of 1 1/4" sch 40 PVC pipe.
Install on 5'foot centers.
1/8" Orifices on 48" centers beginning 24"from the beginning of the lateral and oriented at 12 O'clock.
Install max 8" trench depth on low side of trench and maintain 24" of vertical separation
Install level and along contours.
Install in dry weather only.
Use 1200-Gallon septic and 1200 gallon pump tank.
See pump Chart for Pump Specs
Use Rhombus SJE Control Panel or equivalent w/audible and visual alarms for low and high water.
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
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Pump Selection for a Pressurized System-Single Family Residence Project
Parameters
Discharge Assembly Size 2.00 inches 150 ' I I l i
Transport Length 60 feet i - f{
Transport Pipe Class 40 - _ 1 1 , 1 .
Transport Line Size 2.00 inches —
Distributing Volvo Model None ' -
Max Elevation Lift 20 feet i;
Manifold Length 2 feet 125 ! ,' ') r 1 t ' '
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Manifold Pipe Class 40 - ' . . .
Manifold Pipe Sizo 2.00 inches
Number of Laterals per Cell 4 i f 1 rr t
Lateral Length 50 feet f -
Lateral Pipe Class 40
Lateral Pipe Size 125 inches 100 . ; .4 j r A.
Orifice Size 1/8 inches m --.i,m _ t ' I }}
Orifice Spacing 4 feet IL I I
Residual Head 5 feet IG -is i
Flow Meter None inches r j — • — . - -
Add on'Friction Losses 0 feet f ,
m 75 r .
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Calculations i _ - 1
Minimum Flow Rate per Orifice 0.43 gpm E —I
Number of Otifkxa per Zone 52 C i
Total Flow Rate per Zone 22.5 gpm 0_ 1• t fit `� '
Number of Laterals per Zone 4 i 1 fl 1 - r
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%Flow Differential 1st/Last Orifice 0.8 % I-- i k t ,
Transport Velocity 2.2 fps
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Frictional Head Losses . ' ' ' . i t
Loss through Discharge 1.0 feet -'\
Loss in Transport 0.5 feet I t , t t , 4
Loss through Valve 0.0 feet 25 , ' - r-, , ITS
Loss in Manifold 0.0 feet ,f, .�r. . �- __
Loss in Laterals 0.1 feet -
Loss through Flowmeter 0.0 feet '
'Add-on'Friction Losses 0.0 feet . - r f
Pipe Volumes _ ' f I I _ : ` ` ' • tlt .
Vol of Transport Line 10.5 gals 0 0 5 10 15 20 25 30 35
40
Vol of Manifold 0.3 gals Net Discharge(gpm)
Vol of Laterals per Zone 15.5 gals
Total Volume 25.3 gals
Minimum Pump Requirements PumpData Legend
Design Flow Rate 22.5 gpm PED 3005 System Curve:.__-
Total Dynamic Head 26.7 feet 1l2HP,115V 10
Pump Curve:
Pump Optional Range:
L. , Operating Point:
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