HomeMy WebLinkAboutSWG2025-00441 - SWG Application / Design - 11/10/2025 eM •: MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
s Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00441
APPLICANT DAVIS-BALTER LACEY Phone: 360-801-6107
Address: 340 NE DAVIS FARM RD BELFAIR, WA 98528
SEPTIC DESIGNER Zimny, Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
SEPTIC INSTALLER RICHARD MOORE* Phone: 360-509-1342 - Rich
Address: PO BOX 963 BELFAIR, WA 98528
Site Address: 701 E OLYMPIC VIEW ST
Primary Parcel Number: 222125305001
Permit Description: New 3bd pressure trench with Class B waiver
Permit Submitted Date: 11/10/2025
Permit Issued Date: 01/02/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $720.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/12/2028 (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.
OFFICIAL USE ONLY- -
rn, MASON COUNTY I : I 1 /1 Jq0025 cn
AMOVNT C
Public Health & Human Services RECI"EDBY: „�l W ,'
5 JT`J D N L l N '�,`--Q, o
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 G
415 N.6th Street- Shelton,WA 98584 C/A/G (O oo q / ' I O 0
CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION 2 T1
APPLICANT PHONE m m
m
Lacey Davis 360-801-6107 �]'� z
MAILING ADDRESS-STREET,CITY,STATE ZIP CODE ( I C
340 NE DAVIS FARM RD BELFAIR WA 98528 ��
` IT0 1 7)
SITE ADDRESS-STREET,CITY.ZIP CODE ��1 w
701 E Olympic View St. Belfair WA 98428 J Q `. n- IN
NAME OF DESIGNER PI IONL wiz'
CZI 1
Jim Zlmny 360-516-7287
NAME OF INSTALLER PHONE I
Rich Moore 360-509-1342 �-� �
PERMIT TYPE(select are) DRINKING WATER SOURCE I
k RESIDENTIAL OSS h COMMUNITY OSS f COMMERCIAL OSS h PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL I Z I /j
TYPE OF )RK(select one) PUBLIC WATER SYSTEM
W�C
FI NEW CONSTRUCTION/UPGRADES (1 REPAIR/REPLACEMENT OTHER DETAILS(select elf that apply) 0 TABLE X REPAIR I
CI
SUBMITTALS ❑SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
Q DESIGN FORM(REQUIRED) Q SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/20257 r I IA
El WAIVER(S)(IF APPLICABLE) 3 4.03 ✓❑YES ❑NO O t
DIRECTIONS TO SITE AND SITE CONDITIONS (el locked gate) I P
from Belfair take Hwy 106 east for 2.5 miles and take left on cedar st. 1(
/)first Rt in 150ft oN E Olympic View St. 1
FOLLOW FOR .6 MILES TO LOT AT THE TOP OF CIRCLE MARKED BY PINK RIBBONS. ° 10
FOLLOW PINK RIBBONS TO TEST HOLES ID
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 reporOng purposes)
0 VOLUNTARY 0MAINTENANCE/PUMPING 0BUILDING PERMIT ❑HOME DALE CCOMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS!CONDITIONS
11A-' (- 0 'Z2- (S L1 Z-z 1-- ►'fit" �'
�-• 0--- z___ Sw'�-2— �;,,�s.,,�
SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION D(PIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
t1�\2. (` 111_1 6 p3NiLvlsm y- /-7.,,6
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025
a
DESIGN FORM—PACE ONE Assessor's Parcel Number: 2 2 2 1 2 5 3 0 5 0 0 1
A design will be reviewed when 3 copies of each of the following are submitted:
Y Completed design form that has been signed and dated. Scaled layout sketch- inch ding all applicable items on checklist.
Y 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 s te..11aximum paper size: 11" X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 202d- 004le d Designer's Name: JIM ZIMNY
Applicant's Name: Lacey Davis Designer's Phone Number: 360-516-7287
Mailing Address: 340 NE DAVIS FARM RID Designers Address: 7178 WINDFLOWER PL NW
—
BELFAIR WA 98528 City State Zip SEABECK WA 98380
CLEAR FORM
Cit) State Zip Designer's Email APDDESIGNS@ICLOUD.COM
DESIGN PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATV ❑Other
Treatment Level(check all that apply): 0 A 0 H 0 C 0 131,1 0 131.2 0 131.3 eft 0 N
Drainfield Type
Gravity 0 Pressure IV-french ❑ Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications - --f rats
Number of Bedrooms 3 Schedule/C �— J J s `•
_ . c-� L l
Daily Flow:Operating Capacity 270 gpd Length 11-111
,r, i v ft
N
Daily Flow: Design Flow 360 gpd Diameter r N t q in
Septic Tank Capacity(working) 1250 gal Number rn N
Receiving Soil Type(1-6) 4 Separation v 9' CTC ft
LL
Receiving Soil Appl. Rate 0.6 - ea
SPd/ft put Ji (=I Orli ices ` i i
Required Primary Area 600 ft2 Total Num s. 042 ' /
Designed Primary Area 600 ft2 Diameter — 1/X in
Designed Reserve Area 600 ft2 Spacing (p0 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class 56, q °
Elevation Measurements Length 2 I-1
Original Drainfield Area Slope 1 0% %, Diameter 2 in
New Slope, If Altered 10% °A) Preferred manifold configuration used'? lit-Yes 0 No
Depth of Excavation Up-slope 9 in Transport Pipe
from Original Grade Doun-slope 6 [. o
In Schedule/Class SC, k /
Designed Vertical Separation 12 in Length 3° ft
Gravel-based Drainfield Required? ❑ Yes le No Diameter 2.. in
Pump Required'? 0 Yes P1 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Co.
Diff. in Elevation Between Pump&Uppermost Orifice_5 _ft Dose quantity U S" gal
Drainfield Squirt Height/Selected Residual(head) 5— ft Chamber Capacity(flooc) /CJ(V o gal
Uppermost Orifice 0 Higher ''Lower than Pumo Shutoff Pump controls: Please check those required.
Capacity iii, Total Pressure Head 2Le gpm Timer Elapse Meter Er Event Counter
—
Calculated Total Pressure Head t ek ft If Timer: Pump on _ _ .Pump off 'a Lr 5
Comments APPROVED
QLJOn JAN 0 2 2026
MASON COUNTY ENVIRONMENTAL HEALTH Revised:6/11/2025
RET
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 2 1 2 5 3 0 5 0 0 1
Permit Number. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
ef Test hole locations V Drainfield orientation and layout eference depth from original grade:
it Soil logs it Trench/bed dimensions and Er Septic tank
Er Property lines critical distances within layout 0 Drainfield cover
et Existing and proposed wells Er D-BoxlValvc box locations eference depth from original grade
within 100 ft of property er Septic tank/pump chamber .nd restrictive strata:
Ef Measurements to cuts,banks,and locations Er Laterals,trench bed,top and
surface water and critical areas le Observation port location bottom
1r Location and orientation of Er Clean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components ❑ Orifice placement Other cross-section detail:
er Location and dimension of
primary system and reserve area er Lateral placement with distance Observation ports/clean-outs
to edge of bed Other Information
fie Buildings ❑ Audible/visual alarm referenced ves No
Er Direction of slope indicator Iv Scale of drawing shown on scale 0 0 Design staked out
Er Waterlines bar 0 0 Recorded Notices attached
Er Roads,easements,driveways. fil Elevation benchm.;•�and relative Er 0 Waiver(s)attached
parking elevations of syst «4, pon:nts 0 0 Pump curve attached
Er North arrow and scale drawing ; .;>.' 0 0 Evaluation of failure
shown on scale bar "' , .z ,.
�,t Non-residential justification
•r sv',;', CI Waste strength
,'
r� ,:n.,., y"
Y 0 0 Flow
,, rne4c'(tp:kf:
ESI " �Kli. J
The undersigned designer must be notified by i s lcr at 'me of installation eyes 0 No
17 -1k-zC
Signature f signer Date
The undersigned has reviewed this design on behalf of Mason County Public Heath and determined it to be in
compliance with state and local on-site re•ulations:
IND i 1k (NeC-Cin k 17-17,6
Environmen . Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLL)WING CONDITION:
✓
The design is stamped "Approved"by Mason County Public Health. (`( 1,�L
The Onsite Sewage Permit has not expired,the Permit Expiration Date is: I �Tj(�
V 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:6/11/2025
r 7 NORTH
m
ti I
co
c'S4,
a
0
V)
17
X \r,
O ro
N fD N.)
\uj.
VS'.
c\, ,j • : •:]. .. • ,
D hr,).7 ``
Z ‘J1.7\\/0,
a #
N .`t
O
O
fD
(_ v
ram... —r —
m
CO APPROVED
zCD tp-,..- J A N 02 2026
co K 3 MASON COUNTY ENVIRONMENTAL HEALT I
rD
x- 0 RET
co
v, -v p 4 co r D it
pi LO N3rm-- � n -0 b 2 7. -0o ( ---- `tt C o 1'": M ro II N ro N T n x C7 N •�. N 9 fit. tit v, C
Dm
Ni cor a D r o rp t
CD NJ n z SD- O n o 0 DC0 o / cvN a 3
0 z
o
I -
I 1 NORTH D
_ -, O -I _ O --1 N
A) rD I = A) I 2SSi
v, N * 4$
a N N eL N F..,
m
I '•\\\ • °j
NJ o \ •Q \ I
I
=
N
�DN �; BAN 0
. MASON 2 ?026- CQUNrFN
in
10 rD
YiRa
rD RET NM�NrAI HE4lrN
-a o
rD ,
„ rD
M- -
r. v'
CDri, _ n 3 / / \
1 z re
o I
1 t \Kra-\+�Vr1; , r
` `\ / /
iu O \\ \ / /
\\ \\ j /
i
i
rD
r-r g
tD
•
rfl NN.
240' V
til
n su r--' N m o a-o 0 - ate c • C 0
F, ¢i C4 N ,-r N r 1.._, n - y - 0 ., , .� • , rD O
(D N NDms a Q• x0 - ^ N :; air', % v
0II oo
NJ n o rJ 11if�'sj NJ
In < x `/ ,a s�" 3
m n C`0"' 'p
N
)
)
) )
/ 4w is '�
/ ) i
,..... I I ii
li idqmj -1
—I $ I II- 1 i ,
. ,,, .
, ,f
lf.A ) li t
) g
gi )
4,/
lM ) ) IR
if _ I a
i >
) 1 I I i
> l P
1
, 11 i
i g
i )
, $
APPROVED--ii
IA
11
1 \I
i
JAN 0 2 2026 ;r-' t
MASON COUNTY ENVIRONMENTAL HEALTH z?
RET V N It 4
•
g g it „F
5-
g
liql: ' { P
3
N (" N.-N IuNi ' - f74 } fi 1R .... .',_,,,
; i R N cs�Jl
I ,„
4
r-T. .., o
w CC 1Ii x - =_ �.
l'wa'
C ,y
Pli I Al
,______ ,
Advantage Perc & Design
i rnely•peasonable•30 Years of Loci Lxper
Construction Notes for Pressure Distribution 3 Bedroom System:
Pressure Distribution w/graveless chambers(Rock and pipe may be substituted)
Install 3—70' Laterals of 1 1/4" sch 40 PVC pipe .
Install on/foot centers.
(a I C-c r y . t vtt' p,tGU-S>& 0
1/8" Orifices on 60"centers beginning 30"from the beginning of the lateral and oriented at 12 O'clock.
Install 9"trench depth on low side of trench and maintain 12"of vertical separation
q t R\01)( vpsi ore—
Install level and along contours.
Install in dry weather only. << t�/1'1S(U,2Q-
Use 9,�9�-Gallon septic and 1000-gallon pump tank. feA7 LDS5-7c_C
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
APPROVED
\ND PVOrl. Op-4V JAN 0 2 2026
s,F SON COUNTY ENVIRONMENTAL HEALTH
l -� Thal ``4 4. RET
-k41� ;mac i.
13DI
id
t`,1
A L
12 ,2ii.2 >�
Advantage Perc&design • APDdesiRns@icloud.com • (360) 516-7287
r--
SECURED LID WITH GAS TIGHT SF*I
1 24•DIAMETER
ACCESS RISER
_� um
GRADE
•
---ZTPli r�t---:V * i '. -7,4
TO PUMP
�i — — — j� - CHAMBER
l / I
FROM SEWAGE ' .
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
•
SEGMENTS
•
12 00 SAKI(`J
9Q,41cr.(w0A-
SECURED LID WITH GAB TIGHT SEAL
+•EADED UNION
x/ se DIAMETER
ACCESS RISER
FINISH GRADE _ `j VALVE* •
lip.:
FROM SEPTIC 3 �� _lu i •:, �. TO�
TANK \ � ANTI SIPHON
VALVE*
HIGH WATER ALARM LEVEL . OIlli
I
INDEPENDENT
NORMAL TIMER OFF LEVEL - Rif FFOR FLOAT
LOAT STEM
ENCLOSED PUMP Mi.
MOUNTING
SEDIMENT SHROUD* - CHECKVALVE*
•it ,
B -:+ SUBMERSIBLE
CENTRIFUGAL
'1 PUMP
/(OV PUMP CHAMBER
MOM
j( f l uv-\ •AS NERD
FIGURE 2
J A N 02 20261.1 ,'114
MASON COUNTY ENVIRONMENTAL H ,'" `�;F4
gyp)F T ,;,,,-, a 1
/ z` zr ? T--
Pump Selection for a Pressurized System-Single Family Residence Project
Parameters
Discharge Assembly Size 2.00 inches 100
Transport Length 50 feet
Transport Pipe Class 40
Transport Line Size 2.00 inches 90
Distributing Valve Model None
Max Elevation Lift 10 feet
Manifold Length 2 feet
Manifold Pipe CFass 40 80
Manifold Pipe Size 2.00 inches
Number of Laterals per Cell 4 /
Lateral Length 70 feet
Lateral Pipe Class 40 70 /
Lateral Pipe Size 1.25 inches r
Orifice Size 1/8 inches d /
Orifice Spacing 5 feel <L
Residual Head 5 feet i 60 f
Flow Meter None inches vrt¢Fw a /
'Add-on'Friction Losses 0 feet 13co
j
Calculations '1' 50 /
U
Minimum Flow Rate per Orifice 0.43 gpm ro
Number of Orifices per Zone 60 c
Total Flow Rate per Zone 26.1 gpm 0 40 \
Number of Laterals per Zone 4 3
%Flow Differential 1st'Last Orifice 1.6 % 10
Transport Velocity 2 5 fps
30
Frictional Head Losses
Loss through Discharge 1.4 feet
Loss in Transport 0.6 feet 20
Loss through Valve 0.0 feet i* `f
Loss in Manifold 0.0 feet
Loss in Laterals 0.2 feet
Loss through Flowmeter 0.0 feet 10
'Add-on'Friction Losses 0.0 feet \\
Pipe Volumes
Vol of Transport Line 8.7 gals 00 20 40 60 80 100 120 140 160
Vol of Manifold 0.3 gals Net Discharge(gpm)
Vol of Laterals per Zone 21.8 gals
Total Volume 30.8 gals
Minimum Pump Requirements PumpData Legend
Design Flow Rate 26 1 gpm PFEF50 Effluent Pump System Curve:—
Total Dynamic Head 17 2 feet 12HP,115/230V 10
Pump Curve:
U r ta.,T4V.
Pump Optimal Range:
Operating Point'
� 1
,-/ P; Design Point:O
1
F71;
I
.33 F4'f1
0 • , .•44n7L...n
. • -D OfSrGNERR
• Orenco (2Ll '1< APPROVED
S N S T E M S
►AN 0 2 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET