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Home My WebLink AboutSWG2025-00419 - SWG Application / Design - 10/18/2025 a , 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,EXT400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2025-00419 APPLICANT BAYNES CATHRYN D &JOHN P Phone: Address: 641 NE OLD BELFAIR HWY BELFAIR, WA 98528 OWNER BROWN TERRY R& MERRIK Phone: Address: 370 E BENSON LAKE DR GRAPEVIEW, WA 98546 SEPTIC DESIGNER Zimny,Jim Phone: 360-516-7287 Address: 7178 windflower pl nw Seabeck, WA 98380 Site Address: 641 NE Old Belfair Hwy Primary Parcel Number: 123204390090 Permit Description: New SFR 3-bedroom gravity system with trench drainfield Permit Submitted Date: 10/18/2025 Permit Issued Date: 01/02/2026 Issued By: David Anderson Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system). Permit Expiration Date: 12/29/2028 (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 The abandon house must be removed or not occupied 8 Per the signed Application for Determination of Sewer Adequacy form dated 11/20/2025, the property must connect to sewer if/when it becomes available. 9 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/environmentallonsite/oss-inspection-request.php or call: 360-427-9670, extension 400. — OFFICIAL USE ONLYM ': ---MASO N COUNTY Wiz) �5 0 AMOUNT RECFgx. .6 �(�J r REDFIVED BY: C CO& Public Health Human Services u��l�e Q CU cn � v Environmental Health 360�27 9670,ext.400 or 360 275 4467,eM.41)0 C wrn N 415 N.6th Street - Shelton,WA 98584 C\A G ^ - OO� I q O 0 CLEAR FORM J\/v -/ z 65 ON-SITE SEWAGE SYSTEM APPLICATION D D g xi APPLICANT PHONE rrl m CATHRYN D & JOHN P BAYNES 360-801-0313 r- j z MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE C 641 NE OLD BELFAIR HWY BELFAIR WA 98528 W 73 SITE ADDRESS-STREET,CITY ZIP CODE fn 641 NE OLD BELFAIR HWY BELFAIR WA 98528 o _ NAME OF DESIGNER — ti N ^'ONE Jim Zimny 360-516-7287 /// Li o�' 1 NJ NAME OF INSTALLER c4IONE L < PERMIT TYPE(se4ectone) DRINKING WATER SOURCE _ 1NI lit RESIDENTIAL OSS ri COMMUNITY OSS r1 COMMERCIAL OSS fl PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I " TYPE OF WORK(select one) 2 PUBUC WATER SYSTEM I C PI NEW CONSTRUCTION/UPGRADES n REPAIR I REPLACEMENT OTHER DETAILS(select ell that apply) 0 I-Z TABLE X REPAIR SUBMIMALS 0 SURFACING SEWAGE CIEXISTING FAILURE 0 SHORELINE CU 0 DESIGN FORM(REQUIRED) El SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025' r0 I 0 WAIVER(S)(IF APPLICABLE) 3 .50 Acres DYES ✓❑NO o 1 DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate) T` From Belfair travel .6 miles down Old Belfair hwy. The property is on the left. address is on I the mail box. Test holes are in the front Yard. r- I -9 SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I O - — — OFFICIAL USE ONLY BELOW THIS LINE — --- ___. UPGRADE/FAILURE SOURCE(for reporong purposes) ,.}.- ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT OF SALE ❑COMPLAINT El OTHER a -rift)INSPECTOR0,,—42 S I,P5 ( c 1-1f v �a r ` rJ COMMENTS/CONDITIONS • �t�o Si -01 I` Lt-S R_PP a f S( « fir/ ✓t • Cr9T et)!0 — 11.5 t' t_r5 keS. co- LjS" I v/ nul f SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT V.-VERY G=GRAVELLY S=SAND L=LOAM S,=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL - IN •R SIGNATURE DATE APPLICATION EXPIRATION DATE APP TION APPROVED!Ic tiED BY DATE 12�2 ?/io?5 1 Zf 2 QtZ o Z 8 I I y 1 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2029 ' DESIGN FORM-PAGE ONE Assessor's Parcel Number: 1 2 3 2 0 4 3 9 0 0 9 0 A design will be reviewed when 3 conies 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. ''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: II"1"17" PARCEL IDENTIFICATION Permit Number: SWG D•oa5 - 00`4(1 Designer's Name: Jim Zimmy Applicant's Name: CATHRYN D&JOHN P BAYNES Designer's Phone Number: 360-516-7287 Mailing Address: 641 NE OLD BELFAIR HWY Designer's Address: 7178 Windflower PI NW BELFAIR WA 98528 City State Zip Seabeck,WA98370 CLEAR FORM City State Zip Designer's Email apddesigns@icloud.com DESIGN PARAMETERS Treatment Device ❑Glendon 0 Sand Filter ❑Mound 0 Sand Lined Drainfield 0 Recirculating Filter ❑ATU 0 Other Treatment Level(check all that apply): ❑A ❑B ❑C 0 BL 1 0 BL2 ❑BL3 erE 0 N Drainfield Type ❑Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 '/ Schedule/Class 3034 , Daily Flow: Operating Capacity 270 — gpd Length 67 - ft Daily Flow: Design Flow 360 - gpd Diameter 4 in Septic Tank Capacity (working) 12;i0 ' gal Number 3 Receiving Soil Type(1-6) 4 Separation 5' • ft Receiving Soil Appi.Rate .6 - gpd/ft2 Orifices Required Primary Area 600 — ft2 Total Number of Orifices n/a Designed Primary Area 600 ' ft2 Diameter in Designed Reserve Area 600 ' ft2 Spacing in Trench/Bed Width 3 .- ft Manifold Trench/Bed Length 67' ft Schedule/Class n/a Elevation Measurements Length ft Original Drainfield Area Slope 2 % Diameter in New Slope.If Altered 2 % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation up-slope 15 in Transport Pipe from Original Grade I 1 1. n"'"'-slop`' "In Schedule/Class 3034 Designed Vertical Separation 36 in Length 10 ft Gravel-based Drainfield Required? 0 Yes E1 No Diameter 4 in Pump Required? 0 Yes Lo'No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day na Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity c4;Total Pressure Head gpm 0 Timer 0 Elapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on , Pump off Comments Ava,:oAi1•4/1 1/h. ,DESIGN FORM -PAGE TWO Assessor's Parcel Number: 1 2 3 2 0 4 3 9 0 0 9 0 Permit Number: SWG '0.26- 004419 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch ef Test hole locations lid Drainfield orientation and layout Reference depth from original grade: ' Soil logs le Trench/bed dimensions and C+' Septic tank lid Property lines critical distances within layout R' Drainfield cover ' Existing and proposed wells of D-Box/Valvc box locations Reference depth from original grade within 100 ft of property er Septic tank/pump chamber and restrictive strata: ar Measurements to cuts, banks, and locations It surface water and critical areas ilk Observation port location Laterals,trench bed,top and bottom fd Location and orientation of er Clean-out location 0 Curtain drain collector curtain drain and all absorption 0 Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: Re Location and dimension of Er primary system and reserve area Lateral placement with distance le Observation ports/clean-outs to edge of bed Er Buildings Other Information 0 Audible/visual alarm referenced Yes No Er Direction of slope indicator er Scale of drawing shown on scale 0 0 Design staked out et Waterlines bar 0 Cl Recorded Notices attached lie Roads,easements,driveways, 17 Elevation benchmark and relative 0 0 Waiver(s)attached parking elevations of� �m components 0 0 Pump curve attached ef North arrow and scale drawing ,�Q. + ❑ ❑ Evaluation of failure shown on scale bar .Jr + h r �+et + Non-residential justification %31 •' ' + 0 ❑Waste strength a +++ 0 0 Flow ned designer /v- --/.) The undersigned must be notifie installer at time of installation leYes 0 No Signa r o esigner Date i'-?; t ` ^-- ,_� 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 egulations: / AN U? 2r726 // Z l ZG Z MASO"cvuivrrE„;,... ut4,•;;yyE"•T Environmental Health Specialist Date DJq AL HEALTH 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: r 1 (lt/'?(.1?9 / 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 imminimommi 3 s ..s z o a -C >2 Q r'�n I • •WIhu1 I caCD T > cn z U O '--I RI U G •, \lJ ^ Q I� VI N 3s� avY CI v.O o 0 3 i .. a ,SSI Z w 1 lr J O w teSe 1 v `� `^ 1:: �`` N .. .. .. i i .. 7 i i : i .. ,. y .....') - .. .. .. .. . III 1 � . .U-. 0 \ Lr c/t nil I • . • h N. <V- • • .•..••.•.••.•.•ril. •.• 00 " i .... kr) 0 _ Ali C a) 3 5' • o.•d. - >, r1 .� I. ---- _ Q aunO k .- . 4- '♦ m 0 ~ \ 0 • Q - N. Z .•♦a_ 0`•S. S. \.. 107' a Advantage Perc & Design Timely•Reasonable•30 Years of Locn :_xperience Test Holes for SWG-2025-00419 641 NE Old Belfair HWY 4 Belfair WA 98528 ✓,4,V �J Tax ID # 123204390090 AFC vl?0?6 F�1,FD Test Hole #1 0-53" Fine sandy Loam. Mottles at 50" Test Hole #2 0-57" Fine sandy Loam. Mottles at 52" Test Hole #2 0-52" Fine sandy Loam. 044 17$4;?Cl‘ bf ' s JE<!GNER Z-Zb'LS� Advantage Perc&design • APDdesigns@icloud.com • (360) 516-7287 Advantage Perc & Design g Timely• casonable•30 Years of Local Experience Construction Notes for 3 Bedroom Gravity System Gravity w/graveless chambers (Rock and pipe may be substituted) Install 3 -67' Laterals . Use a 4 hole d-box and speed levelers Install on 5'foot centers. Install 15"trench depth on low side of trench and maintain 36" of vertical separation Install level and along contours. Install in dry weather only. Use 12S0-Gallon septic and add risers for pumping and maintenance System designed for typical residential waste strength sewage only. System designed for 360 Gallons Per Day ®� 50� t �2 s,. ,t 2 3033 'y O a,Ikn.ry LICENSED OES'ONER Advantage Perc & design APDdesigns@icloud.com 110 (360) 516-7287 SECURED LID wrnt OAS TIGHT SEAL 1sr DIAMETER RISERAOCEBB 1. ITS .—A hit r A .ri J LI _ TO PIRIP / — OHNE= �savA� SOURCE _ FLAMING MAT —41 APPROVED MOW Fil Test SITS The.................„N___ I I . 12 8EPTIO1 IK G-pRoQ m =MALI . 4c\,-, ctir..0 O`S Y) J OA `\'��O,P Jnm z LfCENSE0(�,S w ASQ�QJ IGNER [` • /u— / S--z,