HomeMy WebLinkAboutSWG2025-00460 - SWG Application / Design - 12/7/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
-l- Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00460
APPLICANT Zimny, Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
OWNER Lansing, Ronald Phone: 360-874-4699
Address: 71 E Dalkeith Rd Shelton, WA 98584
•
Site Address: UNKNOWN
Primary Parcel Number: 320215502022
Permit Description: New 2bd gravity bed- REVISION 12.31.25
Permit Submitted Date: 12/07/2025
Permit Issued Date: 12/31/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $720.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/19/2028 (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 Drainfield 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 USF ONLY---- ----.
AEMASON COUNTY DA1RL /a n� OC/) 3::.IIP .
AMOUNT RECT. RECEIVED BY: W (n
-. ..,,,.=- Public Health & Human Services 566 ovuoME ,00)-Q., °
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 C 0
415 N.6th Street- Shelton,WA 98584 SWG '] c?15 -
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION z D
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APPLICANT PHONE nil
D �' ro L L G —'_' " ' 360-874-4699 sue- z
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MAILING ADDRESS-STREET.CITY,STATE ZIP CODE '7 g
SITE ADDRESS STREET,CITY.ZIP CODE (p�_� `'
E Wood Ln Shelton, WA 98528 V �`
NAME OF DESIGNER PHONE \ ,-�w� \ (o IN
1
Jiim Zimny 360-516-728 v ,
NAME OF INSTALLER PHONE 0 & I O
PERMIT TYPE(select one) DRINKING WATER SOURCE c N
I'1 RESIDENTIAL OSS f 1 COMMUNITY OSS t-1 COMMERCIAL OSS CIPRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(sele^f one) 2 PUBLIC WATER SYSTEM
R NEW CONSTRUCTION/UPGRADES 7.1 REPAIR/REPLACEMENT OTHER DETAILS(select all Mar apply) ❑ TABLE X REPAIR _ I Vf
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE W
Q DESIGN FORM(REQUIRED) El SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2)?5^ O
❑ WAIVER(S)(IF APPLICABLE) 2 6969 Sq ft OYES ONO n
DIRECTIONS TO SITE AND SITE CONDITIONS.(eN loched gate) / I C
From Shelton Take hwy to E Agate rd take Rt. follow 3.8 miles to stop and take rt on by IN
Crestview rd. follow 2.3 miles to parkway Blvd and take left. follow 300 ft to wood rd. Lot is r
on the corner of wood rd and Parkway. Follow pink ribbons to test holes. o O
. Jz IN
SITE MUST BE FLAGGED FROM MAIN RO 0 AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMc1.1... .\, \ .\ 0/\\,„
BERS N
— — — ---- OFFICIAL USE ONLY BELOW THIS L INE-------
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT CI HOME SALE ['COMPLAINT 0 OTHER. r
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
\: 0 --\-tou h U'y' _.
4_ b 1 t-zmn
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 APPLICATION APPROVED ISSUED BY DATE
16.1‘1\‘C//,AA V-'0U7 tS 121 iq k6 1?1\0,11yi50 Vlk ItK-----
THIS FORM MAY BE S8ANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised.6/3/2025
. Q-5/110 A) .
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 3 2 0 2 1 5 5 0 2 0 2 2
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, inclining 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 see.Maximum paper size: 11"X 17"
PARCEL IDENTIFICATION
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Permit Number: SWG �.W ZoZc- uo S/fioDesigner's Name: Jim Zimny
�.ark j..,p.�S,in _ Designer's Phone Number: 360 516-7287
Applicant's Name: .
Mailing Address: 71 G. paM4.t ictk• Q-d-.
Designer's Address: 718 Windflower pL NW
CLEAR FORM 5 INL 1lf-41"%• w ir,,, et¶ $9 City State Zip Seebeck WA 98380
City State Zip Designer's Email
DESIGN PARAMETERS
Treatment Device
0 Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 kTU ❑Other
Treatment Level(check all that apply): 0 A 0 B 0 C 0 B1.1 0 BL2 0 BL3 'E 0 N
p.to Drainfield Type
'Gravity 0 Pressure 0 Trench lill'Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 3034
Daily Flow:Operating Capacity 180 gpd Length
30 ft
Daily Flow: Design Flow 240 gpd Diameter
4" in
Septic Tank Capacity(working) 1000 gal Number 3
Receiving Soil Type(1-6) ,
3 Separation 36" ft
Receiving Soil Appl.Rate 0.8 gpolft` Orifices
Required Primary Area 300 ft' Total Number of Orifice: N/A
Designed Primary Area 300 ft2 Diameter in
Designed Reserve Area 300 ft2 Spacing in
Trench/Bed Width 10 ft Manifold
Trench/Bed Length 30 ft Schedule/Class N/A
Elevation Measurements Length ft
Original Drainfield Area Slope 1 % Diameter in
New Slope,If Altered 1 % Preferred manifold configuration used? 0 Yes VNo
Depth of Excavation Up-4ope 12 in Transport Pipe
from Original Grade Down-slope 12 in Schedule/Class
Designed Vertical Separation 36 in Length 1.5" ft
Gravel-based Drainfield Required? 0 Yes C1 No Diameter in
Pump Required? I1Yes 0 No Dosi and Pump Chamber
Pump/Siphon Specifications Number of doses/day 6
Diff.in Elevation Between Pump&Uppermost Orifice T ft Dose quantity 30 gal
Drainfield Squirt Height/Selected Residual(head) 11 ft Chamber Capacity(flood) 1000 gal
Uppermost Orifice l 'Higher 0 Lower than1l unp Shutoff Pump controls:Please check those required.
Capacity 4-2).Total Pressure Head II UU gpm Er Timer El Elapse Meter 'Event Counter
Calculated Total Pressure Head 10 ft If Timers' �_, I,ID MD Qr' p off 4 hrs
Comments M
DEC 3 2025
1 MASON COUNTY ENVIRONMENTAL HEALTH
1 RET Review!.6/11/7075
' DESIGN FORM— Ii,AGE TWO Assessor's Parcel Number: 3 2 0 2 1 5 5 0 2 0 2 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch :'ross-Section Sketch
ef Test hole locations er Drainfield orientation and layout Zeference depth from original grade:
of Soil logs le Trench/bed dimensions and le Septic tank
el' Property lines critical distances within layout it Drainfield cover
of Existing and pro,osed wells e' D-Box/Valve box locations deference depth from original grade
within 100 ft of$1 operty er Septic tank/pump chamber and restrictive strata:
et Measurements to cuts, banks,and locations Ii39 Laterals,trench/bed,top and
surface water an. critical areas g Observation port location bottom
el Location and on=ntation of el' Clean-out location 0 Curtain drain collector
curtain drain and all absorption Er Manifold placement 0 Sand augmentation
components 0 Orifice placement )ther cross-section detail:
e' Location and di ension of el Observation ports/clean-outs
ef Lateral placement with distance
primary system • d reserve area to edge of bed
8 ether Information
et Buildings of Audible/visual alarm referenced Yes No
of Direction of slo indicator It Scale of drawing shown on scale 0 0 Design staked out
of Waterlines bar 0 ❑ Recorded Notices attached
of Roads,easement ,driveways, V Elevation benchmark and relative D 0 Waiver(s)attached
parking elevations of system components It 0 Pump curve attached
of North arrow and .talc drawing D 0 Evaluation of failure
shown on scale b:r Von-residential justification
D ❑Waste strength
D 0 Flow
DESIGN APPROVAL
The undersigned designer must be notified b inLtaller at time of installation 'Yes 0 No
%/- ? rZ S-
Signature of esigner ate
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: 2 _
� YDate
ZSEnvironmental Healt Specialist
CAUTION: DESI N APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is s • ped"Approved"by Mason County Public Health. \ I \9 j-/ Q
✓ The Onsite Sew.le Permit has not expired,the Permit Expiration Date is:
✓ Drainfield site •i ditions have not been altered to adversely affect conditions of design approval.
Please Note. The system must be installed by a certified installer,
unless prior , uthorization 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
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