HomeMy WebLinkAboutSWG2025-00444 - SWG Application / Design - 11/12/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
J L 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: SWG2025-00444
APPLICANT VAN ACKEREN CHRISTOPHER Phone: 541-913-0950
EDWARD
Address: 60 SE SELLS DR SHELTON, WA 98584
OWNER VAN ACKEREN CHRISTOPHER Phone: 541 913 0950
EDWARD
Address: 60 SE SELLS DR SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 300 SE Wellswood Way
Primary Parcel Number: 319021400000
Permit Description: New SFR 4-bedroom pressure system
Permit Submitted Date: 11/12/2025
Permit Issued Date: 12/22/2025
Issued By: David Anderson
Current Permit Fees Paid: $555.00 (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 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
rm .:. MASON COUNTY DATE RECEIVED: III ,. ... _
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AMOUNT R D: RECEIVED BY:
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Public Health & Human Services I 55 �`L' , .F v m
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Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 I C
415 N.6th Street-Shelton,WA 98584 S W G a�\'\6 - c c 4 LH YalZ N
ON-SITE SEWAGE SYSTEM APPLICATION z
73
APPLICANT PHONE m m
Chris VanAckeren (541)913-0950 r
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MAILING ADDRESS-STREET,COY,STATE,ZIP CODE 3
60 SE Sells Dr. Shelton WA 98584 03
SITE ADDRESS-STREET,CITY,ZIP CODE ??
Shelton WA 98584 I w
NAME OF DESIGNER V 1 PHONE
,
Dale L. Tahja , 1110 V (360)463-8023
NAME OF INSTALLER , PHONE 0 I CO
PERMIT TYPE(select one) Q •�' \ , DRINKING WATER SOURCE N
l `RESIDENTIAL OSS 5COMMUNITY 0'S MMERCIAL OSS g PRIVATE INDIVIDUAL WELL �„L;PRIVATE TWO-PARTY WELL Z IIV
TYPE OF WORK(select one) l PUBLIC WATER SYSTEM
g NEW CONSTRUCTION/UPGRADES bT REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 03
Q DESIGN FORM(REQUIRED) ❑✓ SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? 0 I
❑ WAIVER(S)(IF APPLICABLE) 4 20 acres DYES ENO 0 r
DIRECTIONS TO SITE ND SITE CONDIT! NS:(ex.locked gate) I o
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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 reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS)CONDITIONS 48.41t,
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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.
INSPEr SIGNATURE DATE APPLICATION EXPIRATION DATE APPLI ION APPROVED/ISSUED BY DATE
/ /2/1V101r i11l y/70 7 F -1 1/7 ?017f
THI •• MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 3 1 9 1 0 1 2 1 4 0 0 010 f 0
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,including all applicable items on checklist.
'0 Scaled plot plan,including all applicable items on checklist. `1 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
Permit Number: SWG (2( .15--- oc q(q' Designer's Name: Dale L.Tahja
Applicant's Name: Chris VanAckeren Designer's Phone Number: (360)463-8023
Mailing Address:
60 SE Sells Dr. Designer's Address: 2450 W. Deegan Rd.W.
Shelton WA 98584 City State Zip Shelton WA 98584
City State Zip Designer's Email daletahja@gmail.com
DESIGI!L PAR'AMETERS..
Treatment Device
❑Glendon 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU 0 Other
Treatment Level(check all that apply): 0 A 0 B 0 C 0 BL1 0 BL2 0 BL3 EfE 0 N
Drainfield Type
❑ Gravity ifrPressure i'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 ✓ Schedule/Class Sch.40 .
Daily Flow: Operating Capacity 360 ' gpd Length 67 ft
Daily Flow:Design Flow 480 / gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 7 gal Number 4
Receiving Soil Type(1-6) 4 —.) Separation 10 ft
Receiving Soil Appl.Rate 0.6 / gpd/ft2 Orifices -
Required Primary Area 800 l ft2 Total Number of Orifices 68
Designed Primary Area 804 ft2 Diameter 1/8 in
Designed Reserve Area 804 - ft2 Spacing 48 in
Trench/Bed Width 3 ft Manifold _
Trench/Bed Length 268 ft Schedule/Class Sch.40
Elevation Measurements Length 70 ft
Original Drainfield Area Slope 1 - % Diameter 1.25 in
New Slope,If Altered 1 % Preferred manifold configuration used? 0 Yes Ih'No
Depth of Excavation Up-slope I g in Transport Pipe —,
from Original Grade Down-slope 1 W'i 29,, - in Schedule/Class Sch.40
Designed Vertical Separation 24 in Length 120 ft
Gravel-based Drainfield Required? 0 Yes Ei No Diameter 2 in
Pump Required? l0'Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications ,---
Number of doses/day
Diff.in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity \ gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,200 gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 34gpm Er Timer Ef Elapse Meter 13 Event Counter
Calculated Total Pressure Head 20 ft If Timer: Pump on ' min. pump off 5 hrs. ,k-N:*1
Comments
Revised:6/11/2025
i
DESIGN FORM—PAGE TWO Assessor's Parcel Number 119 0 2 rr1 4�0 0 0 0 1
Permit Number: SWG v2- — CX�-ly-1
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
IX Test hole locations Q( Drainfield orientation and layout Reference depth from original grade:
ei Soil logs Trench/bed dimensions and Septic tank
i� Property lines critical distances within layout �d' Drainfield cover
le Existin and proposed wells er D-Box/Valve box locations
g p p Reference depth from original grade
within 100 ft of property Septic tank/pump chamber and restrictive strata:
er Measurements to cuts,banks, and locations 8' Laterals,trench/bed,top and
surface water and critical areas e Observation port location bottom
V Location and orientation of f2( 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 e{ Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
i12( Buildings Other Information
le( Audible/visual alarm referenced Yes No
el Direction of slope indicator le Scale of drawing shown on scale ie 0 Design staked out
er Waterlines bar 0 0 Recorded Notices attached
f' Roads,easements,driveways, ' Elevation benchmark and relative 0 ❑ Waiver(s)attached
parking elevations of system components Pr 0 Pump curve attached
0' North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer Inti
t be notifie insta ler at time of installation leYes 0 No
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Signature of Designer Date ++
The undersigned has reviewed this design on behalf of Mason County Public Health and d`�. Li
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�V o 'a t a) i
compliance with state and local on site regulations: +.. �43` y . LL,
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Envir nmental Health Specialist U47 to \ ''/5",.;, I. T
FNil4i'0,y, yl/� Y<
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE Plot cif NG CONDITI <,
✓ The design is stamped"Approved"by Mason County Public Health. I �`�4:41 /�� t✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: l `/ (/
✓ 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
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/r. MASON COUNTY ENVIRONMENTAL HEALTH
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DEC 222025
MASON COUNTY ENVIRONMENTAL HEALTH
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290-SERIES
4.hp Submersible Effluent/Sump Pumps
The Liberty 290 series provides a cost effective"mid- �'� v ,�c1�s
range" ril'IIWIIO@ :�� ias•
pump for on-site waste water systems,liquid
waste transfer and commercial heavy-duty sump pump b0 1gm ._ 1e
appiicatians that require higher head or more flow. 46��isms W �um �
Designed around Liberty's unique"Uni-Body"casting, eo--' linumnium 14
the 290-Series will provide years of reliable performance. unagaminommumigra �c
Ail Models Feature: E:1111111.111111.1111011111111111111.111111 a 8
•Semi-Open impeller permitting passage of solids 1,111111111111111111billiMimM11111111111
up to ii" 10 1111111111 11111111111111111141111.I. a
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•416 stainless steel rotor shaft s����� ���
•Permanently lubricated upper and lower ball bearing o 'IIIIII� o
•Epoxy powder coat finish o 10 zo so say Wm
50 SO to SO 90
•All fasteners-corrosion-resistant stainless steel i 1 38 ri yet 1� gee gi
•1'/z'Discharge Uwe Per armee
•Stainless steel bottom screen-easily removable jet/Lam;
•Maximum fluid tempenxture:140'F. Weight:31 lbs.
•29041erfee Cord Lengths Height 13"
Model 104 264- 35'(- 6014) Midor Wlddt 10"(model 297)
290 Standard Optioned .OptionN Optioned Minimum Sump
291 Standard Optional Optional OPtional Diameters:
293 Standard Optional Optional WA Model 291,299...14"
Model 297 VMF...101' --
297 Standard Optional WA N/A Factory switch Modal 291,193 Model 297
10'cord length standard on ail models.For optional Lengths, settings >y e
ti suffix to model number.
Exempla:for model 290 with 36 cad.Order 290-3Motor Specifications ,Awn on level 13" 9.S"
Mon off le+ el 7" 4.0"
% 60 Hz 3450 RPM rtw tModel 293 teatu►es a tuNrt rsabte wide-angle Host,
hp at$er+enaar can be made«ss91r by esa n9 the r
Oil filled,thermally protected297 ts not e d �or other moe►n2ing point float modrtt
115 V.Models 10.4 amps
208/230 V.Models 6.3 amps
}'' DEC 22202 _)4 I .
MASONcomol, 5
-.lei I Model� -w.. Model 291 �..r� Neal as �. Du•
297 TU
-t Manual, =+I_� i_ Wide angle ( - Widedeangle `IMF-Series
no switch
�_ �L. boat sv+rltch �'_ float switch Vertical mag-
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1t li A!! disconnect (pi98Y-heck) : eelw, smaller pits-
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apaeewttorrs we stgec*to 0110M0voltbout Hoofs.
LWe, Ptmtpe•7000App1.Due Ammo•Dew"New 16rk 14416•Phone 800-&04660 Fax a 1839
Copy/tont a Liberia,Pampa,eRo.2011
AN rights nea•rvd. LUT 8681 R09/11
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Installation/Maintenance �-S 5100214 �,��ff
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Pressure Distribution/Trench Systems i LICENS[= DESIGNERimviclimwmt
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1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions. Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 4ft. Centers. Install the orifices pointing straight down ( 6:00
o' clock).
7. Divert all storm water run-off away from septic system components.
8. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
9. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
11. Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.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.
17. Locate all utilities prior to starting installation.
18. A Final Inspection and Record Drawing fee will be charged upon completion of the
installation.
19. The installer will notfy the designer, Dale Tahja (360)463-8023, 48 hours prior to the
start of the installation.
20. An additional re-design fee may be charged if changes are requested from the applicant
after the original design is approved. pp��
°E� 2 2 2025
MASON COUNTY ENV' 0NMENTAL HE
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