HomeMy WebLinkAboutSWG2025-00460 - SWG Application / Design - 12/7/2025 (2) 415 N 6TH STREET,SHELTON,WA 98584
M .:. MASON COUNTY SEL :360- 75-4467,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: SWG2025-00460
APPLICANT Zimny, Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
OWNER HODGSON PRIMITIVA D Phone:
Address: 7140 SE MILE HILL DR PORT ORCHARD, WA 98366
SEPTIC DESIGNER Zimny, Jim Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
Site Address: UNKNOWN
Primary Parcel Number: 320215502022
Permit Description: New 2bd gravity bed
Permit Submitted Date: 12/07/2025
Permit Issued Date: 12/19/2025
Issued By: Rhonda Thompson
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
I 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/environmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
— OFFICIAL USE ONLYMI .. — --
MASON COUNTY DATERED fl°rf o
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Public Health & Human Services 556 ow, Ne o��Q, W
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Environmental Health 360-427-9670,ext.400 or 360 275 4467,ext.400 SWG � � - (�U .G•�I(� z 2
415 N.6th Street- Shelton,WA 98584 o
65
CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE D �' ro (� L.G 360-874-4699 r' r' r r
MAILING ADDRESS-STREET CITY,STATE ZIP CODE I W
71
SITE ADDRESS-STREET,CITY.ZIP CODE
f 40‘c/
E Wood Ln Shelton, WA 98528 t) ` � ` I W
NAME OF DESIGNER PHONE O V� 1
Jiim Zimny 360-516-728
NAME OF INSTALLER PHONE Q L I O
0 C I
N
PERMIT TYPE(select one) DRINKING WATER SOURCE 73
114 RESIDENTIAL OSS 'n COMMUNITY OSS In COMMERCIAL OSS rl PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I
2 PUBLIC WATER SYSTEM
TYPE OF WORK(select one) I
I
ilA NEW CONSTRUCTION/UPGRADES r7 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR
CISURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE cor _
SUBMITTALS -- r M`
❑✓ DESIGN FORM(REQUIRED) 0 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025� r I
I❑ WAIVER(S)(IF APPLICABLE) 2 6969 Sq ft EYES ✓�NO n
DIRECTIONS TO SITE AND SITE CONDITIONS (ex.locked gate)
From Shelton Take hwy to E Agate rd take Rt. follow 3.8 miles to stop and take rt on N IN
Crestview rd. follow 2.3 miles to parkway Blvd and take left. follow 300 ft to wood rd. Lot is o lo
on the corner of wood rd and Parkway. Follow pink ribbons to test holes. 6 IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS
N Ifs
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE OCOMPLAINT 0 OTHER:
COMMENTS/CONDITIONS
INSPECTOR SOIL LOGS
\: 0 - \.{.1q9 h ul
-1.?)-4- b1-1±-0AA
- t - 51 el, 1M S
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: REQUIRED FOR FINAL APPROVAL
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
APPROVED ISSUED BY DATE
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION � ��
v- ���z` Iz1 to Iv8
THIS FORM MAY BE BANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
Revised:6/3/2025
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,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: 11"X 17"
'; PARCEL IDENTIFICATION
Designer's Name: Jim Zimny
Permit Number: SWG o`t�o),,5" 00 Jimirony 516-7287
i`�` Designer's Phone Number:
Applicant's Name: l— � fl G•�� 718 Windflower pL NW
Mailing Address: /1 E. Q .�1c�4
oic{-V. Q-d-. Designer's Address:
CLEAR FORM 5 kt'`V‘1"‘• W& ci Ys15y
City State Zip seabeck WA 98380
City State Zip Designer's Email _
I I DESIGN PARAMETERS
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 'E 0 N
Drainfield Type
liffGravity
0 Pressure 0 Trench 9Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 3034
g
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 gpd/ft2 Orifices
Required Primary Area 300 ft2 Total Number of Orifices 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 1 'No
Depth of Excavation Up-slope 12 in Transport Pipe
from Original Grade po„„r,-40p, 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? EYes 0 No Dosing and Pump Chamber
Pump/Siphpn Specifications Number of doses/day 6
Diff.in Elevation Between Pomp&Uppermost Orifice 71 ft Dose quantity 30 gal
Drainfield Squirt Height/Selected Residual(head)
1' ft Chamber Capacity(flood) 1000 gal
Uppermost Orifice leHigher 0 Lower than PAnnp Shutoff
Pump controls:Please check those required.
Capacity @ Total Pressure Head 1U gpm Ef Timer g Elapse Meter Et Event Counter
10 OPROVE DIf Timer: Pump on 1 ,Pump off 4 hrs
Calculated Total Pressure Head ft �
Comments
DEC 19 2025
MASON COUNTY FNUIRONUUFNTAL NE4Lul
RET Revised:6/11/2025
DESIGN FORM— PAGE TWO Assessor's Parcel Number:
3 2 0 2 1 5 5 0 2 0 2 2
Permit Number: SWG aoa5 — 004-4
, ic
1 DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
el Test hole locations; 0' Drainfield orientation and layout Reference depth from original grade:
it Soil logs Er Trench/bed dimensions and Er Septic tank
Er Property lines i critical distances within layout 0' Drainfield cover
er Existing and propo d wells D-Bo,,/Valvc box locations Reference depth from original grade
within 100 ft of pr crty Er Septic tank/pump chamber and restrictive strata:
it Measurements to c ts, banks,and locations it Laterals,trench/bed,top and
surface water and c 'tical areas Er Observation port location bottom
Qr Location and orienitation of R Clean-out location 0 Curtain drain collector
curtain drain and all absorption E Manifold placement 0 Sand augmentation
components ❑ Orifice placement Other cross-section detail:
er Location and dimension of Observation ports/clean-outs
it Lateral placement with distance
primary system ancI�reserve area to edge of bed Other Information
Q( Buildings i er Audible/visual alarm referenced Yes No
ie Direction of slope indicator Q' Scale of drawing shown on scale 0 ❑ Design staked out
fe Waterlines I bar 0 0 Recorded Notices attached
yr Roads,easements,ilriveways. V7 Elevation benchmark and relative 0 0 Waivers)attached
parking elevations of system components 2 ❑ Pump curve attached
of North arrow and scale drawing
0 CI Evaluation of failure
shown on scale bar, Non-residential justification
❑ ❑Waste strength
❑ 0 Flow
DESIGN APPROVAL
(
The undersigned designer must be notifiedb, installer at time of installation ErYes 0 No
Signatu4 of esigner Dge
I
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:
Vz1l CI
Environmental Health Sp cialist Date
CAUTION: DESIGii APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. �z��� ��
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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 a thorization is obtained from Mason County Public Health.
llatio p
An Insta Fee is required.
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This form may be scinned and available for public view on the Mason County Web site. Revised:6/11/2025
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