HomeMy WebLinkAboutSWG2025-00445 - SWG Application / Design - 11/12/2025 M AS O N COUNTY 415 N 6TH STREET,SHELTON,WA 98584
• + SHELTON:360-427-9670,EXT 400
r I':t,fr BELFAIR:360-275-4467,EXT 400
JP Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2025-00445
APPLICANT HJORTON JACOB H Phone: 360-388-2519
Address: 301 E LANSKY DR SHELTON, WA 98584
OWNER HJORTON JACOB H Phone: 360-388-2519
Address: 301 E LANSKY DR SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 11-B E Lansky Dr
Primary Parcel Number: 220245000016
Permit Description: New SFR 4-bedroom pressure system with trench drainfield and
Class B Waiver
Permit Submitted Date: 11/12/2025
Permit Issued Date: 01/06/2026
Issued By: David Anderson
Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/20/2028 (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 USE ONLY
MI.
Ii tA>�O COTY DATERECENEO: I , I�'aO C >t1 ; AMOUNT RE D. RECEIVED co
t'- g ,-- II Public Health & Human Services �.` D'e0� o �>�' o N
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 S WGaoa6 - N O415 N.6th Street-Shelton,WA 98584 (�[ t 5 O 2 V'� 2 to
• ON-SITE SEWAGE SYSTEM APPLICATION z
APPLICANT PHONE RI
Jacob H. Hjorten (360) 388-2519 rz
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE C
301 E. Lansky Dr. Shelton WA 98584 00
13 m
SITE ADDRESS-STREET,CRY ZIP CODE `���
11-B E. Lansky Dr. ANA' , Shelton WA 98584 N N
NAME OF DESIGNER ' PHONE
Dale L. Tahja ' (360) 463-8023 N
NAME OF INSTALLER PHONE 0 Q
PERMIT TYPE(select one) DRINKING WATER SOURCE 1V
PRESIDENTIAL OSS c0ICOMMUNITY OSS In=COMMERCIAL OSS Ri PRIVATE INDIVIDUAL WELL t 15 PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(select one) al 41.
PUBLIC WATER SYSTEM r
I „NEW CONSTRUCTION/UPGRADES }REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR C71
SUBMITTALS ❑SURFACING SEWAGE O EXISTING FAILURE 0 SHORELINE W
Q✓ DESIGN FORM(REQUIRED) El SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? r O
El WAIVER(S)(IFAPPLICABLE) 4 2.42acre nYES NO C
DIRECTIONS TO SITEAND SITE CONDITIONS:(ex.locked gate)
Go onto Harstene Island, turn right onto Island Drive South, turn right onto Hartstene Island o
Rd. S., turn right onto Lansky Dr., turn left onto access road for (311, 313, 315, 317, Lansky
Dr.), property on the left. ® o
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. O)
OFFICIAL USE ONLY BELOW THIS LINE •
UPGRADE!FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
Tit] v --n14 65L (7 /r7 y) .cser re
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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 EXPIRATION DATE • APPLIC ON PPROVED/ISSUED BY DATE
/1/40/1761 // /z0 ( )?F 1(6 v76'
THIS F RM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6/3/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: .2 2 0T 2 ! 4 d 5 0 0 ! 0 0 f 1-
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. 0 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
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Permit�3nmber. S`hiGY 2 cCDC-4 Designer's Name: Dale L.Table
Applicant's Name: Jacob H. Hjorten Designer's Phone Number: (360)464-8023
Mailing Address:
301 E.Lansky 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
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Treatment Device
❑ Glendon O Sand Filter O Mound O Sand Lined Drainfield O Recirculating Filter O ATU O Other
Treatment Level(check all that apply): O A O B O C O BLI O BL2 O BL3 prE O N
Drainfield Type
❑Gravity Pressure lieTrench O Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Numbex of Bedrooms 4 Schedule/Class Sch.40
Daily Flow: Operating Capacity 360 gpd Length 54 ft
Daily Flow:Design Flow 480 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 gal Number 5
Receiving Soil Type(1-6) 4 Separation 6 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 800 ft2 Total Number of Orifices 70
Designed Primary Area 810 ft2 Diameter 1/8 in
Designed Reserve Area 800 ft2 Spacing 48 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 270 ft Schedule/Class Sch.40
Elevation Measurements Length 70 ft
Original Drainfield Area Slope 6 % Diameter 1.25 in
New Slope,If Altered 5 % Preferred manifold config
uration used? ❑Yes ErNo
Depth of Excavation Up-slope 17 in Transport Pipe
from Original Grade Down-slope 15 in Schedule/Class Sch.40
Designed Vertical Separation 13 in Length 120 ft
Gravel-based Drainfield Required? O Yes Et No Diameter 2 in
Pump Required? Er Yes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff.in Elevation Between Pump&Uppermost Orifice 8 ft Dose quantity 90 gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,200 gal
Uppermost Orifice f 'Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 32 gpm er Timer E( Elapse Meter IiiP Event Counter
Calculated Total Pressure Head 18 ft If Timer: Pump on 3 min. ,pump off 5 hrs.57 min.
Comments
Revised:6/11/2025
.DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 ' 2 0 2 , 4 5 0 0 0 0 1 [ 6
F
Permit Number: SWG D.,vo1 J- G04445
' t y t , , ;' DESIGN CJ.cKLISTS, `if 'l F
J ,
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
id Test hole locations le Drainfield orientation and layout Reference depth from original grade:
Pr Soil logs le Trench/bed dimensions and V Septic tank
g( Property lines critical distances within layout V Drainfield cover
✓ Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade
within 100 ft of property V Septic tank/pump chamber and restrictive strata:
O Measurements to cuts,banks,and locations Id Laterals,trench bed,top and
surface water and critical areas le Observation port location bottom
lie Location and orientation of Pf Clean-out location 0 Curtain drain collector
curtain drain and all absorption Er Manifold placement 0 Sand augmentation
components
le Orifice placement Other cross-section detail:
✓ Location and dimension of Lateral placement with distance le Observation ports/clean-outs
primary system and reserve area to edge of bed
Other Information
fg Buildings le Audible/visual alarm referenced Yes No
fifi Direction of slope indicator IV Scale of drawing shown on scale Er 0 Design staked out
er Waterlines bar 0 0 Recorded Notices attached
✓ Roads, easements,driveways, V Elevation benchmark and relative le 0 Waiver(s)attached
parking elevations of system components V 0 Pump curve attached
Rf North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑Flow
. =t ,. ,.- .j I.-ESI FRO A z f ,. , _ . :
The undersigned designer m ben 'fled ins,a er at time of installation VYes 0 No
Signature of Designer 0 Date
The undersigned has reviewed this design on behalf of Mason County Public Health and det �
"/ 'to be i '
compliance with state and local o regulations: . _4 .� 2-pV//‘/(oz‘ ,, ,,,,,...,./1.,,,.. _ g. .o 0,, i
Environmental Health Specialist Da•x;,t4t*z141 a w %. i
40
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CO,i ;��� o
✓ The design is stamped"Approved"by Mason County Public Health. �� )✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: / /`�/ (ZC G 6 %%
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
Please Note: The system must be installed by a certifie !'�taller,
unlessprior authorization is obtained from Mason Coun cP i Health.
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An Installation Fee is required. I "000",� X06�,, ki0
This form may be scanned and available for public view on the Mason County Webs RevUag: 6/11/2025
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O Dale L.Tahja t
LICENSED DESIGNER \3"
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JAN 0 6 2028
MASON COUNTY ENVIRONMENTAL HEALTH
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Liberty Pumps 280 - 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
Automatic)
Performance Curve: 2 . .
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Pressure Distribution/Trench Systems 5100214 ITS
O Dale L.Tahja
ir LICENSED DESIGNER f
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,with orfice schields,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.
APPROV E®
JAN 0 6 2026
'JASON COUNTY ENVIRONMENTAL HEALTH
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