HomeMy WebLinkAboutSWG2026-00007 - SWG Application / Design - 1/8/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
�~ BELFAIR:360-275-4467,EXT 400
1'l Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2026-00007 COO N1
APPLICANT PUGET SOUND CONSTRUCITON Phone: 360-265-0743
SEVICES
Address: P O BOX 1876 BELFAIR, WA 98528
OWNER PANZERA JOSEPH JR Phone: 360.265.0743
Address: P O BOX 1876 BELFAIR, WA 98528
SEPTIC DESIGNER Lawrence Purdum Phone: 2535099922
Address: PO Box 801 Gig Harbor, WA 98335
Site Address: 1561 E TRAILS END DR
Primary Parcel Number: 222235102061
Permit Description: New 3bd pressure trench-partially installed under SWG2020-00576
Permit Submitted Date: 01/08/2026
Permit Issued Date: 01/08/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/08/2029 (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/onsite/oss-inspection-regUest.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
IVY A S O N COUNTY DATE RECEIVED: f I / O�r j acQ( C ›U !Ir o cn n
AMOUNT ECEIV RECEIVED BY:e., ,,,,,,
Public Health & Human Services 'q5 �I jO p CO Cl)
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 ^^ cn
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415 N.6th Street-Shelton,WA 98584 SWG - 0000 O z
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ON-SITE SEWAGE SYSTEM APPLICATION z
APPLICANT , c.„0PHONE m f r
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MAILING.2 DDRESS-STREET,CITY STATE,ZIP CODE -.... ..,,,,,,:z.... .),............_____.
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SITE AD R S-STREET,CITY,ZIP CODE C �I a.,,Q1 (4,jv ctk-5
NAME OF DESIGNER PHONE /'—'—,J
WW1&(\,t h)(ik 0)1/4A .C.N1 — D 01 -9;5 3-ct .
NAME OF INSTALLER &'.. g PHONE B I\'-)
Cam_ C PERMI TYPE(select one) CO DRINKING WATER SOURCE Cl)
IV
RESIDENTIAL OSS 51COMMUNITY OSS IF-- ILh�COMMERC e SS 0 RIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z (BUJ)
TYPE 'F WORK(select one) UBLIC WATER SYSTEM i
ONEW CONSTRUCTION/UPGRADES EREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR Vi
SU�B-IJ�ITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CO
LU/ DESIGN FORM(REQUIRED) O SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFT 4/1/2025? r O I^
❑ WAIVER(S)(IF APPLICABLE) 3 1 5�W EYES NO n
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT C3 OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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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.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION
DATE APPLICATION APPROVED/ISSUED BY DATE
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THIS FORM 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: 2 �7, 3. 7 A s- I 0 •-), ® tp
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
Permit Number: SWG, — CO Designer's Name: \RM VPM�� ��(f kkiM
p . y Designer's Phone Number:
Applicant's Name: ? f
U ( , „(� �S ( g — c.0
Mailing Address: Po i k i�` Designer's Address: 0 (I
r3 Ai V4 k5-/Jj City State Zip t _
City State Zip Designer's Email 1 1 \ V ‘Al . Vv,
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
❑ Gravity Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class ik 0Daily Flow: Operating Capacity 16 h gpd Length \ ft
Daily Flow:Design Flow gpd Diameter t in
Septic Tank Capacity(working) I gal Number
Receiving Soil Type(1-6) Separation -5 ft
Receiving Soil Appl.Rate A99 gpd/ft2 Orifices
Required Primary Area Il' U v ft2 Total Number of Orifices ',
Designed Primary Area ft2 Diameter k I in
Designed Reserve Area P(i ) ft2 Spacing in
Trench/Bed Width 'A ft Manifold
Trench/Bed Length k ft Schedule/Class ` O
Elevation Measurements Length c_ ft
Original Drainfield Area Slope `j,"( % Diameter in
New Slope,If Altered 0 k % Preferred manifold configuration used? ,❑Yes O No
Depth of Excavation Up-slope 1.. in Transport Pipe
from Original Grade Down-slope in Schedule/Class
Designed Vertical Separation '1;1 in Length 4 ft
Gravel-based Drainfield Required? 0 Yes ) I No Diameter 0 in
Pump Required? 0 Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff.in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) 4c ft Chamber Capacity(flood) \') 6 gal
Uppermost Orifice 0 Higher gfLower th n Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm yl Timer I Elapse Meter Event Counter
Calculated Total Pressure Head ft If Time A, o Pump off i
Comments _
S . ,k S Z0"� ' n '1-ke
JAN 0 8 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET Revised:6/11/2025
,DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 1-1,1.- IS- I 0 0 UIJ
Permit Number: SWG O 1 AOOO'7
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
;2' Test hole locations )71 Drainfield orientation and layout Reference depth from original grade:
❑ Soil logs 1 Trench/bed dimensions and O Septic tank
t Property lines critical distances within layout ❑ Drainfield cover
O Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Septic tank/pump chamber and restrictive strata:
O Measurements to cuts,banks, and locations O Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
❑ Location and orientation of 1r Clean-out location 0 Curtain drain collector
curtain drain and all absorption Z Manifold placement O Sand augmentation
components 0 Orifice placement Other cross-section detail:
[,I7 Location and dimension of O Lateral placement with distance O Observation ports/clean-outs
primary system and reserve area to edge of bed
Cr Buildings Other Information
Vi Audible/visual alarm referenced Yes No
KZ Direction of slope indicator IZI Scale of drawing shown on scale 0 pt Design staked out
C' Waterlines bar O u'Recorded Notices attached
pt Roads, easements,driveways, O Elevation benchmark and relative O "Waiver(s)attached
parking elevations of system components 0 JZf Pump curve attached
P North arrow and scale drawing Get CA 1 O p Evaluation of failure
shown on scale bar cS ,0 Non-residential justification
0 O Waste strength
c ahCl O O Flow
DESIGN APPROVAL
The undersigned designer must bej tiff d by 1 taller
ra�t time of installation p'Yes O No
Signature of Designer Date
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:
-(C6174,e,
Environmental Health Specialist Date
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: f il 't 174
✓ 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
PROJECT DESCRIPTION:
Li
.. . CONSTRUCT NEW 3-BR SFR. PRESSURE DIST OSS IS EXISTING
A RECORD DRAWING OF EXISTING COMPONENTS AND TIMER SETTINGS
C -,,, , WILL BE PROVIDED ONCE THE SFR IS CONSTUCTED.
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/ PROPOSED _
// 3-BR SFR ; EXISTING SIT SEPTIC DESIGN SITE PLAN
/ SCALE: 1 " = 20'
/ / 46 /
�� / EXISTING P/T / O 20'
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I ?it/ /: PAIR AI�7FIF D I_r~ 11
/ / j / / 6"FLUSH PORT(TYP) ,14vp: m` b.
AI V 2.41�s?`� S
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� • 1 XI IN EXPIRES 2/25/2027
RI RY Fl D 1/8/20
F 19,
IFOLD 41APPROVED
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o> JAN 0 8 2026
`.) MASON COUNTY ENVIRONMENTAL HEALTF
RET
THIS IS NOT A SURVEY
MARKS
ARE B FEATURES.ON ASSUMED TOPOTUY.M PROVIDED BY T°HE DER AND
PIERCE COUNTY PLANNING RECORDS.AND ARE INTENDED ONLY FOR
THE REVIEW AND CONSTRUCTION or THE PROPOSED SEPTIC SYSTEM -
DESIGN.
0LOT lEX atiEDSU INU.D/Aping ONSBE EN° TD��ERs, THE ONSSED SEPTIC SYSTEM
SEPTIC SYSTEM DESIGNED FOR THIS DPRO CLIENT:
AND/OR PROVIDE A SITE EPLANN..IATI Tat OT RATED FOR WRN A SINK GARBAGE
METHODS AND EQUIPMENT OESSEW D�PRRIMA: gFFNLUREOOFTHESEPPT PUGET SOUND CONSTRUCTION SERVICES
SYSTEM.FOR WHICH THE OWNER IS ABLE.
THIS IS NOT A SURVEY, SITE FEATURES.TOPOGRAPHY ELEVATIONS.
AND BENCHMARKS ARE BASED ON PR ASSUMED DATUM OVIDED BY THE ONSITE SEPTIC SYSTEM DESIGNED FOR THIS PROPERTY
THE OWNER AND PIERCE COLD&PUNNING REMMS,AND GIS IS INTENDED F HOUSEHOLD GREY WATER AND B KWATER PROPERTY INFORMATION:INFORMATION,AND INTENDED ONLY FOR THE REVIEW NO CONSTRUCTION SEWAGE ONLY E.G.TOILETS. SINKS.ETC.FLOOR
OF THE SEPTIC SYSTEM DESIGN, DRN§DRAT .FROM AND IECHAN CONDE STORY
FIELD MEASUREMENTS PERFORMED WITH A TOPCON GPT-GO33A ROBOTIC TOT ON° SY ER STEM
4GE SOURCES NOT T°�CONNECTED P N: 22223-51 -02061 SEPTIC DESIGN. L L C
TOTAL STATION.TOPCON ROBOTIC PRISM.TOPCON FC-203 DATA COLLECTOR
APEX SEPTIC DESIGN.LLC RECOMMENDS THAT ApLI�CENSED PROFESSIONAL DDRAND RAO TAPE. �Mod T PPPTtIICC TANKS. DO NAPS, O NOT WASH PAINT OTTFO THE SEPTIC TPO SINKS
A OR NNSO',REACH, SITE ADDRESS:15 61 E TRAILS END DR Po Box 79+.Vaughn,WA 98394 253.5og.s1922
DETLANERMINE
INENE SURVEYOR ALWAYS BE
USED
TTOPOGRIAPHY.Y.AND PROVIDE A LEGAL SITE PLAN. THA-BADTERIAL T DRAIN INTO THE SEPTIC TANKS
OTHER BACTERIA- CHEMICALS
DRAWN: LP, 1/8/2026 PAGE 1 OF 1