HomeMy WebLinkAboutSWG2025-00309 - SWG Application / Design - 8/4/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
as,. 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: SWG2025-00309 ..01i N11
APPLICANT BURNS ROBBY E Phone:
Address: 1381 W DELIGHT PARK RD SHELTON, WA 98584
OWNER BURNS ROBBY E Phone:
Address: 1381 W DELIGHT PARK RD SHELTON, WA 98584
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: UNKNOWN
Primary Parcel Number: 419017600040
Permit Description: New 3bd gravity trench
Permit Submitted Date: 08/04/2025
Permit Issued Date: 01/14/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/07/2028 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
Mt
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: 08. — 0-# . a5 . D
II'
AMOUNT RECEIVED: W o'
RECEIVED BY:
Public Health & Human Services
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 ^ �� — OO��� 0
O 0
415 N.6th Street-Shelton,WA 98584 S W G (^Z)v
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE M
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ROBBY BURNS �a 360-490-7121 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODEMO g
1381 W DELIGHT PARK RD SHELTON WA 98584 co
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73
SITE ADDRESS-STREET,CITY.ZIP CODE
XXX DELIGHT PARK RD d •
XSHELTON WA 98584 I
NAME OF DESIGNER ( PHONE
CINDY WAITE 360-701-0205
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NAME OF INSTALLER PHONE v
TBD 40''
PERMIT TYPE(select one) KING WATER SOURCE I C]
WC RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS ff4- W PRIVATE INDIVIDUAL WELL 6 PRIVATE TWO-PARTY WELL Z I
C+
TYPE OF WORK(select one) PUBLIC WATER SYSTEM
W'NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I -I
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
Ca
E DESIGN FORM(REQUIRED) WI-SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? O
LI WAIVER(S)(IFAPPLICABLE) 3 5-Q.t%r'i ❑ YES Q NO C I
DIRECTIONS TO SITE AND SITE CONDITIONS'(ex.locked gate) / I O
GO NORTH ON OLYMPIC HIGHWAY, GO UNDER HIGHWAY 101, TURNING ONTO I o
GOLDEN PHEASANT RD, TURN ONTO DELIGHT PARK RD, GO TO MANKE GATE AND r I
OWNER WILL MEET YOU THERE TO UNLOCK GATE. CONTACT ROBBY BURNS AT -i 0
360-490-7121 I .p
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I 0
• OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT CI OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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0 E./ 1 10L
1
cA \ SIP I' 11/V/
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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 A PROVED/ISSUED BY DATE
tIrraii41/1 I6 11 11.5 t)7/2/d \ (u( (gic, .
THIS FORM MAY BgSCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 1 9 0 1 7 6 0 0 0 4 0
A design will be reviewed when 3 conies of each of the following are submitted:
Completed design form that has been signed and dated. '1 Scaled layout sketch,including all applicable items on checklist.
'1 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: II".I(/7"
1 PARCEL IDENTIFICATION
Permit Number: SWG ,S, G ?u2 j_OO.3Oq'Designer's Name: CINDY WAITS
Applicant's Name: ROBBY BURNS Designer's Phone Number: 360-701-0205
Mailing Address: 1381 W DELIGHT PARK RD Designer's Address: 80 E PICKERING LANE
SHELTON WA 98584 City State Zip SHELTON WA 98584
City State Zip Designer's Email cindyewaite@msn.com
I
DESIGN PARAMETERS
Treatment Device
O Glendon O Sand Filter O Mound O Sand Lined Drainfield O Recirculating Filter O ATU
Treatment Level(check all that apply): ❑Other
O A O B DC O BLI ❑BL.2 ❑Bl.i ❑E ON
Drainfield Type
'Gravity O Pressure Trench 0 Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class ASTM 2729
Daily Flow:Operating Capacity 270 gpd Length 50
ft
Daily Flow: Design Flow 360 gpd Diameter 4
in
Septic Tank Capacity(working) 1200 gal Number - 4
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl. Rate .6 gpd/ft2 Orifices
A
Required Primary Area 600 ft2 Total Num Orifi ASTM PERF
Designed Primary Area 600 �� °` •>"'
ft2 Diame o.4.. in
Designed Reserve Area 600+ ft2 Spa =
in
Trench/Bed Width 3 ft ' 5t
ciNo51 Arm' 'fold
Trench/Bed Length 200 ft S. oulektsEsreD DESIGNER
Z
Elevation Measurements Length LAPIHLS U&l6r ft
Original Drainfield Area Slope <1 % Diameter
in
New Slope, If Altered % Preferred manifold configuration used? O Yes O No
Depth of Excavation Up-slope 15 in Trans e
port Pip from Original Grade Down-slope 15
in Schedule/Class SCHEDULE 3034
Designed Vertical Separation 36+ in Length 60 ft
Gravel-based Drainfield Required? ttf Yes O No Diameter 4
in
Pump Required? ❑Yes lEfNo Dosing and Pump ha ber
Pump/Siphon Specifications Number of doses/day 6
Diff. in Elevation Between Pump&Uppermost Orifice _ft Dose quantity
gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) 0 gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls: Please check those req ire .
Capacity @ Total Pressure Head gpm O Timer O Elapse Meter O Event Counter
Calculated Total Pressure Head ft If Timer: Pump on y mao f
Comments A P Pikt i
AFTER CLEARING, DESIGNER WILL STAKE OUT LATERALS
JAN 14 2026 l
MASON CGU4,4A'EW2CNµFNTAL MFALTH
RET Revised:6/11/2025
DESIGN FORM-PAGE TWO Assessor's Parcel Number: 4 1 9 0 1 7 6 0 0 0 4 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
11 Test hole locations ' Drainfield orientation and layout Reference depth from original grade:
V1 Soil logs it Trench/bed dimensions and
fit Septic tank
IX Property lines critical distances within layout 11 Drainfield cover
RI Existing and proposed wells lx D-Box/Valve box locations
within 100 ft of property Reference depth from original grade
P P y 1> ' Septic tank/pump chamber and restrictive strata:
$ Measurements to cuts, banks,and locations
surface water and critical areas bottom
11 Laterals,trench/bed,top and
Observation port location
ocation and orientation of IX Clean-out location O Curtain drain collector
curtain drain and all absorption O Manifold placement O Sand augmentation
components
if Location and dimension of
V Orifice placement Other cross-section detail:
primary system and reserve area ef Lateral placement with distance VObservation ports/clean-outs
91 Buildings Ato edge of bed Other Information
el udible/visual alarm referenced Yes No
IX Direction of slope indicator
;if Scale of drawing shown on scale ❑ lie Design staked out
gl Waterlines bar
O O Recorded Notices attached
VI Roads,easements, driveways, 1 Elevation benchmark and relative O O Waiver(s)attached
parking elevations of system components ' O Pump curve attached
fif North arrow and scale drawing O O Evaluation of failure
shown on scale bar Non-residential justification
❑ O Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be noti by inst ler at time of installation Iii"Pes O No
Signature Designer 2.-L,-
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:
Environmental Health S ecialist 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: t 11 /i 'S
✓ 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.
2/"' \,f
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
(x ( W Delight Park Rd, Shelton, WA 98584, USA, Shelton Township, Parcel Id: 419017600040
1 Out building
2 Proposed residence Lake
3 Clean out
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4 1200 septic tank
5 Transport line 0 _.
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6 D Box 'o W
7 Primary drainfield j cap Li,
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8 Reserve drainfield /Ov' Z vim• 1-0o O 2 ,_
9 Proposed well l 'r = tool W t.:10 Waterline
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_ BENCH MARK
GIS Legend t.o,.t' FOUNDATION
1 100.00
- Measure Length Septic tank 2 99.00
Bottom
WA Mason 10 it. Contours "°' of
toL gravel 4 98.00
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Scale=> 1 in : 100 ft ' ''N
DRAINFIELD LAYOUT 6-a),
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APPROVED
JAN 14 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET
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X1=CLEANOUT/OBS PORTS CL/ ) T ,`' - `,. ,, liI' klX2=D BOXNALVE BOX / N �,� V G(.� ���' 7 tq;E.:;:, :) IGNR S
X3=Check Valves )
X4=Flow Control Valves
X5=Soil Logs
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APPROVED
JAN 14 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET
F(A2.. 4 SecLie.
1—Aceass Riser To Grade
Inlet with 45 Ell Facing Down Ca)
• sum!L! (o>equal)required
Leveling Pei- i ----1
Distribution Box(No Scale)
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pP
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CIND 1TE
' LICENSED DESIGNER
I_,l•,I1ts4s,
1200 Gallon Double Compartment Septic Tank
Litl Ground Level
----r---- �:.dam+ w� -----
Se;. from e I r
hawse IQ ' �1�� To Dramtield
Li�u;t#Levat
Scam Layer .
Inlet Tee
h Baffle
lit Compartment Outset Tee
Battle
2nd Compartment
Dravw1 ng
not to Sludge
scale
t61iei / g 4 ( .2..e/
APPROVED
JAN 1 4 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET OF CINDY EIW ITE F�
LICENSED DESIGNER
norkt, ..;10:
Installation Notes
Gravity Distribution System:
XXX W DELIGHT PARK RD 41901-78-00040
1. The prepared site plan is not a survey. It's the owner's responsibility to verify property
lines, utility lines (water, sewer, power, phone and gas) prior to installation.
2. Install cleanout between residence and septic tank
3. Gravel based drainfield required
4. Install system during dry weather with acceptable soil conditions
5. Keep wheeled vehicles off the drainfield area before, during and after installation.
Tracked equipment only
6. All ground, surface water and roof drains must be diverted away from the septic tanks
and drainfield. Ensure the final grade slopes away from these areas and water doesn't
collect on or around them. Use swales, berms, catch basin and tight lines, curtain drains,
etc. to divert all waters.
7. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the
drainfield
8. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
9. Install access risers on the septic tank, D-box and observation ports.
10. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
11. Lids must form a water and gas tight seal with the access risers
12. Install effluent filter at the septic tank outlet.
13. This system must be installed by a Mason County Certified Installer.
14. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
15. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is based on 45 gallons per day per capita with two persons per
bedroom. The minimum design flow per bedroom per day is the operating capacity of
ninety gallons multiplied by 1.33. This results in a minimum design flow of one hundred
twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety
gallons per bedroom per day.
16. Install laterals or bed with contour of the ground
17. Install trench bottoms level and always maintain a minimum of ix inches into native soil
18.Filter fabric required over drain rock prior to backfilling. drain rock extends
above the original grade, run the filter fabric at least 2 he own the trench wall
tee-
9 S
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APPROVED O� �M' E WAITE %�+
LICENSED DESIGNER
JAN 14 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET
System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank should be pumped every three to five years or as needed.
3. System owners are responsible for having maintenance performed every three years as
per WAC246-272A.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
6. Keep the flow of sewage at or below the approved design operating capacity.
7. Keep waste strength at residential waste strength parameters.
8. Spread loads of laundry through the week.
9. Do not use excessive bleach or detergents with added whiteners.
10. Do not shower, do laundry and dishwasher at the same time
11. Antibiotics can kill or impair the biological process in the septic tank.
12. Leaky plumbing can hydraulic overload your on-site septic system.
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LICENSED DESIGNER
AP
PROVED
JAN 14 2026 C ,
MASON COUNTY ENVIRONMENTAL HEALTH
RET