HomeMy WebLinkAboutSWG2026-00020 - SWG Application / Design - 1/22/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, EXT 400
BELFAIR:360-275-4467,EXT 400
f Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2026-00020
APPLICANT Jim Zimny Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
OWNER FARANDA ANTHONY VINCENT Phone:
Address: 380 NE MATTHEW DR BELFAIR, WA 98528
Site Address: 380 NE Matthew Dr
Primary Parcel Number: 223365200002
Permit Description: 3BR Gravity
Permit Submitted Date: 01/22/2026
Permit Issued Date: 02/03/2026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/28/2027 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
M. s. MASON COUNTY DATERKEt� 0' Qal�°��
AMOUNT RKEMED: RECEIVED 8Y: W c co
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i Public Health & Human Services a ,3 4ij ONLINE
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.4430 ^ ≤ 0
415 N.6th Street - Shelton,WA 98584 S WG //1 rl 6 - c ( f\-� ^^ Z P3
ON-SITE SEWAGE SYSTEM APPLICATION _ih D D
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APDLIGANT PHONE ------_` m
Anthony & Latina FARANDA 360-801-5280" z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
380 NE MATTHEW DR BELFAIR WA 98528 ��'� �t m
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SITE ADDRESS-STREET,CITY,ZIP CODE
380 NE MATTHEW DR BELFAIR WA 98528 / PI �, I! I J,
NAME OF DESIGNER PHONE (t, ill
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Jim Zimny 360-516-7287 1' �. Q cp �N)
NAME OF INSTALLER PHONE �"-•""" 1
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PERMIT TYPE(select one) DRINKING WATER SOURCE N I "V
$ RESIDENTIAL OSS f COMMUNITY OSS 1-1 COMMERCIAL OSS DRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I'�
TYPE OF WORK(select one) PUBLIC WATER SYSTEM ____ I
A NEW CONSTRUCTION/UPGRADES A REPAIR/REPLACEMENT OTHER DETAILS(select all that appl)) 0 TABLE X REPAIR 1 I '
SUBMITTALS O SURFACING SEWAGE III EXISTING FAILURE 0 SHORELINE c vl
0 DESIGN FORM(REQUIRED) El SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SZE WAS LOT CREATED AFTER 4/1/2025', rc; I rj
❑ WAIVER(S)(IF APPLICABLE) 3 nYES TINO (7
I0DIRECTIONS TO SITE AND SITE CONDITIONS (ex lacked gate) ..
From Befair take St RTE 300 2.5 miles and take rt on Larsen Lake rd. are first left on NE I a
Mathews Dr. follow .4 miles to address on Rt. Test holes are in the back yard through the I
gate _Jro 0
Nile
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I(s)
_-. OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING❑ BUILDING PERMIT O HOME SALE❑COMPLAINT El OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
0 •,, . )S / 442)c
SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM S,=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSP TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLI ATION APPROVED/ISSUED BY DATE
/ W 1 , 1-2%�� ( ..zS '‘2:-/ ' , % W`
TH F F. AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:01/09/2026
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 2 2 3 3 6 5 2 0 0 0 0 2
A design will be reviewed when 3 conies 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.tfaxinram paper size: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG a 7),(0 - COC) O Designer's Name: JIM ZIMNY
Applicant's Name: Antony& Latina FARANDA Designer's Phone Number: 360-516-7287
Mailing Address:
380 NE MATTHEW DR Designer's Address: 7178 windflower pl nw,
BELFAIR WA 9852 City State Zip Seabeck WA 98380
CLEAR FORM
City Stale Zip Designer's Email apddesigns@iclloud.com
DESIGN PARAMETERS
Treatment Device
O Glendon O Sand Filter O Mound O Sand Lined Draintield O Recirculating Filter O ATU O Other
Treatment Level(check all that apply): O A ❑B O C O BL I O BL2 O BL3 IKE O N
Drainfield Type
'Gravity O Pressure IlieTrench O Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length / 40 ft
Daily Flow: Design Flow 360 gpd Diameter ':j,r, 4 in
Septic Tank Capacity(working) 1200 gal Number /` 5
Receiving Soil Type(1-6) 4 Separation 5' CtC ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 _ Orifices
/Required Primary Area 600b !o-�
�1 �' ft2 Total Number of Orifices NA
Designed Primary Area 600 ft2
Diameter in
Designed Reserve Area NA ft2 Spacing in
Trench/Bed Width 200 ft Manifold
Trench/Bed Length 3 ft Schedule/Class NA
Elevation Measurements Length ft
Original Drainfield Area Slope 3 % Diameter in
New Slope,If Altered 3 % Preferred manifold configuration used? O Yes O No
Depth of Excavation Up-slope •g in Transport Pipe
from Original Grade Down_slope 7 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 10 ft
Gravel-based Drainfield Required? O Yes 11 No Diameter 4 in
Pump Required? O Yes rfNo 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) ft Chamber Capacity(flood) gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls: Please check those re s . ..
Capacity m Total Pressure Head
gpm • Ti ■Oa*ft ❑ Event Counter
Calculated Total Pressure Head ft If Ti ' P li n t i • I f
Comments A. FEB 0 3 Nib
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MASON COUNTY ENVIRONMENTAL HEALTH
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DESIGN FORM —PAGE TWO Assessor's Parcel Number: 2 2 3 3 6 5 2 0 0 0 0 2
Permit Number: SWG - 000?.0
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
• Test hole locations Q( Drainfield orientation and layout Reference depth from original grade:
er Soil logs erTrench/bed dimensions and Er Septic tank
et
Property lines critical distances within layout V Drainfield cover
Existing and proposed wells D BoxNalve box locations Reference depth from original grade
within 100 ft of property et Septic tank/pump chamber and restrictive strata:
Measurements to cuts, banks, and locations
Laterals,trench bed,top and
surface water and critical areas O Observation port location bottom
de Location and orientation of le Clean-out location O Curtain drain collector
curtain drain and all absorption ❑ Manifold placement O Sand augmentation
components 0 Orifice placement Other cross-section detail:
le Location and dimension of et Observation ports/clean-outs
primary system and reserve area Er Lateral placement with distance
to edge of bed Other Information
er Buildings 0 Audible/visual alarm referenced Yes No
Direction of slope indicator
Scale of drawing shown on scale O O Design staked out
er Waterlines bar O O Recorded Notices attached
le Roads,easements,driveways, Elevation benchm and relative O O Waiver(s) attached
parking elevations of sys components O O Pump curve attached
er North arrow and scale drawing ler O Evaluation of failure
shown on scale bar p a,x h -4r
0 t , ` fi y ,�W , ti Non-residential justification
y` ( p O Waste strength
1 . s O ❑ Flow
FEB 0 3 Lo :p4",Ft*Giki.'
'26,, L A .IiIIQY 1 AS0Nuud,m c-"P.0 /—/a
The undersigned designer must fie y .n ller at tim installation VYes O No
Signat a of esigner 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 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:
✓ 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
County Stamp
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= 121' Designer Info:
"'"' ��_ Jim Zimny.
APD
7178 Windflower PL NW
185' Seabeck. WA 98380
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= Th#1 - 0-46" Fine loamy sand Applicant Info.
Tyoe 4 soil w Anthony& Latina FARANDA
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0-48" fine loamy sand pi
Type 4 soil `
BELFAIR WA 98528
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#23365200002
Not A Survey FED 3 �, Date:
Datum NAD83 MASON COUNTYENVIRpNMENTALHE~ 1/ 10/2026
LFc.FNn ALTH
Or Bench Mark `LBW Page
lif soil log
— Property Line Scale
-• Power Line
---- Water line 1" = 40'
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Typical Trench Profile Typical 0 box and Riser Assembly
County Stamp
4"Clear out with removable cap Flow
6 " Min Sandy Cover locking riser lid
1 4'3O3 .e
8 Max T nch Dept
sp:•d levers
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4' 3034 ' •e '
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Restrict a layer or water table
Jim Zimny
Not to Scale Advantage Perc&Design
Not to Scale 7178 Windflower PI NW
Seabeck,WA 98380
(360)516-7287
Applicant Info
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Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers (Rock and pipe may be substituted)
Install 5 -40' Laterals .
Use a 6 hole d-box and speed levelers
Install on 5' foot centers.
Install 7"trench depth on low side of trench and maintain 36" of vertical separation
Install level and along contours.
Install in dry weather only.
Use existing 1200-Gallon septic Tank.
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
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Advantage Perc &design • APDdesians@icloud.com • (360) 516-7287