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HomeMy WebLinkAboutSWG2026-00019 TANK ONLY - SWG Application / Design - 1/21/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 J L 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 Tank Only Permit: SWG2026-00019 OWNER PERRY ET UX EDWIN C Phone: Address: DEBORAH S PETERSON HOODSPORT, WA 98548 APPLICANT PERRY ET UX EDWIN C Phone: Address: DEBORAH S PETERSON HOODSPORT, WA 98548 SEPTIC DESIGNER JIM HUNTER* Phone: 360-753-1226 Address: PO BOX 162 OLYMPIA, WA 98507 Site Address: 140 N Discovery Dr Primary Parcel Number: 423185000039 Repair: Replace the existing septic and pump tanks with a 1000-gal Permit Description: septic tank (coated) and a 1000-gal pump tank(coated), and remove and reinstall the existing effluent pump Permit Submitted Date: 01/21/2026 Permit Issued Date: 01/30/2026 Issued By: David Anderson Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system). Permit Expiration Date: 01/21/2027 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic and Pump Tanks Surfacing Sewage? No Existing Failure? Yes Shoreline? Yes Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Public Water System Additional Details: 1000 gal septic(coated) &1000 gal pump(coated) Permit Conditions: 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 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/OR 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 at s's. MASON COUNTY DATE RECEIVED �lIc2 I ��� c/ .. cn D cn AMOUNT RECEIVED- RECEIVED BY: CO Public Health & Human Services -�- j lea cif _,v m Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 1 ^ N 415 N.6th Street-Shelton,WA 98584 SVVG olt�v1(P — DO I 91 O 0 fl1 N k ON (--4 V v��VJ I Z 6 CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION D 73 m C) APPLICANT PHONE m m ED PERRY n J©� � 503 317-2299 _ z MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE I i I c 140 N DISCOVERY DR , l o il HOODSPORT WA 98548 m l:::::1SITE ADDRESS-STREET,CITY,ZIP CODE 140 N DISCOVERY DR PzLg c., , ; HOODSPORT WA 98548 I N NAME OF DESIGNER e-.....! PHONE I CO JIM HUNTER ] Q il 360 753 -1226 0cn NAME OF INSTALLER �1.r�-3 PHONE v I O O t� PERMIT TYPE(select one) --10,„K to I O DRINKING WATER SOURCE 0 O C L�J RESIDENTIAL OSS ECOMMUNITY OSS IU COMMERCIAL OSS E PRIVATE INDIVIDUAL WELL E PRIVATE TWO-PARTY WELL Z TYPE OF WORK(select one) P.PUBLIC WATER SYSTEM LAKE CUSHMAN 1 6 NEW CONSTRUCTION/UPGRADES ff REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I SUBMITTALS a SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co DESIGN FORM(REQUIRED) fig-SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? I- I DWAIVER(S)(IF APPLICABLE) 2 0.36 _ O YES Q NO O 1 DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate) HOODSPORT, NORTH ON 119 TO END OF 119, TO POTLATCH, TO DISCOVERY TO I LOT ON RIGHT AT ADDRESS. E. I --I I 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) 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ['OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS daQ/ 5eitcg ciosiop 1-04/6 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 APPLICAT APPROVED/ISSUED BY DATE .,__. -' / (2/ (70 ? -7_ / 06/Z6a THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 42318-50-00039- -- 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: 1I"X 17" PARCEL IDENTIFICATION Permit Number: SWG cloak DC019 Designer's Name: JIM HUNTER Applicant's Name: ED PERRY Designer's Phone Number: 360 753-1226 Mailing Address: 140 N DISCOVERY DR Designer's Address: PO BOX 162 HOODSPORT WA 98548 City State Zip OLYMPIA WA 98507 City State Zip Designer's Email JHANDASSOCIATES@HOTMAIL.COM DESIGN PARAMETERS Treatment Device ❑Glendon O Sand Filter O Mound O Sand Lined Drainfield O Recirculating Filter 0 ATU ❑Other Treatment Level(check all that apply): 1A 'LIB IC J BLI J BL2 J BL3 J E J N Drainfield Type ❑Gravity 0 Pressure 0 Trench O Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class N/A Daily Flow:Operating Capacity ` 6 0 gpd Length N/A ft Daily Flow:Design Flow 240 gpd Diameter N/A in Septic Tank Capacity(working) 1000 gal Number N/A Receiving Soil Type(1-6) N/A Separation N/A ft Receiving Soil Appl.Rate N/A gpd/ft' Orifices Required Primary Area N/A ft2 Total Number of Orifices N/A Designed Primary Area N/A ft2 Diameter N/A in Designed Reserve Area N/A ft2 Spacing N/A in Trench/Bed Width N/A ft Manifold Trench/Bed Length N/A ft Schedule/Class N/A Elevation Measurements Length N/A ft Original Drainfield Area Slope N/A % Diameter N/A in New Slope,If Altered N/A % Preferred manifold configuration used? l 'Yes O No Depth of Excavation Up-slope N/A in Transport Pipe from Original Grade Down-slope N/A in Schedule/Class N/A Designed Vertical Separation N/A in Length N/A ft Gravel-based Drainfield Required? O Yes O No Diameter N/A in Pump Required? t2f Yes O No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 4- N/A Diff. in Elevation Between Pump&Uppermost Orifice N/A ft Dose quantity - N/A gal Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) . le 60 Itgal Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head N/A gpm 0 Timer O El se Meter 0 Event Counter Calculated Total Pressure Head N/A ft if Timer: Pump on /4' ,Pump off (S IA- Comments . ' '1, ef4Uiea f pomp -to be rei' te( dud re(W1qlled i- 4 e pomp 77gf(. Revised:4/14/2025 DESIGN VORM—PAGE TWO Assessor's Parcel Number:42318-50-00039-- -- Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch E( Test hole locations O Drainfield orientation and layout Reference depth from original grade: 0 Soil logs 0 Trench/bed dimensions and o' Septic tank 0 Property lines critical distances within layout ®' Drainfield cover 0 Existing and proposed wells 0 D-Box/Valve box locations Reference depth from original grade within 100 ft of property ®' Septic tank/pump chamber and restrictive strata: Ea Measurements to cuts,banks, and locations O Laterals,trench bed,top and surface water and critical areas 0 Observation port location bottom O Location and orientation of O Clean-out location 6l Curtain drain collector curtain drain and all absorption l' Manifold placement 0 Sand augmentation components ®' Orifice placement Other cross-section detail: O Location and dimension ofEr Observation ports/clean-outs primary system and reserve area Lateral placement with distance to edge of bed Other Information 0 Buildings 0 Audible/visual alarm referenced Yes No 0 Direction of slope indicator p' Scale of drawing shown on scale � O Design staked out 0 Waterlines bar O O Recorded Notices attached 0 Roads,easements,driveways, a Elevation benchmark and relative O O Waiver(s) attached parking elevations of system components 0 O Pump curve attached E( 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 notifi . bIii, . t. e of installation O Yes Er No t.1..t. I.(4,04 Signatur- of Designer Date4) N The undersigned has reviewed this design on behalf of Mason County Public He y and determine'144/., in compliance with state and local on-si gulations: Oyu, .4ti / (5a( 2l6 o41�-- '070 �® En ironmental Health Specialist Date ��Q 16' p ✓it���FN CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDIT/444 ✓ The design is stamped"Approved" by Mason County Public Health. �� ?OZ. 45, • 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. 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ED PERRY APPROVED �-� om:.� E N EATER NORM.MDR LEVEL " • "°"° E Nil SITE ADDR MENT ME.•NF l.�:i �°°^ 140 N DISCOVERY DR girl ,,,.. 1 DE R R LEGAL- * LK CUSHMAN#3 LOT 390 OF SEPTIC TANK(TYPICAL ,,,/ PUMP CHAMBER(TYPICAL) Ste ..r'1440 4U5/ k� 11_tf 161-"of felt festd. saw iff fvtiG5 x TP# 42318-50-00039 SITE#