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HomeMy WebLinkAboutSWG2026-00027 - SWG Application / Design - 1/28/2026 1 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 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: SWG2026-00027 APPLICANT MILLER DONNA J Phone: 816-529-6907 Address: 301 E WALLACE KNEELAND BLVD SUITE 224-320 SHELTON,WA 98584 OWNER MILLER DONNA J Phone: 816-529-6907 Address: 301 E WALLACE KNEELAND BLVD SUITE 224-320 SHELTON,WA 98584 SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023 Address: 2450 W DEEGAN ROAD WEST SHELTON,WA 98584 Site Address: 310 E Ballantrae Dr Primary Parcel Number: 321275000085 Permit Description: 2BR Oscar II -New Permit Submitted Date: 01/28/2026 Permit Issued Date: 02/23/2026 Issued By: Jeff Wilmoth Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/04/2029 (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 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. 10/ -\--. OFFICIAL USE ONLY MASON COUNTY DATERECENED: O1 / a� U3 m J,1r t }, AMDUNTREO?NED RE OY: C N . ,� .i ,t Public Health & Human Services g c y�° m Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 ..5. W 415 N.6th Street Shelton,WA 98584 SWG ao)- e -/hbo37 Z 2 ON-SITE SEWAGE SYSTEM APPLICATION APPLICANT PHONE m m m Dana Kolka / (816)529-6907 z 3 MAILING ADDRESS-STREET Y STATE,ZIP CODE CIT 03 61 E. Errigal PI. /,,'s. �•, Shelton WA 98584 m COm SITE ADDRESS-STREET,CITY,ZIP CODE • `• r N 310 E. Ballantrae Dr. r� f, ,p`,`° , Shelton WA 98584 m w NAME OF DESIGNER `/ PHONE C) N Dale L. Tahja � (360)463-8023 . NAME OF INSTALLER PHONE v —a <_ PERMIT TYPE(select one) 4) DRINKING WATER SOURCEFn. N ® RESIDENTIAL OSS Cl0 COMMUNITY 0 COMMERCIAL OSS Cl PRIVATE INDIVIDUAL WELL Cl0 PRIVATE TWO-PARTY WELL 0 y TYPE OF WORK(select one) t;t PUBLIC WATER SYSTEM Lake Umedck Water Co. r ®NEW CONSTRUCTION I UPGRADES O REPAIR I REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR U7 SUBMITTALS O SURFACING SEWAGE 0 EXISTING FAILURE CI SHORELINE 02 ® DESIGN FORM(REQUIRED) O SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? ^ 0 O WAIVER(S)(IF APPLICABLE) 2 0.26acre 0 YES aii NO t 0 DIRECTIONS TO SITE AND SITE CONDITIONS:(ex,locked gate) Go out to Lake Limerick Development, go past first entrance, go under railroad overpass, i o turn left on Ballantrae, property on the right. 0 0 OD co SIJEMUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS 01 OFFICIAL USE ONLY BELOW THIS LINE UPGRADE)FAILURE SOURCE(for reporUing purposes) s ❑VOLUNTARY ❑MAINTENANCE/PUMPING O BUILDING PERMIT O HOME SALE O COMPLAINT O OTHER: INSPECTOR SOIL LOGS COMMENTS 1 CONDITIONS 6i1 ; -.v L5 Z-11 2q RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: V=VERY G=GRAVELLY S=BAND L=LOAM SI a SILT C o CLAY E-EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL •IN OR SIGNA RE DATE APPUCATION EXPIRATION DATE AP :CATION APPROVED/ISSUED SY DATE 1 i IT lI FO +, y�Y BE SCANNED AND AVAILABLE FOBS PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:01/09/2026 ', , DESIGN FORM—PAGE ONE Assessor's Parcel Number: F2-171-2-71-5—011 0 I 0 I 0 8 , 51 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. 0 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"X 17" �' tk, :t Y f1.1 y..+t.�" r Ei' _. Y 5 3J },.i {w,� ,� (.�.� C (� 4 �s.,.- S'r+.J- nt r. r^, r l 4 mss. , Z ,a.,x ..` J. r .-c. 3..- 5.... ; �.: • Y:3 a _�3 *:itD 3VAj� AO r. r-r�. k c �: .S t.'`'� ..,`,. :-1 .Y_"5_j*r- Permit Number. SWG 2O26-OOO27 Designer's Name: Dale L.Tahia Applicant's Name: Dana Koika Designer's Phone Number: (360)463-8023 Mailing Address: 61 E.Errigal PI. 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 � 5Ls� �yy tF�Yl � x ' � it a '. ��.. {1,�� t y��.yy. �'� ;-.�t4" r a .�. t -a .� � .. . r. ._ r:RM° .�4 rj:.i-,'z .ter'. -. "i�. `�'3 ^L::.x �.. iA)g$tO*k �:'v P{�, .i +Fi-ai!2: ,is:� FC .:.1...: is Y.C..-x ",, ', Treatment Device ❑Glendon O Sand Filter O Mound O Sand Lined Drainfield O Recirculating Filter l O ATU O Other Oscar II Treatment Level(check all that apply): ❑A O B tJ air�C O BLl O BL2 BL3 PIE O N Drainfield Type ❑Gravity lePressure O Trench O Bed f'Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class OS-100 coil "P Daily Flow:Operating Capacity frif 180 gpd Length 50 ft Daily Flow:Design Flow 3OO 240 gpd Diameter 1 in Septic Tank Capacity(working) 1,000 gal Number 3 _ Receiving Soil Type(1-6) 3 Separation 1 I J Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices rn Required Primary Area 300 ft2 Total Number of Orifices 300 emitters _ Ig�, Designed Primary Area 312 ft2 Diameter hietafim \ Bioline in ----' ._,! Designed Reserve Area 312 ft2 Spacing 6 s�...T tm p g e in c: t. anifold Trench/Bed Width 13 N.Y1 , µ Trench/Bed Length 24 ft,,-" l=. Sc edule/Class z„ Sch.40 C' 1Elevation Measurements . , li .'T 2 3 2026 o 250 ft Original Drainfield Area Slope 0 1*‘SON CCPSWeKOVIRONMENTAL HEALTH 1 in New Slope,If Altered 0 % Prefers na fold configuration used? O Yes 'No Depth of Excavation Up-slope 3 in Transport Pipe from Original Grade Down-slope 0 in Schedule/Class Sch.40 Designed Vertical Separation 24 in Length 5 ft Gravel-based Drainfield Required? O Yes e No Diameter 1 in Pump Required? ErYes O No - Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 360 Diff.in Elevation Between Pump&Uppermost Orifice ft Dose quantity 0.77 gal Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) 1,000(2 compartment) gal Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm l Timer Er Elapse Meter Event Counter Calculated Total Pressure Head ft If Timer: Pump on 22 sec. pump off 3 min.38 sec. Comments Using a 1,000 gal. 2 compartment pump chamber to accommodate pretreatment for the reserve area. Revised:6/11/2025 ' DESIGN FORM—PAGE TWO Assessor's Parcel Number- 3 t 2 '-.1 2 7 5 0 0 g LL 8 5y Permit Number: SWG 2026-00027 I-FC t /1rSTS { s r Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 1d Test hole locations V Drainfield orientation and layout Reference depth from original grade: l Ef Soil logs Er Trench/bed dimensions and Er Septic tank Er Property lines critical distances within layout p' Drainfield cover ✓ Existing and proposed wells Pi D-Box/Vahle box locations p p 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 it Laterals,trench bed,top and surface water and critical areas V Observation port location bottom la( Location and orientation of Er Clean-out location O Curtain drain collector curtain drain and all absorption Et Manifold placement le Sand augmentation components O Orifice placement Other cross-section detail: 12r Location and dimension of Lateral placement with distance Fr Observation ports/clean-outs primary system and reserve area to edge of bed i� Buildings Other Information Er Audible/visual alarm referenced Yes No. 1r Direction of slope indicator le Scale of drawing shown on scale er O Design staked out ✓ Waterlines bar O O Recorded Notices attached it Roads, easements,driveways, A'Elevation benchmark and relative O O Waiver(s)attached parking elevations of p. s ste o •2•,n , V O Pump curve attached Er O O Evaluation of failure North arrow and scale drawing .� r, shown on scale bar Non-residential justification 2 3 2026 O O Waste strength FEB .U.- O ❑Flow 4.0A-$Qi rcji- :; n., QM-S-,�hki 44.; k The undersigned designer must be notified b instal er at time of installation VYes O No 4-1—. , Ct\',, Signature of Designer ; � Date The undersigned has reviewed this design on behalf of Mason County Public Health and det A 'it toi,P ii / t compliance with state and local •: ite regulations: P•c.O*-c,TO, -2.c ��► E vir• u1-n a ealth Specialist Date �i�151V ,"15 .�" W �i 46%t>441)/ w /.64) U - CAUTION: DESIGN APP'OVAL IS VALID ONLY UNDER THE FOLLOWING COND �'ire� •o I ✓ The design is stamped"Approved"by Mason County Public Health. � ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: a — (I"" 7 ✓ 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 1 V,,,:g • (° f -„ fp.„*.r--h--p.-1----?.-- 9, 10 _,.._, . / ..-„,..,,,,„: vi..) (IA P - - _. H 1 I i i o i -. , - .: "---'"--'--- _,_ /- � 6' 1 Ind r ' . / ice — C9 -- 4fv< l t< ,,f : ' ' /i' 6,2/ la Jay / :5-- " O , --I ,1' v1N� r � NiT'u I.I1'-.1:3d ��l�vo�in v��ldvno , , . ,t 9 7 £ i _srev '3' a� z ad 17° w 3A nok1 qa d i .74: ' • b____ ..if r e--- , . -1.�9 ,.i . c ,. O ' lift.0 . -^"'? 1 (4) , . U1 Ul- 1 ...4.1C.,03 9 IA �� �1 �./, A p 1 Pte. .„ /1/.c., /T4. ."'0,Ol 9r iar0 0 0 t 2 if o O3 ____... ..2.-- -N,— ---\--&. \ -\S - _____?.. tsDac) C.-\'\c,kkv6e...\- _ F.- ry I VA -- r 4' \O• 5. • O of 44 6 ' et g PlOV & rl- 5110214 in rk k o 34,Tahja r• , FEB 2 3 2O2 LICE:‘.SED DESIGNER MASON COUNTY ENVIRONMENTAL HEAL-I-I \ .. o \ e.._\ `R O.5, c_dc -I.. giBPI • • 7. 1 I 11 n C :� .�5 - \bo C_O\1, ..,„, _,„ r,,,,,,_„, „,,, . ,., , --\ , -,\ „. _.,...,„ .„, __, \(7 , ,1 _ ______ _ -- - ,__ _ .., II ( ' 1\; j- ) il I 1 . e t 1 i if,/.,.--,----,,,, \ \ --,\ ‘ i 7 „F"' -\i f --',. \ '. ,. t‘ ,,,.:,,,/ I ) I c- " I C,A0V\ W5C"j 's < k 'BS• /1/ 1:i1.---/ AL 13. '°= S rr tit d.- iii s ,,t- krs ........... . P e [ =g r '....-11-).sz' , -.1." t 1 i , , -0 • t \\ 'N. J+ • Q. . ..,...:., b" 1p 111 Q' _ ,., �° % Off\ , ,. _ ,I i n �ss, 1\` d m r o ti� i. t is i C a 9.-, ;A 5 � ` Al P , r 1 Ft 61 7 • .. is --- �,- o ..,,,,t. 1O Pt 9 .0.9.. 01 1 ni ., --.) i.__ . P `1a C C ��s� {jj °. /. L, 0 • F:� 1 9.rP .4 L (n2 s. ., }, 4 2 1 1• 1. A I ., a a a x ra,�¢ r 'W .i-.5 v jy a ✓ . r ' dkl 'Ili-.-; r—,.... - .-•:--',,,,iYAV---?. -'' . ix earlll finiliaStC Reinforced Thermoplastic motor bracket and discharge with built-in guide bearing.This 1/2 HP pump has a stainless steel top bearing and motor coupling.These are assembled with our A.Y.McDonald stainless steel motors.Two wire single phase models include pump,motor,and 10'lead. This four inch submersible is supplied with grounded leads meeting the National Electrical Code(N.E.C.)specifications. The performance curve below will assist you in choosing the pump that meets your needs. MODELS I E.30 GPM , 300 : , ,. .ii! if ..,� '' alt_` ' i _... 1/2 SP 122 FT. Q 53P.SJ j 200 • ,--. �-,•_.�_.�__. .-.._-..__. .� _, -. ' E- ...-----r--.-------:-----"-'r' !'"7"--7-_ .1 .. - .. te0 -y lip i©4SFACES-r.-° ----•.- __M `> .. _ �i Simplex 0 5 10 15 20 25 30 35 40 Oapiox 0 10 20 30 40 50 60 70 00 1 `' Peurplex 0 20 40 60 WI 100 120 140 100 - . FL0411 Si"ial q � ',-Y.;r,,:ri Specifications r V��1.% r� ti O),c),° - P�`\`P��`\ LOT-30 1/2 Plastic 115 1 10.94 9.53 23 I ''wn- zx f' SUBMITTAL INFORMATION e - Stainless steel pump shell and pump shalt - Powered by A N.icDonald submersible motors 112.liP, - Reinforced Thermoplastic diffusers and impellers - 11/4"FNPT Discharge - Thermoplastic intake screen and cable guard . NO-LEAD:The weighted average of the wetted surface of this no-lead product contacted by consumable water contains less than one quarter of one percent(0.25%)lead. 4.i.,' .''...s-, Lowridge Onsite Technologies.inc. Toll free:1-877-476-8823 dave@Iowridgetech.com - P.O.Box 1179 Fax:1-425-335-3622 oscaronsite.corn 4 r Lake Stevens,WA 98258 • A.Y.McDonald considers the Information on this assembly drawing correct when published.item and option availability,including specifications,are subject to change without notice. Submitted br: 1/2022 Installation/Maintenance Oscar -- II 1. Install audio/visual high water alarm. 2. Divert all storm water run-off away from septic system components. 3. No curtain(french) drains allowed within l Oft. of the up-slope edge of the drainfield and reserve area. 4. No curtain (french) drains allowed within 3Oft. of the down-slope edge of the drainfield and reserve area. 5. Have the System maintained in accordance with manufacturer's requirements. 6. All material and workmanship must meet County and State requirements. 7. Deviation from this approved design without prior approval from the Designer and Mason County Health Department will make this design null and void. 8. 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. 9. Locate all utilities prior to starting installation. 10.A Final Inspection and Record Drawing fee will be charged upon completion of the installation. 11. The installer will notfy the designer, Dale Tahja (360)463-8023, 48 hours prior to the start of the installation. 12. An additional re-design fee may be charged if changes are requested from the applicant after the original design is approved. 13.All water line and sewer line crossings or areas where required separations can not be met, the Washington State Pipeline Separation Design and Installation Standards must be followed. , npn ,A - cr, 0q �9'tf cEB 2314VjV �LHG^Y'TH oy�asyy�0k) OOUN�V EN�IRONM��T 1 MASON07, 5100214 ��1 O Data L.Tahja - LICENSED DESIGNER • ft.wovsmove kwt