HomeMy WebLinkAboutSWG2026-00045 - SWG Application / Design - 2/20/2026 . 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: SWG2026-00045
APPLICANT BADACZEWSKI MARTA ELSIE Phone: 1.248.497.3091
Address: 20 NE BARTLETT PL TAHUYA, WA 98588
OWNER BADACZEWSKI MARTA ELSIE Phone: 1.248.497.3091
Address: 20 NE BARTLETT PL TAHUYA, WA 98588
SEWAGE DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 20 NE Bartlett PI
Primary Parcel Number: 223305000371
Permit Description: new sfr 3BR pressure
Permit Submitted Date: 02/20/2026
Permit Issued Date: 03/11/2026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $570.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/20/2029 (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.
8 Septic system must be placed within the front 200'of the property or otherwise be re-
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reviewed by Mason County Planning.
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
Ca
1, DATE RECEIVED:
• -m• A N NTY
I' ■�_ ' J AMOUNT RECEIVED: RECEIVED BY: C
co
Public Health & Human Services 5 i� CO CD
/ Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 - O
415 N.6th Street-Shelton,WA 98584 SV1/G aoo� �\
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ON-SITE SEWAGE SYSTEM APPLICATION
mAPPLICANT PHONE m
MARTA BADACZEWSKI 248-497-3091 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E
20 N E BARTLETT PL • TAHUYA WA 98588 rn
SITE ADDRESS-STREET,CITY,ZIP CODE •
20 N E BARTLETT PL TAHUYA WA 98588 I ►`'
NAME OF DESIGNER PHONE I N
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE v I W
ra
PERMIT TYPE(select one) DRINKING IN; WATER SOURCE �� -
K RESIDENTIAL OSS 51COMMUNITY OSS I�COMMERCIAL OSS E PRIVATE INDIVIDUAL WELL Wr�1 PRIVATE TWO-PARTY WELL Z I c)
TYPE OF WORK(select one) PUBLIC WATER SYSTEM I
f lI.NEW CONSTRUCTION/UPGRADES D-1REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE X REPAIR I CP
SUBMITTALS � 0 SURFACING SEWAGE 0 EXISTING FAILURE O SHORELINE CO
RDESIGN FORM(REQUIRED) IwUSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? O I
ci
ffIWAIVER(S)(IF APPLICABLE) 3 .65 AC ❑ YES ❑✓ NO Z I
O
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I
GO NORTH ON HWY 3 TO BELFAIR, TURN LEFT ONTO OLD BELFAIR HWY,TURN LEFT I o
ONTO HWY 300, TURN RIGHT ONTO BELFAIR TAHUYA RD, GO TOWARDS HAVEN RD, r
TURN RIGHT ONTO BARLETT PL, PARCEL IS ON THE RIGHT SIDE OF ROAD, TRAVEL o (')
TRAILER ON SITE, HOLES ARE TOWARDS THE BACK OF THE TRAVEL TRAILER I
SITE MUST BE FLAGGED FR 6477 MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. S
OFFICIAL USE ONLY BELOWTHIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
.\-&)1 6°1'6
--(°.(7, Ll(
0v2
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.
IN CT R IGNATURE DATE APPLICATION EXPIRATION DATE AP (CATION APPROVED/ISSUED BY DATE
�g .,7.../.;161 - P)-2D - i kl- (°
T S F MAY BE SCANNED AND AVAILABLE FOR PUBSIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: I 2 2 13 l• 3 1 5 0 0 0 I 3 7 1
A design will be reviewed when 3 copies of each of the following are submitted:
d 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. d 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 Designer's Name: CINDY WAITE
Applicant's Name: MARTA BADACZEWSKI Designer's Phone Number: 360-701-0205
Mailing Address: 20 N E BARTLETT PL Designer's Address: 80 E PICKERING LANE
TAHUYA WA 98588 City State Zip SHELTON WA 98584
City State Zip Designer's Email cindyewaite@msn.com
DESIGN PARAMETERS
Treatment Device
❑Glendon O Sand Filter O Mound O Sand Lined Drainfield O Recirculating Filter O ATU O Other
Treatment Level(check all that apply): O A O B O C O BL1 O BL2 O BL3 IE O N
Drainfield Type
❑Gravity liPressure li r Trench O Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class SCHEDULE 40
Daily Flow: Operating Capacity 270 gpd Length 50 ft
Daily Flow: Design Flow 360 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1200 gal Number 4
Receiving Soil Type(1-6) 4 Separation 9 ft
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices 40
Designed Primary Area 600 ft2 Diameter 3/16 in
Designed Reserve Area 600 ft2 Spacing - 60 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Cl , ' SCHEDULE 40
44,'. I)
Elevation Measurements Length s,r F9 1-2 ft
4
Original Drainfield Area Slope 3 % Diamet ��a . .- "I)O 2 in
New Slope, If Altered '/o 1 P6. nu.' _onfi 'on used? 21 Yes O No
s
Ati �' � Y„ CF � .51 fi, r114,
Depth of Excavation Up-slope 7 n 44L ..•O, LIC I Np • '' '. port Pipe
from Original Grade ' °" - CHEDULE 40
g Down-slope 6 Fr 1n AAi r on4Ls
Designed Vertical Separation 24 IIO�, N• ength Pr'' 40 ft
Gravel-based Drainfield Required? O Yes vv �gN L 7'le NoA
��}\� '� �)�J` ��i�ter� � ��,N 2 in
x .
Pump Required? Yes O N , I'>+� p sing and Pump Chamber
MAR � i 2��.G� v�,�,;
Pump/Siphon Specifications MASON C Number of doses/da' 6
�UNTY E VV�RON F iT-; �`"
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantif r]EALTH 45 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1455 gal
Uppermost Orifice O Higher NILower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 23.6 gpm g Timer i1 Elapse Meter [it Event Counter
Calculated Total Pressure Head 6.39 ft If Timer: Pump on ,Pump off
Comments
USE EXTREME CARE WHILE CLEARING, DESIGNER AND INSTALLER TO MEET ON SITE TO LAY OUT LATERALS WHEN I VI
CLEARING IS COMPLETE, CONTROL PANEL TO BE SET AT TIME OFINSTALLATION AT
270 GPD
Revised: 6/11/2025
DESIGN.FORM=PAGE TWO Assessor's Parcel Number:_? 121313I 1 2 1 3 1 3 1 1 1 5 0 01 01 3 j 71 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
ill Test hole locations ix Drainfield orientation and layout Reference depth from original grade:
fit Soil logs li Trench/bed dimensions and Q( Septic tank
Cilf Property lines critical distances within layout t Drainfield cover
1g Existing and proposed wells IX D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 1t Septic tank/pump chamber and restrictive strata:
. Measurements to cuts, banks,and locations f7lvfr "11444'
gr-'- surface water and critical areas Laterals,trench/bed,top and
' Observation port location bottom
k,Location and orientation of il Clean-out location 0 Curtain drain collector
curtain drain and all absorption It Manifold placement 0 Sand augmentation
components
ci Orifice placement Other cross-section detail:
it Location and dimension of Observation ports/clean-outs
primary system and reserve area Lateral placement with distance
to edge of bed LI Buildings Other Information
gr Audible/visual 4larm referenced Yes No
it Direction of slope indicator X�10
Q( Scale of deawing shown on scale 0 iiDesign staked out
it1 Waterlines bar 0 0 Recorded Notices attached
gr Roads, easements,driveways, ✓ Elevation benchmark and relative O O Waiver(s)attached
!
parking elevations of system components O Pump curve attached
ill North arrow aiid al dr dad, in �( U -, t,� , O 0 Evaluation of failure
shown on scal bar L ! 4 0 1 -u Non-residential justification
MAR 9 202 . f 4,
MAR 0 0 20? � µ/)o 00 F owe strength
MAsnMi rnH ITV r-1,11/1r,,,,.,
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�I , ,_ni,,�r�aUNIc� ALL HEAL' ' � 'idi" `' V'' .TAL HEALTH
I y/J IR 2+ -RI tri:ill In
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The undersigned designer must be notif d by installer at time of installation I 'Yes O No
iyj 6,1,4 31 Letl2-®7-4
Signatur 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 . - site regulations:
1 WNPM ‘)4OP
En ir nr a i I ealth Specialist Date
CAUTION: DESIGN APPRO AL 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: �� ''�0
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
lAllt
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
20 NE Bartlett PI, Tahuya,WA 98588, USA, Belfair-Tahvya Townsh p, Parcel Id: 223305000371
:_.,m 1 Proposed residence
2 Audio/Visual alarm
•
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' �_ —1—_ I lean out —
r(":)- � BENCH MARK I I 4 1 1200 septic t ----1— -?
c Z: TAr F`�q��ill '4 '. Foundation — p p p k
I 1 j 100.001 5 1200 um
.� Septic tank I
2 99.50 _ Trans -
a �D . ..o,.•., -b,: Pump Yank I 3j 99.00 Port line
• d __ Valve box
• m Bottom of sand drain 4j 98.50
� s . w� I 5( _ 8 Primary Reserve dr f Id
®' .. 9 Owners well
`�f 10 Waterline I—
_11 Neighbors well
, 64,, 4 toy ' .I �1 ` _, - "'c- O c-- cr- rA.--.:t :y_' I 5----e,/-4c.. trio
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WA Mason loft. Contours 0, - " NV
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Scale= 1 in ft 40 's '1
DRAINFIELD LAYOUT
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X1=CLEANOUT/OBS PORTS('i) er5' 151q 1418t 1.I 's,',• •.
X2=D BOXNALVE BOX (I ) O` ENSEDCINDYi � AIDE'. .`
LICENSED •
LDESIGNER
X3=Check Valves 14' I. n! 1,1 al v° bdi ,....--,:-.v%----.
X4=Flow Control Valves eni ri a z/-a sd'i &q,-
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7) ‘11
- ` MAR 1 1 2 �7 4` 1I--1
MASON COUNTY ENVIRONiv1EN TAL HEALTH
ORIFICE SPACING 5
Lateral# Length Length Orifice # Distance from Distance from end Length#
# (Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 50 600 60 10 2.5 2.5 50
2 50 600 60 10 2.5 2.5 50
3 50 600 60 10 2.5 2.5 50
4 50 600 60 10 2.5 2.5 50
200 40 200
• TRANS LENGTH H 40
GPM I 223.g
K (2"SCHEDULEN 40).; 284.5;
FRICTION LOSS i i'0:3998'481
Squirt I 2
Elevation difference 4 '
I TDH 6.3998481.
- .I MAR 9 1 ^� ,D Y(t'i t. I.ESIGNER
MASON COUNTY ENVIRONMcNTA!HE-,�T� • ~
TRENCH CROSS SECTION vr,,
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l ' .._ - ,,,..C.Z,V-4....1,Al-diL.---t-pg,,,,ade
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6"PVC
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' !k LAST ORIFICE;WITH
ORIFICE SHIELDS IF
ORIFICE ORIENTATION IS
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BACKFILL 4,, �,�I UPWARD
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�— PRESSURE LATERAL
�\\< oO10 ° [0:676,310,7'0
oOQo°o AS SPECIFIED
PVC HOSE OR \\ , r o 0
LONG SWEEP \-�" , ', DRAIN ROCK;6"MW.
\-.„,...\-. \i'~.,,, \�.. �'�/, �'' QELow PIPE
UNDISTURBED SOIL
6"PVC WITH.DRAIN
HOLES; EXTEND TO
BOTTOM OF GRAVEL TO
MONITOR PONDING
(-_‘ ,, ,3019
„Crkle _ INFILTRATIVE SURFACE, L' .‘J VA\ '
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M:ONrTGRIN:GICLEANOUT PORT '-
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COUNTY CNVIRO/,,l,lENT.i
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. Drainfield Control'Box(Sloping,Ground; Manifold Below Laterals)
RISERWITRLOCIUNG LID
TO ORAINFIELU
PREESSURELAZERALS.
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. G ` ' :, FLOWGON RQLVALVE
1 A, U' SLOTSAS
REQUIRED
Vii'
I a I n. FLAP CHECK ti+/.�''� rl.r
t I VALVE c'" 'l`t. '�R'�`f
LONG SWEEP 90 1 ��1 f7 ' X10 0`0,1) I �, iA,
DEGREE ELBOW' 0 �" iao oaf °��n� �a`\�N.IL SECTION IAA
WASHED ROCK
' ORAINSUMP
`1__ TRANSPORTPIPEFRQM
PUMP CHAMBER
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LID WITH TIGHTSEAL
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ACCESS'RISER \
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FINISH.GRADE
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ER061'SEWAGE /
moo
CHAMBER
SOURCE if ' FLOATING MAT
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APPROVEQ
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EFFLUENT'
FILTER'.
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SEDIMENTS: I I '
SEPTIC TANK
klypicALI
SECUREIV.ID,WITH,GAST,IGHT SEAL
THREADED UNION
,` "ACCESS,
�' ACCESS,RI$ER' •FINISH'GRADE ----r, SERVICE
, ,, r_` VALVE*
FROM SEPTIC' L�L i'-
' TANK �i�q'! iuu��n
f k TO DRAINEIEI:D.
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EMERGENCY'&TORAGE I
I' i ANTI SIPHON
HIGH.WATER ALARM:LEVEL - r VALVE*
1
I
WORKING VOLUME INDEPENDENT
FLOAT STEM
NORMAL TIMER OFF LEVEL. I ,--. _--- _�.
Q; ' — FOR FLOAT
ENCLOSED:PUMP MOUNTING
SEDIMENT SHROUD" CHECK VALUE'
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1:8" •F , I
,Q SEDIMENTS ''UUI'�P —1,� 3U8MER918LE.
-o. CENTRIFUGAL
It
��e .Isl4ti 9�'li s� PUMP
u•_1 PUMP CHAMBER S'
kX . (TYPICAL) ? " 64. o
� €„_''''V;g �� *AS NEEDED
• O CINDY E WgITE ?�:
LICENSED DESIGNER •
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MASON COUNTY ENVIRONMENTAL HEALTH r
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Pump Specifications :
I
250-Series Submersible
Sump / Effluent Pump ���' '`
LITERS PER MINUTE
0' 20 40 60 80 100 120 140 160 180
25 4 I I I I I I I I
- 7
20
- 6
- 5
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LICcE.NNSSF�7• DE..;.::; CR \I'l
{ - 6 I o:( , 1i`r /.,'-'4 i110.,.420 30 40, 50 0
TO U I ti13 `4t3) 'g L.-.:, I r_l
"d 0 ,, GALLONS PER MINUTE
MAR 11 2r�r ,
ht p� t.:.,,1,
250_ /bl�f��UNTY Eh�1renieI�IV$ bg-A4 mns Inc. All rights reserved. Specifications subject to change without notice. *
I�I}{� 711,[S(11 Il LI Pumps
Installation Notes
Pressure Distribution System
20 N E Bartlett PI 22330-50-00371
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 E. Extreme care in clearing drainfield area.
3. Installer and designer to meet on site after clearing to stake out the drainfield.
4. Concrete tanks required
5. Case transport line if going under driveways or parking area.
6. Keep wheeled vehicles off the drainfield area before, during and after installation. Tracked
equipment only,
7. 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.
8. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the drainfield
9. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
10. Install access risers on the septic tanks, valve box and ends of laterals.
11. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
12. Lids must form a water and gas tight seal with the access risers
13. Install effluent filter specified in this design at the septic tank outlet.
14. This system must be installed by a Mason County Certified installer.
15. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
16. 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.
17. Install laterals with contour of the ground
18. Install trench bottoms level and always maintain a minimum of six inches into native soil
19. Install locator tape on top of all drainfield laterals.
20. Install threaded clean outs at the ends of all laterals (caps must extend to within six inches
of finish grade and be in a valve box as shown on diagram.
21. Install audio/visual alarm
122. Filter fabric required over drain rock prior ackfilling. If the drain rock extends
above the original grade, run the filter fab ' east 2 inches down the trench wall.
44' 11
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AR I f zd c} , J •i ! DIGNER
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MASON COUNTY ENVIRONMENTAL ' ._.
�1ENTAL HEAL;H �.sc ,I
System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septictank and pump tank should be pumped every three to five years or as
needed.
3. System owners are responsible for having maintenance performed annually.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owners shall not at any time change or alter settings in the control box.
6. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
7. Keep the flow of sewage at or below the approved design operating capacity.
8. Keep waste strength at residential waste strength parameters.
9. Spread loads of laundry through the week.
10. Do not use excessive bleach or detergents with added whiteners.
11. Do not shower, do laundry and dishwasher at the same time
12. Antibiotics can kill or impair the biological process in the septic tank.
13. Leaky plumbing can hydraulic overload your on-site septic system.
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O CIN; ,'i. WAITE 'i
LICE'Ir.i r,DESIGNER
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MASON COUNTY ENVIRpNMENTAI6'64 . '
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