HomeMy WebLinkAboutSWG2025-00294 - SWG Application / Design - 7/26/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,427967 , 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: SWG2025-00294
APPLICANT Ambrose/McCurdy Phone:
Address: 52 E Shady Valley Ln ALLYN, WA 98524
CONTACT Needham, David Phone: 3608654450
Address: 15435 Olympic View Rd NW Silverdale, WA 98383
SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck, WA 98380
Site Address: 52 E Shady Valley Ln
Primary Parcel Number: 122085003004
Permit Description: Replace existing root bound drainfield
Permit Submitted Date: 07/26/2025
Permit Issued Date: 03/24/2026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/12/2028 (based on date of inspection)
Permit Conditions:
I 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 U EONLY
OIVL) E
1
MASON COUNTY ArERSCVF71 _6
a ` Public Health & Human Services CD
I � R BY:
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Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 /'�
415 N.6th Street-Shelton,WA 98584 SWG - 009.9 Oa9 , 0 0
ON-SITE SEWAGE SYSTEM APPLICAi I®N
it
APPLICANT I HONE
Ambrose/McCurdy r z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE ^ C
52 E Shady Valley Ln, Belfair Wa 98524 (JAL 2 Z0Z5 o m
SITE ADDRESS-STREET,CITY,ZIP CODE
52 E Shady Valley Ln, Belfair Wa 98524 �y �--
NAME OF DESIGNER HONE N
Jim Zimny 360-516-7287
NAME OF INSTALLER HONE (7 I N
PERMIT TYPE(select one) DRINKINGV TER SOURCE I
M RESIDENTIAL OSS Fl COMMUNITY OSS iFl COMMERCIAL OSS C1 PRIV TE INDIVIDUAL WELL 10 PRIV T TWO-PARTY WELL z
TYPE OFWORK(selectone) PUB IC WATER SYSTEM
NEW CONSTRUCTION/UPGRADES h REPAIR/REPLACEMENT OTHER DET ILS(select all that apply) ❑ TABL REPAIR I�
SUBMITTALS ❑SUR ACING SEWAGE ® EXISTING F ILURE ❑SHORELINE
❑✓ DESIGN FORM(REQUIRED) v❑SEPTIC DESIGN(REQUIRED) BEDROOMS I LOT SIZE WAS L T CREATED AFTER 411!2025? 0
❑ WAIVER(S)(IF APPLICABLE) 2 .97 Acres ®✓ S ®NO n
IDIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I 4
From Shelton take hwy 3 north 18 miles to Shady Vail y Ln on the right. Fc II W to the stop I.nt
sign and go straight down the dirt drive and follow to t e property ont�he rig . Site is r
marked with pink ribbons. o 14
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SITE MUST BE FLAGGED FROM MA IN ROAD AND TEST HOLES MUST BE FLAGGED WiTh TEST HOLE VMERS. (y
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OFFICIAL USE ONLY BELO VTHIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCEIPUMPING ❑BUILDING PERMIT ❑HOME SAL ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS CO14ENTS/CO D TIONS
4;.1
SOIL CODES: REC RD DRAWI G AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R RO S REQ 12ED FOR I AL APPROVAL.
I ECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE�/ APPL I N APP VED!IS UED BY DATE
THI FOR AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON CO NT?WEBSITE I ! Revised:6/3/2025
I jaw
DESIGN FORM—PAGE ONE Assessor's Parc l Number: 1 2 2 0 8 5 0 0 3 0 0 4
A design will be reviewed when 3 copies of each of the following are s ibmitted:
`'Completed design form that has been signed and dated. `'Scaled layout sketch,including all plicable items on checklist.
Scaled plot plan,including all applicable items on checklist. 0 Cross- ection sketch. inch ding all i plicable items on checklist.
This form may be scanned and available for public view on the M son County Web site.Max 7 wn paper size: 11"X 17"
PARCEL IDENTIF CATION
Permit Number: SWG Designer'sJame: Jim myn
Applicant's Name: Ambrose/McCurdy Designer's hone Number: 360- 6-7287
Mailing Address: 52 E Shady Valley Ln Designer's ddress: j717ir indflower pl NW
Belfair WA 98528 City S to Zip 'Seab k wa 98380
City State Zip Designer's mail APD I SIGNS&iCloud.com
DESIGN PARAMETERS
1
Treatment Devi e
❑Glendon ❑ Sand Filter O Mound O Sand Lined Drainfield ❑Recirculating Filter ❑ i TU ❑Other
Treatment Level(check all that apply): ❑A ❑B ❑ C ❑BLl BL2 O BL3 [ O_E N
Drainfield T rpe
V'Gravity O Pressure O Trench @1'Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications La e als
Number of Bedrooms 2 Sche ale/Class 13034
Daily Flow: Operating Capacity 180 gpd Lengt 45 ft
Daily Flow: Design Flow 270 gpd Diam ter 4" in
Septic Tank Capacity(working) 1000 gal Numi er 3
Receiving Soil Type(1-6) 3 Separ tion 36" etc ft
Receiving Soil Appl.Rate 0.8 gpd/ft'- Or ces
Required Primary Area 400 ft2 Total 4umber of Orifices NA
Designed Primary Area 400 ft2 Diam ter in
Designed Reserve Area 400 ft2 S aci
in
Trench/Bed Width 9 ft p hP Mai old
Trench/Bed Length 45 ft Sche ile ss•`' ° NA
Elevation Measurements Lengt o 03 r it
LICENS
ti rIG
Original Drainfield Area Slope 0 % Dia .s N R in
New Slope,If Altered 0 % Prefe •ed maaniiold configuration i ed? ❑Yes ❑No
Depth of Excavation Up-slope 6" in
'Frans Pipe
from Original Grade Doxmi-slope 6"
in Sche le/Class 3034
Designed Vertical Separation 36" in Lengt i 80' ft
Gravel-based Drainfield Required? O Yes 21 No Diam ter 4 in
Pump Required? ❑Yes P'No Dosing and P np Chamber
Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose uantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chan er Capacity (floo ) gal
Uppermost Orifice fl Higher O Lower than Pump Shutoff Pump controls:Please cl Ick thos equired.
Capacity @ Total Pressure Head gpm Timer O Elapse ter O Event Counter
Calculated Total Pressure Head ft If Tim er: Pump on ,Pump off
Comments
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MASON COUNTY RPvi ed rn 1»m c
NVIRONMENTn1 ucAlT.,
DESIGN FORM—PAGE TWO Assessor's Parc l Number: 1 2; 2 0 5 0 03 0 0 4
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sket h Cross- ction Sketch
Test hole locations r' Drainfield orientat on and layout Refere c depth from original grade:
Soil logs g Trench/bed dimen ions and eptic tank
Er Property lines critical distances,"ithin layout rainfield cover
@f Existing and proposed wells D-Box/Valve box oeations
p p Refere c depth from original grade
within 100 ft of property g' Septic tank/pump hamber rind res 'ctive strata:
' Measurements to cuts,banks,and locations aterals,trench/bed,top and
surface water and critical areas V Observation port 1 cation ottom
Qf Location and orientation of Clean-out location ❑ urtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ and augmentation
components 0 Orifice placement Other c ss-section detail:
V' Location and dimension of Lateral placement vith distance fib bservation ports/clean-outs
primary system and reserve area to edge of bed
6e Buildings ther formation
Pf Audible/visual ala n referenced Yes No
ET Direction of slope indicator
Scale of drawing s own on scale L ❑ esign staked out
@ Waterlines bar b 0 ecorded Notices attached
V Roads,easements,driveways, ✓ Elevation benchma k and relative ❑ aiver(s) attached
parking elevation f system components 1P 0 imp curve attached
V North arrow and scale drawing ❑ ❑ aluation of failure
shown on scale bar
Non-re i lential justification
0 0 aste strength
F' VAL . :,s i.
The undersigned designer must be notified ins ller a time installation e es No
Signat of signer ate ;
The undersigned has reviewed this design on behalf of Mason ounty Public Health and d termined ft e in
compliance with state and local on4ie re ulations:
E iro n 1 Health Specialis Date
CAUTION: DESIGN APP OVAL IS VALID ONLY UN ER THE FOLK WIN CONDITION:
✓ The design is stamped "Approved"by Mason County Publi Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expi ation Date is:
✓ Drainfield site conditions have not been altered to adversel affect condition of desi approval.
Please Note: The system must be inst ,lled by a c ertif d installer,
unless prior authorization is obtained f om Mason Cot i ty Public Health.
An Installation Fee is required.
This form may be scanned and available for public view n the Mason Iunty b site.' Revised: 6/11/2025
i
TH#1- 0-42" LOAMY SAND v <.,
TYPE 3 SOIL '
TH#2- 0-49" LOAMY SAND
TYPE 3 SOIL
TH#3- 0-45" -LOAMY SAND -2!= -_
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TYPE 3 SOIL
1252' . 423.' el 213'
parking el 245'
Th# 45'
I /
2 4'
2 BRM 9'
O SFR Dec TH#2 p
0 2 '
so el 258'
reserve area
el 261' 423' eI 21t
LEGEND Datum NAD83
Bench Mark
- soil log
Design amp -
Applicant Info: — Property Line
Designer Info: - Power Line
JimZimny Ambrose/McCurdy ---- Water line
APD 52 E Shady Lane
7178 Windflower PL NW Belfair Date:
Seabeck.WA 98380 Scal e
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7/25/25
r� =_sicn #122085003004
1" - 50'
APDdesigns@icloud.com
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Construction Notes for Gravity Distribution bed for 2 edroom System:
Gravity Bed Distribution w/Rock and pipe (graveless Char bers may be substituted
Install 9 x 45' beds.
Install 4 outlet d-box with an outlet pipe going to each infi trator leg using seed le lers.
D box must have an access riser to the surface of the grou id.
Install 6" deep and level in trench
Install in dry weather only.
Use and certify existing 1000 Gallon septic with secured ri ers to the surface of the g ound.
System designed for typical residential waste strength se age only.
System designed for 240 Gallons Per Day
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MASON COON Y ENVIRONMENTAL
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County Stamp
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Bed Profile
Designer tamp
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• 45'
4„ 1, 181,
3034 Transport Line Designer Info:
3' O 9, Jim Zimny
APD
7') 3' 7178 Windflower PL NW
Seabeck,WA 98380
I N S P PORT APDdesigns�icloud.com
D box w/ Locking lid riser Applicant I
W ,kIJ cover tiG/ iP
LICENSENER
36" Vertical Seperation Ndtive soil Date;
7/25/2025
-Page
Scale
1" = 10'