HomeMy WebLinkAboutSWG2026-00084 - SWG Application / Design - 3/25/2026 \ �\
iViASON COUNTY 415 N 6TH STREET,SHELTON, 98584
' SHELTON:360-427-967967 0,,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: SWG2026-00084
APPLICANT ASSENBERG AUTUMN Phone: 360-229-1578
Address: 7650 W SHELTON MATLOCK RD SHELTON, WA 98584-8989
OWNER ASSENBERG AUTUMN Phone: 360-229-1578
Address: 7650 W SHELTON MATLOCK RD SHELTON, WA 98584-8989
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
SEPTIC INSTALLER TAYLOR TONEY* Phone: 360-489-9169
Address: 2971 E PHILLIPS LAKE RD SHELTON, WA 98584
Site Address: 7650 W Shelton Matlock Rd
Primary Parcel Number: 420182100020
Permit Description: Repair-2BR pressure
Permit Submitted Date: 03/25/2026
Permit Issued Date: 05/06/2026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 03/31/2027 (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 USE ONLY
• MASON COUNTY DATE RECEIVED:
AMOUNT RECEIVED• RECEIVED BY:
Public Health & Human Servicesp D N
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 C N
415 N.6th Street-Shelton,WA 98584 S W G —
V�� O Z fn
z ON-SITE SEWAGE SYSTEM APPLICATION n v
M n
APPLICANT PHONE rn
AUTUMN ASSENBERG C/0 B-LINE 360-426-4221 z
C
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
7650 W SHELTON MATLOCK RD SHELTON WA 98584 m
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7650 W SHELTON MATLOCK R 4 S LTON WA 98584
SITE ADDRESS
NAME OF DESIGNER ONE I
CINDY WAITE n 360-701-0205
NAME OF INSTALLER PHONE O I
B-LINE CONSTRUCTION 360-426-4221
PERMIT TYPE(select one) f�i e�`� NNi1KING WATER SOURCE
W RESIDENTIAL OSS COMMUNITY OSS IO UCOM �IY�L O WJ PRIVATE INDIVIDUAL WELL p I1 PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(select one) J PUBLIC WATER SYSTEM I
uiNEW CONSTRUCTION/UPGRADES MREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I N
SUBMITTALS R1 SURFACING SEWAGE ❑ EXISTING FAILURE ❑SHORELINE
LYI.3DESIGN FORM(REQUIRED) I1]SEPTIC DESIGN(REQUIRED) BEDROOMS LOTSIZE WAS LOT CREATED AFTER 4/1/2025? W I -
0
WAIVER(S)(IF APPLICABLE) 3 10 AC ❑ YES ❑✓ Na 0 IO
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
GO OUT SHELTON MATLOCK ROAD, ADDRESS IS RIGHT AFTER THE DAYTON I o
STORE ON THE RIGHT, GO UP HILL, STAY TO THE LEFT TO THE END OF THE
DRIVEWAY. o 0
IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I CD
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE DCOMPLAINT DOTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
2a
RECORD DRAWNG AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS RE RED FOR FINAL APPROVAL.
7'w
SIGNAT DATE APPLICATION EXPIRATION DATE PPLIC TIO APPROVED/ISS D BY DATE
Ljl 1- 3 /
HIS RM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
DESIGN FORM PAGE ONE Assessor's Parcel Number:
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. J 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 pqper size: 11"X 17"
_ _ _-_- __ PARCEL IDENTIFICATION_
Permit Number: SWG Z O /' - d 1 Designer's Name: CINDY WAITE
Applicant's Name: AUTUMN ASSENBERG/B-LINE Designer's Phone Number: 360-701-0205
Mailing Address:
7650 W SHELTON MATLOCK RD Designer's Address: 80 E PICKERING LANE
SHELTON WA 98584 City State Zip SHELTON WA 98584
City State Zip Designer's Email
cindyewaite@msn.com
i DESIGNS-PARAMETERS-_ ._
Treatment Device
❑Glendon 0 Sand Filter ❑Mound O Sand Lined Drainfield ❑Recirculating Filter ❑ATU ❑Other
Treatment Level(check all that apply): ❑A ❑B ❑C ❑BL 1 0 BL2 ❑BL3 Yl E ❑N
Drainfield T
❑Gravity 'Pressure I(Trench d ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
NI
Number of Bedrooms 3 Sc Ie Clas�
SCHEDULE 40
Daily Flow:Operating Capacity 270 gpd L 34 ft
Daily Flow:Design Flow 360 gpd it 1.25 in
Septic Tank Capacity(working) 1200 gal r 6
Receiving Soil Type(1-6) 4 ptiy 9 ft
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 612 fl Total Numb. f Ori. ' 40
*
Designed Primary Area 600 ft2 Diameter ' �� ,y.� 3/16 in
Designed Reserve Area 600 ft2 Spaci - 60 in
<`�- acs
Trench/Bed Width nifold
51ens.'t>3 ``� 3< SCHEDULE 40
Trench/Bed Length 204 ft Sc e/ Y E.wAi'IE.. `f?r,:
LICENSED DE.IGNER - 1-2 ft
Elevation Measurements
Original Drainfield Area Slope
71 % Di Lxi'IRES 05,101
Diameter
2 in
New Slope,If Altered % Preferred manifold configuration used? l 'Yes O No
Depth of Excavation Up-slope 6 in Transport Pipe
from Original Grade Down slope 6 is ch uler, 1 s : �:?- SCHEDULE 40
;to �
Designed Vertical Separation 24 d' Length 40 ft
_.
", 1"IJ amt 2.026 2 in�r '
Gravel-based Drainfield Required? d Yes ❑No �{ 0
Pump Required? Rf Yes ❑No MASON CO TY ENVIRONMENTAand Pump Chamber
Pump/Siphon Specifications Nur@ordoses/day 6
Diff.in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1275 gal �\ >
Uppermost Orifice I!IHigher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 24.78 gpm 9 Timer Rf Elapse Meter Event Counter
Calculated Total Pressure Head 8.43 ft If Timer: Pump on ,Pump off
Comments
EXTREME CARE ON CLEARING AREA OF DRAINFIELD, SYSTEM NEEDS TO BE IN THE TOP 6"
OF ORIGINAL SOIL, PUMP CONTROLS TO BE SET AT TIME OF INSTALLATION FOR 270 GPD
Revised:6/11/2025 /.
DESIGN FORM-PAGE TWO
Assessor's Parcel Number: 4 ( 21 0 1 i 81 2111 0 I 0 U!_ 11 U
Permit Number: SWG Z.G Z6 —
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
R Test hole locations C . Drainfield orientation and layout Reference depth from original grade:
Soil logs Trench/bed dimensions and % Septic tank
ft{( Property lines critical distances within layout , Drainfield cover
IA Existing and proposed wells ft D-Box/Valve box loin Reference depth from original grade
within 100 ft of property Septic tank/pump chamber and restrictive strata:
Measurements to cuts,banks,and locations A Laterals,trench/bed,top and
surface water and critical areas Observation port location bottom
l, "Location and orientation of °17. Clean-out location 0 Curtain drain collector
curtain drain and all absorption ] Manifold placement 0 Sand augmentation
components -A Orifice placement Other cross-section detail:
M Location and dimension of Lateral placement with distance 1 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
Buildings ' Audible/visual alarm referenced Yes No
�
Direction of slope indicator 1 w. . Scale of drav�ng si own on scale ) 0 Design staked out
Waterlines bar ❑ 0 Recorded Notices attached
Roads,easements,driveways, ❑ 0 Waivers attached
, ,lev ion benchmark and relativeWaiver(s)
0 Pump curve attached
parking ,;" �vLoL�yno,_ .;v ents 0 ❑ Evaluation of failure
North arrow and scale drawing
shown on scale bar .'k MAY 062026 Non-residential justification
❑ 0 Waste strength
M SON COUNTY ENVIRONMENTAL HEALTH ❑ ❑ Flow
DES G,-APPROVAL.
The undersigned designer must be notified installer at time of installation i .Yes ❑ No
3 J262,(0
Signature o Designer Date
The undersigned has reviewed this ign on behalf of Mason County Public Health and determined it to be in
compliance with state and local o -sit regulations:
As W(uj���
— � Zee
Env ron t Health Specialist Date
CAUTION: DESIGN APPR VAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. �
if' 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
7650 W Shelton Matlock Rd, Shelton,WA 98584, USA,West Mason Township, Parcel Id: 4201821
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Parcel Lines Buffer 5 ft Il
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GIS Legend
Parcel Lines Buffer 5 ft
WA Mason 10 ft_Contours i __ - - -- -
- A
T1 Mobil home .
2 Out building �_ 1
3 1200 gallon septic tank BENCHMARK
4 1200 gallon pump tank Foundation 1 100.00
iI
5 Decommissioed existing septic tan Septic tank 2 99.50 0
6 Audio/visual alarm I Pump Tank 3 99.00
7 Clean out Bottome of drainfield.j� 4 99.50,
- �—
g Primary Reserve Drainfield _
9 Transport line TLI
10 Well
11 Waterline 1 %'t�`
flflflF
)MAY 06 2026 rx .a:,
MASON COUNTY ENVIRONMENTAL HEALTH
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1. QO I ✓sue'
32.
1 SL D- Q " /
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Mobil home I -
------------- - -
2 Outbuilding
1200 allon se tic tank BENCHMARK
3 --- -- �g - - Foundation 1
4 1200 gallon pump tank --
e ic
5 Decommissioed existing septic tan 1t tank
6 :Audio/visual alarm Pump Tank- - - — --
- 7 Clean out Bottome of drainfi!i ;
8 Primary Reserve Drainfield
9 Transport line
10 Well
11 Waterline � .
CI" WAITE
E''GNER LICE
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ORIFICE SPACING 5
Lateral# Length Length Orifice # Distance from Distance from end Length#
# (Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 34 408 60 7 2 2 34
2 34 408 60 7 2 2 34
3 34 408 60 7 2 2 34
4 34 408 60 7 2 2 34
5 34 408 60 7 2 2 34
6 34 408 60 7 2 2 34
204 42 204
TRANS LENGTH 40
GPM I 24.78
K (2"SCHEDU LEN 40) 284.5;
FRICTION LOSS 0.437618'
Squirt 2
Elevation difference 6
TDH 8.437618
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TRENCH CROSS SECTION
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DRAINFIELD LAYOUT
I - - - - A
6a2� F��N
_® �� MPsoN co
---- / - .._..--
IJ!Li. i,\
X1=CLEANOUT/OBS PORTS (L) ` •
X2=D BOX/VALVE BOX o Cis .
LICE' 'cD ac�GNER
X3=Check Valves
X4=Flow Control Valves C��
. Drainfield Control Box(Sloping Ground, Manifold Below Laterals)
RISERWITH LOCKING UD
TO DRAINFIELD
PRESSURELA1E1W
A
A
tf
FLOWCOMROLVALVE
SLO1SAS
REQWRED
FLAPCHECK %\
O O O /
p�OGR�a iE.Wow= o I �j/� gj Qo° o r\
WASHEDROCK SECTION A-A
OR.N StW
TRANSPORTPIP6FR \ '
PUMPCHANtEIEdt
per' CINDY EITE ��.' r `v�
LICENSED DFSI E
LYWIRL% Jc 10.
g1o�
THREADED CAP OR PLUG
p IY& Q" ' 6"PVC
LAST ORIFICE;WITH
ORIFICE SHIELDS IF
ORIFICE ORIENTATION IS
BACKFILL i UPWARD
MATERIAL 6' -24"
ACCIlp0Q�00 ---�
f\�°pO°g� 0000°00 0
'-- PRESSURE LATERAL
PVC HOSE OR \�\\ ° ° o0°opt 0 0000 AS SPECIFIED
LONG SWEEP \/
ELBOW O 0 �\
DRAIN ROCK;6"MIN.
UNDISTURBED SOIL --/
6"PVC WITH DRAIN
HOLES; EXTEND TO
BOTTOM OF GRAVEL TO
MONITOR PONDIN
INFILTRATIVE SURFACE ::jr!c 1t..r.:\
O
LICENSED D N TORING/CLEAN0UT PORT `.�
( PLE) SONc-.
EXPIRES GSnOi
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zoo
SECURED LID WITH GAS TIGHT SEAL •
1 24•DIAMETER
ACCESS RISER
FINISH GRADE
- - -�TO PUMP
CHAMBER
FROM SEWAGE
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS
IC c
Tye
��PT ANK
Ys 6 2026
r�°sr V�AY 0
SECURE ID WITH GAS TIGHT SEAL NVIR0NMENTAL HEAD'
MASON READNQ1D.
24'DIAMETER
ACCESS RISER
FINISH GRADE SERVICE
VALVE*
FROM SEPTIC �Z i
TANK TO DRAINFIELD
EMERGENCY STORAGE
ANTI SIPHON
HIGH WATER ALARM VALVE*
WORKING VOLUME INDEPENDENT
NORMAL TIMER OFF L _
--- ----- FOR FLOAT
ENCLOSED PUMP MOUNTING
SEDIMENT SHROUD* CHECK VALVE
SEDIMENTS SUBMERSIBLE
".;p CENTRIFUGAL
�� aaae \'. ;; PUMP CHAM9ER PUMP
I T►" 61.E .s
*AS NEEDED
EXPIRES 5/Q, I�O / J
Pump Specifications
250-Series Submersible
Sump / Effluent Pump
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Installation Notes
Pressure Distribution System:
42018-21-00026 7650 W Shelton Matlock Rd
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. Installer to contact the designer prior to starting installation.
3. Installer to contact the designer for final inspection
4. Extreme care to be taken on clearing the property
5. Concrete tanks required
6. Gravel based drainfield required
7. Keep wheeled vehicles off the drainfield area before, during and after installation.
tracked equipment only
8. 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.
9. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the
drainfield
10. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield. _
11. Install access risers on the septic tanks, valve box and ends of laterals.
12. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
13. Septic tank can be moved but must meet required setbacks.
14. Pump controls to be set at 270 GPO
15. Lids must form a water and gas tight seal with the access risers.
16. Install effluent filter at the septic tank outlet.
17. This system must be installed by a Mason County Certified installer.
18. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
19. 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.
20. Install laterals with contour of the ground.
21. Install trench bottoms level and always maintain a minimum of six inches into native
soil..
22. Filter fabric required over drain rock prior to backfilling. If the drain rock extends
above the original grade, run the f ,;a ric at least 2 i ches down the trench wall
into original grade. `'
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51004.1
O� CINDY E WAIT F�.
LICENSED DESIGNER
System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank 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. Keep the flow of sewage at or below the approved design operating capacity.
7. Keep waste strength at residential waste strength parameters.
8. Spread loads of laundry through the week.
9. Do not use excessive bleach or detergents with added whiteners.
10. Do not shower, do laundry and dishwasher at the same time
11. Antibiotics can kill or impair the biological process in the septic tank.
12. Leaky plumbing can hydraulic overload your on-site septic system.
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O CIN WAIT
LICENSE