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HomeMy WebLinkAboutSWG2026-00119 - SWG Application / Design - 4/22/2026 MVMASO N COUNTY 415 N 6TH STREET,SHELTON,97 ,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: SWG2026-00119 APPLICANT Jim Zimny Phone: 360-516-7287 Address: 7178 windflower pI nw Seabeck, WA 98380 OWNER MOORE BELINDA KAY Phone: 360-517-0976 Address: P O BOX 5153 BREMERTON,WA 98312 SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287 Address: 7178 windflower pl nw Seabeck,WA 98380 Site Address: UNKNOWN Primary Parcel Number: 123292200010 Permit Description: New 4bd gravity trench Permit Submitted Date: 04/22/2026 Permit Issued Date: 05/07/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $570.00 (additional fees may be required upon installation of system). Permit Expiration Date: 04/24/2029 (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. 8 Continue to work on closing the Enforcement Case 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 • l1ASON COUNTY "ATERECENED: • AMOUNT weVED: REffJVED BY: ublic Health & Human Services S 71O Uf�lll� � (gi! Co N vlronmental Health 360-427A670,ext.400 or 360-275-4467 ext.400 ��� _ O I N 0 4 5 N.6th Street-Shelton,WA 98584 O Z U1 ON-SITE SEWAGE SYSTEM APPLICATION APPLICANT PHONE rn M Belinda Moor 360-801-9125 z MAILING ADDRESS.STRE T,CITY,STATE,ZIP CODE P O BOX 515 , Belfair Wa 98528 m SITE ADDRESS-STREET ITY,ZIP CODE Fern Way, Bel air Wa 98528 I— NAME OF DESIGNER PHONE Jim Zlmny 360-516-7287 NAME OF INSTALLER PHONE PERMIT TYPE(select one) DRINKING WATER SOURCE N ^, JV I RESIDENTIAL OS F COMMUNITY OSS ,l COMMERCIAL OSS N PRIVATE INDIVIDUAL WELL f PRIVATE TWO-PARTY WELL TYPE OF WORK(select on )7 PUBLIC WATER SYSTEM NEW CONSTRU ON/UPGRADES rI REPAIR/REPLACEMENT OTHER DETAILS(select elf that apply) ❑ TABLE X REPAIR IN SUBMITTALS ❑SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE Q DESIGN FORM( EQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/20257 ❑ WAIVERS IF PLICABLE 4 0 ( )( > 2.5 Acres ��YEs �No � I DIRECTIONS TO SITE AND ITE CONDITIONS:(ex.locked gate) From Belfair t tke Northshore Rd 1.1 Miles to Sandhill rd and take rt. I p go .9 miles to fern Way and Take rt. take second driveway on left to the bottom of the hill and the site i flagged on the rt. test holes are flagged and seen from the red. SITE MUST BEFLAGGED F OM MAW ROAD AND TEST HOLES MUST BEFLAGGED WITH TEST HOLE NUMBERS ID OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOUR E(for reporting purposes) ❑VOLUNTARY ❑ AINTENANCE/PUMPING❑ BUILDING PERMIT❑HOME SALE❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS © S _ Z,J\ : Q — o L-'fiij LO ---12o'fr SOIL CODES: 0 S vf-/ ' RECORD DRAWING AND INSTALLATION REPORT V=VERY G=GRAVELLY S=SAND L=LOAM Si CL SILT C= VE=EXT 1 ELY R=ROOTS . REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE THIS FORM MAY BE SC NNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:01/09/2026 Dt.SIGN FOR —PAGE ONE Assessor's Parcel Number: 1 2 .3 2 , 2 2 0 0 0 1 0 A design will be re iewed when 3 copies of each of the following are submitted: ` Completed design orm that has been signed and dated. Scaled layout sketch,including all applicable items on checklist. Scaled plot plan,i luding all applicable items on checklist. Cross-section sketch,including all applicable items on checklist. This form i ay be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"X 17" PARCEL IDENTIFICATION Permit Number: SWG - CO Designer's Name: Jim Zimny Applicant's Name: Belinda Moore Designer's Phone Number: 360-516-7287 Mailing Address: P 0 BOX 5153, Designer's Address: 7178 Windflower PI NW IiiuI Belfair Wa 98528 City State Zip Seabeck,Wa 98380 . _________________ City State Zip Designer's Email apddesigns@icloud.com DESIGN PARAMETERS Treatment Device ❑Glendon ❑ Sa d Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter 0 ATU ❑Other Treatment Level check all that apply): ❑A ❑B ❑C ❑BLI ❑BL2 ❑BL3 VfE ❑N Drainfield Type V"Gravity ❑Pressure V'Trench 0 Bed 0 Sub Surface Drip Septic ank/Drainfield Specifications Laterals Number of Bedroos s 4 Schedule/Class 3034 Daily Flow: Operat g Capacity 360 gpd Length 50 ft Daily Flow: Design low 480 gpd Diameter 4" in Septic Tank Capaci (working) 1250 gal Number 4 Receiving Soil Typ (1-6) 3 Separation 6! ft Receiving Soil App Rate 0.8 gpd/ft2 Orifices Required Primary ea 600 ft2 Total Number of Otiflees N/A Designed Primary ma 600 ft2 Diameter in Designed Reserve i ea 600 ft2 Spacing h �'F in Trench/Bed Width 3 ft Trench/Bed Length 200 0 '033 ft Schedule/ s 3 „ =gym ' N/A LICE! DESI;t!ES E evation Measurements Length ft Original Drainfield rca Slope Q % Diameter in New Slope,If Alter d ( 4 % Preferred manifold configuration used? ❑Yes ❑No Depth of Excavatio Up-slope 32." in Transport Pipe from Original Grad I1-Slope S(3' in Schedule/Class 3034 Designed Vertical S paration 3 (y in Length 50' ft Gravel-based Drain eld Required? 0 Yes No Diameter 4" in Pump Required? ❑Yes IR-No Dosing and Pump Chamber Pu p/Siphon Specifications Number of doses/day Diff, in Elevation B tween Pump&Uppermost Orifice ft Dose quantity gal Drainfield Squirt H ightl Selected Residual(head) ft Chamber Capacity(flood) gal Uppermost Orifice I Higher ❑Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total P essure Head gpm O Timer ❑ Elapse Meter 0 Event Counter Calculated Total Pr ssure Head ft If Timer: Pump on �,4ump off Comments A P U ' ' MAY 0 7 2026 ERMEHATh RET Revised:6/1 1/2025 DESIGN FO —PAGE TWO Assessor's Parcel Number: 1 2 3 2 92 2 0 0 0 - 1 0 Permit Number: SWG S,O — l Ct DESIGN CHECKLISTS Scaled Plot P an Scaled Layout Sketch Cross-Section Sketch e Test hole 1 cations V Drainfield orientation and layout Reference depth from original grade: V Soil logs V Trench/bed dimensions and V Septic tank Q( Property li es critical distances within layout V Drainfield cover V Existing an proposed wells V D-Box/Valvc box locations Reference depth from original grade within 100 t of property V Septic tank/pump chamber and restrictive strata: Q( Measurem nts to cuts,banks, and locations V Laterals,trench/bed,top and surface wa er and critical areas Q( Observation port location bottom ❑ Location aid orientation of V Clean-out location 0 Curtain drain collector curtain dra 1 and all absorption 0 Manifold placement ❑ Sand augmentation component 0 Orifice placement Other cross-section detail: Q< Location at d dimension of O Lateral placement with distance V Observation ports/clean-outs primary sy tern and reserve area to edge of bed g Other Information Q( Buildings ❑ Audible/visual alarm referenced Yes No Qr Direction o slope indicator V Scale of drawing shown on scale ❑ VDesign staked out V( Waterlines bar ❑ ❑ Recorded Notices attached VRoads,eas ments,driveways, ' Elevation benc d rela - e 0 0 Waiver(s)attached parking elevations of sv ~� rents ❑ 0 Pump curve attached � 2 Q< North arro and scale drawing � .,� , ❑ ❑ Evaluation of failure shown on Cale bar � f Non-residential justification ❑ ❑Waste strength O Jnn I'r Zinuvt ' LICEN- .D 'Ea' mss:-2 ❑ ❑ Flow DESIGN APP OVAL The undersign d designer must be notified /install at time of installation VYes ❑ No 11 ' y 2G,2c0 Signature/ f Desifcer Date The undersigni d has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance wi i state and local on-site regulations: GG__ Environmental Health Sp cialist Date CAUTION: )ESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped "Approved"by Mason County Public Health. 1 I L ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ✓ Drainfield ite conditions have not been altered to adversely affect conditions of design approval. Please N te: The system must be installed by a certified installer, unless pr or authorization is obtained from Mason County Public Health. An Instal ration Fee is required. This form ma r be scanned and available for public view on the Mason County Web site. Revised:6/11/2025 251' 333' /' County Stamp o z c, ;,i•:b ; esign mp • •• OZ` 2012 J33 Proposed well IAas Alters Zfmny y, LIC dSED DESIG 1 ��• �• Yh.CR eT'z3 ' 30' o° \ / s. '>sJ ; Designer Info: \ Jim Zimny f APD eseve ar \ i 7178 WindflowerPLNW O ` i Seabeck,WA 98380 m el 0' ' m \`. mm APDdesigns@icloud.com m 1 `. 100' Well Radius, 19 T ------------ Applicant Info: Belinda Moore ® I Fern Way Belfair WA 98528 22 �LSN i #123292200010 �AgON G®�N� Date: LEGEND Dat NAD83 4/10/2026 Th#1 0-68" med loamy sand ©- Bench 'ark Page Th#2 0-64" med Loamy sand y sSe1I Th#3 0-58" med Loamy sand — Property one -•- Power'Li Th#2 0-59" med Loamy sand --- Water li Scale e1200' 333 Not A Survey i E1162' 1" = 40' Typical Trench Profile Typical D box and Riser Assembly County Stamp( 4"Clean out with removable cap Flow 6" Min Sandy Cover 4'303 e locking riser lid ac , s d levers Z'Min Trench Depth Designers Stamp Vertical Separation 4'3034 e ' l estrlct a layer or water table Jim Zimny Not Co Scale Advantage Perc&Design Not to Scale 7178 Windflower Pi,NW Seabeds,WA 98380' t360)516-7287 Applicant Info A AAAJAIAAA AA AAAAAAAAAAAAA AAAAAA AAAt AAA AJ (� Screw on fitting 4'Obsevatlon Port W/removable cap Sandy Cover r MateHal araa . ra Jr ��. Graveless Chamber Parcel Info -(�20=Z Co I23Z.`iZ2 Oaal Typical Side View gravity Graveiss chamber W/Observation/Clean Port APPROVED MAY 07 2026 Dom` 1 Z :Not To Scale MASON COUNTY ENVIRONMENTAL HEALTH RET rage No of • .j ('� � ;ate Y T,�.�� y � x {`, C 1 H1�H lN3 b1 �� 20 kf�NJiS30 3SN J] $max - -- - ",•,"" t 1uw11 Uc J s u ,n I ^" 1"'_`_v <� c1 } y r ..,..,__.>-,...,..._._. 1 .>__ ,... _.... ,ti• —"." p F.+ -^.-- ''tip,;,'-��`--a� �.. a�� f.'rAy; L,rt is try .: ' f I-' _ - � tali;'y. R�. i . �. _____ AP- 'oç7 .L1lI� L'yGT3 2t38itYfi� �f dMf1�1�t r"—' 30Yi1dH� �i�ilYlQ.t6 '�.tEtOll�lNldlN QS GaRJf 103Q Advantage Perc & Design Timely•Pe<nsonabie•30 Years of Local Experience Const uction Notes for Gravity 4 Bedroom System: Equal Dist ibution w/rock and pipe or infiltrators Install 4— 50' laterals in equal distribution with a 6 hole d-box risered to the surface of the ground. Install on 'foot centers. Install 18' deep on low side of trench maintain 36" of vertical separation Install lev I and along contours. Install in c ry weather only. Use 1250 Gallon septic Tank with Risers to the surface of the ground System ck signed for typical residential waste strength sewage only. System dE signed for 480 Gallons Per Day N Jn n. ..Ii.iriy LICEMS. DE ICIFR APPROVED MAY 07 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET Adv ntage Perc&design ® APDdesi ns@icloud.com ® (360) 516-7287