Loading...
HomeMy WebLinkAboutSWG2026-00114 - SWG Application / Design - 4/17/2026 MASON 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 Tank Only Permit: SWG2026-00114 APPLICANT ORR FAMILY TRUST AGREEMENT Phone: ERIC &CYNTHIA Address: CARL ERIC ORR&CYNTHIA MARIE ORR SAN DIEGO, CA 92116 OWNER ORR FAMILY TRUST AGREEMENT Phone: ERIC &CYNTHIA Address: CARL ERIC ORR&CYNTHIA MARIE ORR SAN DIEGO, CA 92116 SEWAGE DESIGNER CINDY WAITE* Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON,WA 98584 Site Address: UNKNOWN Primary Parcel Number: 219010090011 Permit Description: Placement of new septic and pump tank to deliver effluent to existing 3bd drainfield on 219015000077 (SWG2005-00357) Permit Submitted Date: 04/17/2026 Permit Issued Date: 05/08/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system). Permit Expiration Date: 04/17/2029 (based on date of inspection) Type of Work OSS New Construction Components being Replaced: Septic and Pump Tanks Surfacing Sewage? No Existing Failure? No Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring Additional Details: 1200g septic and pump tank Permit Conditions: 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 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 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 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/OR 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. ( A MASON COUNTY 415 N 6TH STREET,SHELT967 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 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 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/OR 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 Øt MASON COUNTY DATERECENED:4 1 Z N D COMMUNITY SERVICES AM Ol9N; EI • RECEIVE BY: W N Public Health(Community Health/Environmental Health) CO 360427.9670,ext 400 or 360.275-4467,ext 400 415 N.6th Street-Shelton,WA 98584 S\A/G — J V CV/ Z U� ON-SITE SEWAGE TANK ONLY APPLICATION APPLICANT PHONE m m ORR FAMILY TRUST 619.9887887 z z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 4367 N TALMADGE DR, SAN DIEGO, CA 92116 m SITE ADDRESS-STREET,CITY,ZIP CODE X 691 DANA DR, SHELTON, WA. 98584 NAME OF DESIGNER , PHONE A`to G I Z,r`+.� I � CINDY WAITE 3620-701-0205 NAME OF INSTALLER PHONE BYm----e-e°e®®® ..p TBD <_ ITYPE OF WORK(select one) DRINKING WATER SOURCE y CD N NEW CONSTRUCTION!UPGRADES ❑ REPAIR!REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL D PRIVATE TWO-PARTY WELL z COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM III SEPTIC TANK ❑ PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I O ❑ OTHER 3 .77 AC HOME, .29 AC DF OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST O I O ❑ SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE II 100FT+PUBLIC/COMMUNITY WELLS 0 SUBMITTALS I1 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I] PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REQUIRED) IN 10FT+DRINKING WATER SUPPLY LINES O 91 PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) I] 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST I O (] PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES Q EXISTING/PROPOSED OSS COMPONENTS AND LINES D WELLS WITHIN 100FT I] WATER SUPPLY LINES III DRIVEWAYS/PARKING I]SURFACE WATERS,STREAMS,RIVERS,ETC... - 0 DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS IN NORTH ARROW IN SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I —� GO ACROSS HARSTINE ISLAND BRIDGE, TURN RIGHT AT TEE, TURN RIGHT AT NEXT TEE, GO ALL THE WAY SOUTH END OF ISLAND, KEEP TO THE RIGHT AND GO TO GATE. CODE IS 2580. PARCEL IS ON THE LEFT SIDE OF ROAD AFTER THE GATE SEE PAGE TWO FOR EXPLANATION. OFFICIAL USE ONLY BELOWTHIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY O MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: COMMENTS/CONDITIONS AJJ sq& �Vvwy 4 f cc f - 111 SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 Orr Family Trust 4367 n Talmadge Dr San Diego, Ca. 92116 April 1, 2026 RE: Parcel#21901-00-92011 Residence site Parcel#21901-50-00077 Drainfield Site SWG2005-00357 was approved for parcel#21901-00-92011.The drainfield was installed 9/07. The septic system transport lines were installed for parcel#21901-00-92011, 21901-00- 92012 and 21901-00-92014 in 4" iron ductile casing(page 6).The transport system served two three bedroom systems on parcel#21901-50-00077 and one three bedroom system on parcel#21901-50-00078 This tank only permit is to install the septic and pump tank on parcel#21901-00-92011 with an ry hook up. APPROVED MAY 0 8 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET L 3�D AIT€ ' I ,SIGNER L EXPIRLS 05/101 120ONCSR & 12OONCSR-HW C ROC[L.E5 I 102" -� ------63------- 31 --� 2" I j � i I - 71 8 24 TOP VIEW I ' I 1 165„ I L------------ — ------ �'I 0 0 i `"` MAY 0 8 2026 �r ; 3„ �� � ;'•"�c9' MASON COUNTY ENVIRONMENTAL HEALTH ham' �'+ MASTIC 57 8 24' ORENCO TANK ADAPTERS LICE ED DESIGN 2 �� '.`.•'hcS 65.10 •-�•. 4' CAST-A-SEAL GASKET 4 PVC BAFFLE 4 4" J- FLOOD CAP. 965 GALS. FLOOD CAP. 65 463 GALS. 54" 51 30" ___ 2- 1 /2" H 3 , APPROX. WEIGHT 1 1 ,000 LBS. 1475 GALS. FLOOD & 120ONCP-HW srtE'---;,� CAP. A P P R O V E D MAY 08 2026 MASON COUNTY ENVIRONMENTAL HEALTH 96" 102" RET ---------------------- I I . ' I I I I I I . 6" TOP VIEW 24" 18" 71 I 65.' 4 j I I I I I --------- 3 driLl:5' LICENSED DE$(GNER MASTIC • 24 ORENCO TANK AD TER EXPIRES E5;IGI r� 4' CAST-A-SEAL GASKET 4" 25.43 GALS. PER/INCH 65" 51 " 4 2- 1 /2" H 3 �I l APPROX. WEIGHT 1 1 ,000 LBS. ®D A 1r ` 1 Public water system J Q ; ��� +;, 2 Two party water system o � ! 3 Private water system �' a -- ' , 4 �(J1 L(��1 ' 11250 septic tank 5 11250 pump tank ,- � �`' � I`;' ,,4 !�7�:Transport line instailed by Ron Gold rx�_: , a,. 8 Connection for drainfieid i ,� e ,, " 9 Septic tank for 21901-00-90Al2 �: I 10 j Pump tank for,21901-00-90012 O Ly 9 ', ParceLLines Buffer 5 ft \ r~ �' ` ,55 - ! I _ - _.30.0 \ t 311.0 , y _�_�.�_-..-�._ •7 R-..-...,'_� }4ew y � l) J d1 t S'$ �' �t ,♦�' L' � 'F ,• GIS Legend r a •_ � Y � .� . IB ! d,..�. o..... �«- ....5' �,'.. aa�c [1f t t F.;?fi d i�! a . n iat7 .t «+!^'"" ��,.K.,m- -- �IbO-___.. ad' F✓,�", �'�" o'�S ��n4d�i�'MksF,�.��5 �:. Y ,, ¢�. F 4t...f... r.YR. .6 t ryr ,1,�-.'p '�X :',+.•.�..r • �'+"' s.,�r- 51ky aa.:-1 lode='� Jr�y ?�}k M1r� SI �;16� �^s.,s .,, � `\ ti Polt Plan for ,Joe and Abby Santos Scale 1 60 ' Patcet#2190'C \�� 1112'-0" Patcel # 219010090012 �— 6o'_o" 1os-10 \ �' $5° Pri to Two Party Well 242'-11" Transport lines to drainfie d � �` I4 N 28'-8" ! / Transport line ® ti, O Ls S��\ ' � jr i: 100'-W /? I!1� 100' A 1 50 \101'-1 It � c b Ii • , 154'-2" CP o +:• o �II t7 1 p Septic tan 1 f{ -I43'-6"-4..55'-o"— Future > r Home r 98'-3" ` -' `\\ Lot B plus or min s 21 o cfa Beach \\ '-0" ,ry /� 97'-0" � t� � Designed .,, - z% c By William L Russel{ 200 E Arellem Rd •� ,�° Union WA 98592 55 ' , " t 360-898.3773 ' Transport line / ' " LI June 21 2005 \ 75..52from Richard Brown / / ` � P on lot D / �.' �? Septic and Pump Chamber--in order to meet all the setbscks an easement has been grannted`~ allowing the tanks to be placed on Leroy Wagne?s lot. / y ' 0) LICENSED E IGNER EXPIRES 1Z/1T/O ° Septic System Transport Line for end lines#2,#3 Richard Brown de Abby and Joe Santos end line#1— Dana Dr.,Hartstine Is.,Mason Co.,WA -water line 4"pvc casing drivewa y 1105'-3 lines together +20'+158(178)=1283 total length line I +92'+145'(257')= 1342'total length lines 2,3 1105/3=368.33 flex coupling 546.33'(1) 993,67'(2,3) 1 90'-4"iron ductile casing 540'total combined length 177 water line ditch to well 93'power and water ditch to house 270'additional ditch 4"pvc casing 54'-4"iron ductile casing• Pte. �'� � a�s, .. 5q ft r. pyc casing os. LICENSED DESIGNER driveway EXPIRES 05„0, MAY 0 6 2026 MASO COUNTY ENUIR)NMENTAL HEALTH power transformer R E T flex coupling -gate water line driveway 4"pvc casing flex coupling power transformer — C water line ditch(177') Iwater,power,phone flex coupling on line#1 buried with line#1 end 4"pvc casing �(� Scale: 1�� : 100' prepared by. end line#1 end lines#2,#3 R.G.Foresfi'y Consultant 43.2' P.O.Box 68 64.3' metal shop building Hoodsport,]WA 98584 garage foundation (360)426-9540 _ ms a JM 20M Printed From Mason County DMS r)-- I. `' `v"![' a ..l.N rdNA — Pump Selection for a Pressurized System-Single Family Residence Project ORR Parameters Discharge Assembly Size 1.00 inches 250 Transport Length 1300 feet Pt°°5 Transport Pipe Class 40 Transport Line Size 1.00 inches Distributing Valve Model None Max Elevation Lift 100 feet Manifold Length 2 feet Manifold Pipe Class 40 200 Manifold Pipe Size 1.00 inches - _ Number of Laterals per Cell 3 Lateral Length 1 feet Lateral Pipe Class 40 Lateral Pipe Size 1.00 inches y — ) - - - .\---- - Orifice Size 1/8 inches U Orifice Spacing 1 feet x150 Residual Head 5 feet Flow Meter 0.625 inches coo _ L _ 'Add-on'Friction Losses 0 feet Z Calculations m Minimum Flow Rate per Orifice 0.43 gpm 100 Number of Orifices per Zone 6 ,g j Total Flow Rate per Zone 2.6 gpm 12 Number of Laterals per Zone 3 — %Flow Differential 1 st/Last Orifice 0.0 % -- - - - - ---- - - Transport Velocity 0.9 fps Frictional Head Losses 50- - - Loss through Discharge 0.2 feet Loss in Transport 5.9 feet Loss through Valve 0.0 feet Loss in Manifold 0.0 feet Loss in Laterals 0.0 feet Loss through Flowmeter 0.3 feet � 'Add-on'Friction Losses 0.0 feet 0 2 4 6 8 10 12 14 16 18 20 Net Discharge(gpm) Pipe Volumes Vol of Transport Line 58.4 gals Vol of Manifold 0.1 gals Vol of Laterals per Zone 0.1 gals PumpData Legend Total Volume 58.6 gals P1005 NH Effluent System Curve: Pump Data T✓ P1005 High Head Effluent Pump Minimum Pump Requirements 10 GPM 1/2HP Pump Curve: 115V 1fd Design Flow Rate 2.6 gpm Total Dynamic Head 111.4 feet Pump Optimal Range: A P P R O V E - Operating Point: MAY o 8 202.6 .', Design Point: MASON COUNT'(ENIIRON!>3EN�AL HEALTH ��� 'Y.. ` Orenco o=• IND E WAII"Et; LICENSc D DI=SIGNER Plot plan of drainfield for.Joe Santos on lot 77 of Hartstene Island Estates#2 TR 34 EX S 100ft. Parcel #219015000077 Drainfields will serve the lots at 21901009 and 219010090011 on E Dana Dr. w N Scale=1 inch c. ( O 2 UUWallw� A w O a test holes _ ` 1 ._.. 142' �_ 1 _ Slope @ 7.5%± 1 7$ 1 ai '\L 81,19 / 1 � ` T_n 1 ' E a N 3 U)Install valve box as per GI radon Sp cs. Seasonal drainage 37'-5„ ? o mostly from next lot. ' Lo 7 1 " - - T" t 0 -- ------ - --- -- -- -- - - -- --- - - - - -- -- - Septic pump lines from lots A,B,& D of short plat 2575 O I C Peale Dr. 2 ,-0, f° E 1oa-o" 111'-11" ® w WILLIAM RUSSELL 3`M .� HIGHLAND EXCAVATION 200 E.ARELLEM ROAD LICENSED DESIGNER UNION,WA 98592 EXPIRES 121 171 LAS `II II r`i ` 1853223 IIII���IIIiI�iIi11111�I1I11 itimsrie°ms as:4ma FIRST AMF1111AN T'TLF I 1 11 92.0011 paten Co, U FIRST pNERICpN TITLE OECL Bettina To' b O 3 _ CoURTESY RECORDING ONLY Amlericanyiftle for accuracy or We lrsI validity W this instrument or tar DECZARATIO F CGtYfENANT any didoñ of FOR ON-S/ tsESYSTEM I(We)the undersigned,grantors hereby declar this covet and place same on record, I(we)the grantor(s)herein,am(are)the owner t -foe-y le of cstatc situated in Mason County.State of Washington, o wit: �a interest in)the followinb described real [Aa-k1- e4')e. L6Wi. t c-ga#z s * 2. T - 3y x S too' and having the Tax Parcel Number of: on which die grantor(s)ow mid operatc rtions an on-sirssewage disposal system and drain field repair area that serves a struc tcicteed o�t�dt following described real estate situated in Mason County;State of Washington;to wit: PrN 7' I i-Z ,3 F77V 1.07- / OF 5P #&1(lo LOT73 o1' 5P and having the Tax PprcelNum an grantor(S)ts(a>re) ul maintain the en-site sewage disposal system in such a manner to facilitate treatment ancp4t' t�I fie effluent. It is the p se pt1tose grants and covenants to allow easements for placement and access and to prevent certain pr i. hich may have significant adverse impacts to the fitnction of the septic system. NOW/ HERE ,die grantor(s)agree(s)and covenant(s)that said grantor(s),his(her)(their)heirs, siege sots at d assigns will allow an utility ebsement for the use and purpose of conveying sewage from one p cc't other,to allow an easement for die purpose of maintaining or repairing the.on-site septic system and app n thereto within 10 feet of ally portion of die septic system and to prevent practices not consistent cal regulations in this area, These co a ants shall run with the land and shall be binding to aft parties having or acquiring any 'aMerest i to land described herein or any 9 8 nght,title,or part thereof,and shall inure to the benefits of each owner thereof. SS bond dtis day ocf� Signature Si store Stoic ofWeshington County of Mason ) the whdercigned eta Public in and for the above seined County and State do he `" personally appeared before m tabs Incto certify that on a the individual) ,day of in and who executed the within instrument,and acknowledge that h she th meld the sown to be the described tset and dead,for the uses and purposes mentioned. g �' X ey)signed and sealed the aaitie as frce and voluntary act GIVEN under my hand and omelet seal the day and yea host ntuw• i j otary I'uhlia In and S of hjngtnn,residing at Notary ietiblJ y Cnnunisnion Expires: J3tat®of WMnpton MY Appointment Oct 29.2007 _ - _ ........0 .• �v 1Coau'No: P. O. Box 1850 �►�lve 415 North Sixth Street Road Narnefl / i Shelton, WA 98 ITY PERMIT Subject to all term, conditions an rovisions written or printed below or on any part of this form. PERMISSION IS HEREBY GRANTED TO: Address: OA At to L9ô Ph: J'6O 'az-o 93 (Legal Description/when applicable) To Construct/Install: ..5&''77c / irJT vA/ P -1w r4./ f Installations shall be in conformance with Mason County Ordinance No.85-97,Accommodation of Utilities on County Road Right-of-Way,and to the satisfaction of the County Engineer. Traffic control shall be in conformance with the Manual on Uniform Traffic Control Devices(MUTCD). When installation disturbs the surface of the roadway,repai of said surface shall be performed as per items II through 14 on the Mason County Requirements for Installations and Maintenance of Underground Utilities(attached hereto). Contractor: - Address: Phone: License No. Expires: A bond in the amount of$____________is required to ensure compliance with the conditions as set forth in this perm t. Said bond will be held for_ year(s). Perminec's non-compliance to the conditions of this permit shall result in the forfeiture of all or part of the Bond(contingent upon the costs incurred by Mason County to effect repairs,etc.). A Fee in the amount of$ /O./ .O ,plus footage fees,accompanies this permit. T - "F7ox .03 = to It is the responsibility of the applicant to notify all utilities and private property owners when such property is liable t injury or damage through the performance of the above work and the applicant shall make all necessary arrangements relative to the protection of such property and/or Utilities. _No franchise necessary. �® d� `This permit subject to existing Franchise. J- This Permit issued contingent upon an Application for a Franchise being made to the Bo rd of Mason County Commissioners on or before the 31 st of December, No work shall be done under this permit until the Pertnittee has communicated with the office of the Department of Public Works and/or received instructions from .Mason County Road Supervisor. Phone No. - Dept. of Public Works: 427-9670, Ext'n: 450. This permit shall be void unless the work herein contemplated shall have been completed on or before DATED at Shelton, Washington, this day of Issued by: Title: Printed From Mason Uounty UMMMS Printed from Mason County DMS UTILITY INSTALLATIONS Fees: $10.00 permit fee+any footage fees along R/W• $100.00 bond-bond will be held for one year after installation(this bond shall be posted by property owner,not the contractor '3 cents/ft for each foot to and including 1,000' I cent for each additional foot over 1,000'to and including 10,000' 12 cent for each additional foot over 10,000 feet Surface Types to Determine if Permittee shall PUSH under county road or MAY CUT surface. F = BST surface --can be cut with permission by this office I = A/C surface —Pennittee shall NOT CUT surface E = GRAVEL surface--Permittee can cut with permission by this office Utility Installation Specifications: Legal description of property involved Where utility is being installed: Rd.,Development,etc. Type of Line being Installed Whether they are going to drill under road or cut. Utility line must be installed inside a casing and be wrapped with locate tape for road crossings. Said casing shall be a minimum of 3b"below roadway surface. If more than one utility installed/spacing required between casings shown on sketch provided by this office. Casing shall extend a minimum of 2'beyond roadbed edge. Hand out is available for utility installations(specifications). Gas Line Installations: Follow Utility Specifications;also,include the following on the permit: "Gas main shall be installed per Mason County regulations and Gas Transmission&Distribution,Fed ni Pipeline Safety Standards(Part 192,Title 49,Code of Federal Regulations)." CULVERT INSTALLATIONS Specifications for the culvert permits are included in the permit application. Any special/additional specifications may be added by this office on an individual basis. The Bond for a regular access w/out culvert and a 12"x 20 culvert is$25.00 The Bond for a 12"x 40'to 12"x 50 culvert is$50.00($25.00 bond for each additional 25') Hand-out(sketch)is available showing side-view of installation of access culvert. Prime- From Mason County DMS 1 Printed from Mason County DMS