HomeMy WebLinkAboutSWG2026-00031 - SWG Application / Design / As-Built - 2/4/2026 MASON CO U NTY 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: SWG2026-00031 (,J O/ j
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APPLICANT Sara Stover Phone:
Address: 14501 Wilmot Way LAKE OSWEGO, OR 97035
OWNER Sara Stover Phone:
Address: 14501 Wilmot Way LAKE OSWEGO, OR 97035
SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023
Address: 2450 W DEEGAN ROAD WEST SHELTON,WA 98584
Site Address: 430 E THORNTON RD
Primary Parcel Number: 221357700180
Permit Description: New 3bd OSS pressure trench with Class B waivr
Permit Submitted Date: 02/04/2026
Permit Issued Date: 05/18/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/06/2029 (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.
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 DATERECGVED: Cl)
RECEIVED (flE7CEIVED BY:
Public Health & Human Services Gj
Environmental Health 360-427-9670,ext.400 or 360-275-4467,exL 400 y O
415 N.6th Street-Shelton,WA 98584 S W G c.oa l�, OO o O
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE M
,Sara Stover (562)777-5273 c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
Wilmot Way C_ Lake Oswego OR 97035 M14501
SITE ADDRESS,-STREET,CITY,ZIP CODE Q� '
430 E. Thornton Rd. � ' Shelton WA 98584
NAME OF DESIGNER PHONE
Dale L. Tahja <c' (360)463-8023 I
NAME OF INSTALLER PHONE I -�
PERMIT TYPE(select one) DRINKING WATER SOURCE co W
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RESIDENTIAL OSS ❑ COMMUNITY OSS ❑COMMERCIAL OSS • PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(select one) ❑ PUBLIC WATER SYSTEM
0 NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT OTHER DETAILS(select al/that apply) ❑ TABLE X REPAIR I J
SUBMITTALS ❑SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
DESIGN FORM(REQUIRED) ❑SEPTIC DESIGN(REQUIRED) BEDROOMS I LOT SIZE I WAS LOT CREATED AFTER 4/1/20259 I
❑ WAIVER(S)(IF APPLICABLE) 3 J 5 acre ❑ YES • NO n I
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go onto Harstene Island, left onto Harstene Island Dr., right onto Thornton Rd., property on I o
the right, directly across from 401 E. Thornton Rd.
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SITE MUST BEFLAGGED FROM MAIN ROADAND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I 0
OFFICIAL USE ONLY BELOWTHIS LINE
UPGRADE!FAILURE SOURCE(for reporting purposes)
o VOLUNTARY ❑MAINTENANCE/PUMPING❑ BUILDING PERMIT❑HOME SALE❑COMPLAINT OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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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.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE r¼vy1yth1 Q4L/14 aTHIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:01/09/2026
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 13 57 7 0 0 1 8 0 1
A design will be reviewed when 3 copies of each of the following are submitted:
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. 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"X17"
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Permit Number: SWG` 2026-00031 Designer's Name: Dale L.Tahja
Applicant's Name: Sara Stover Designer's Phone Number: (360)463-8023
Mailing Address:
14501 Wilmot Way Designer's Address: 2450 W. Deegan Rd.W.
Lake Oswego OR 97035 City State Zip Shelton WA 98584
City State Zip Designer's Email daletahja@gmail.com
Treatment Device
❑Glendon ❑Sand Filter O Mound O Sand Lined Drainfield ❑Recirculating Filter O ATU ❑Other
Treatment Level(check all that apply): ❑A O B ❑C O BLI O BL2 O BL3 ❑E ❑N
Drainfield Type
❑Gravity i'Pressure 'Trench ❑Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class Sch.40
Daily Flow: Operating Capacity 270 gpd Length 67 ft
Daily Flow:Design Flow 360 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 7-15 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices 51
Designed Primary Area 600 ft2 Diameter 1/8 in
Designed Reserve Area 600 ft2 Spacing 48 1n
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 201 ft Schedule/Class Sch.40
Elevation Measurements Length 50 ft
Original Drainfield Area Slope 11-18 % Diameter 1.25 in
New Slope,If Altered 15 % Preferred manifold configuration used? O Yes ll?I°No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade Down-slope 7.5 in Schedule/Class Sch.40
Designed Vertical Separation 12 in Length 10 ft
Gravel-based Drainfield Required? ❑Yes if No Diameter 2 in
Pump Required? P'Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Dif.in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 67.5 gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 25 gpm L!I' Timer l' Elapse Meter 6�' Event Counter
Calculated Total Pressure Head 16 ft If Timer: Pump on 2.7 min. Pump off_5 hrs.57.3 min.
Comments
My first site plan indicated a slope of 13% -24%, using the county mapping and contours. Once I set up
the benchmark and shot in the laterals, the slope was determined to be 11% - 18%
Revised:6/11/2025
t 12 21 3 5 7 7 0 Q 1 � 8 0
DESIGN FORM—PAGE TWO Assessor's Parcel Number ,
Permit Number: SWG 2026-00031
DESIGN CIIEcKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
VT Test hole locations Ur Drainfield orientation and layout Reference depth from original grade:
V Soil logs Trench/bed dimensions and V Septic tank
V Property lines critical distances within layout V Drainfield cover
V Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property V Septic tank/pump chamber and restrictive strata:
Measurements to cuts,banks,and locations V Laterals,trench/bed,top and
surface water and critical areas V Observation port location bottom
P1' Location and orientation of V Clean-out location O Curtain drain collector
curtain drain and all absorption ( Manifold placement O Sand augmentation
components Id Orifice placement Other cross-section detail:
V Location and dimension of v( Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
v Buildings P Audible/visual alarm referenced Yes No
f ( Direction of slope indicator It Scale of drawing shown on scale P1' 0 Design staked out
Waterlines bar ❑ O Recorded Notices attached
Roads, easements,driveways, Elevation benchmark and relative V ❑Waiver(s)attached
parking elevations of system components V ❑Pump curve attached
North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
O O Waste strength
�r.�iixy../�^f ��{ ❑ ❑Flow
DESIGN APPROVAL - , y a `" ,a• - t _f
The undersigned designer m the notified install at time of installation eYes O No
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and be.siZ
compliance with state and local on-site regulations: ���P �,°3'" N 9 o '
Environmental Health pecialist - ate �Sb, h/
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITI
✓ The design is stamped"Approved"by Mason County Public Health. „ /c 2 I
V' The Onsite Sewage Permit has not expired,the Permit Expiration Date is: (��p
✓ 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
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APPROVED
MAY 16 2626
MASON COUNTY E1dUlRONMENTAL HEALTH
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• APPROVED
MAY 18 2026
MASON COUNTY ENVIRONMENTAL HEALTH
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2aoAMSERIES.
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1/2 hp Submersible Efluent/Surnp Pumps
The Liberty 280-Series provides a cost effective"mid- POP A 11 a ce Cue: O�•S@!'lfes
range"pump foron-site waste watersystem%Uquid 40 12
waste transfer and commercial heavy-duty sump pump
applca tlonsthat require higher head or more flow. 3fi 11
Designed around Liberty's unique"UnI.Body"casting, 30 9
the 280-Series will provide years of reliable performance. 25 s
All Models Feature:
•Vortex style impeller permitting passage of solids 115 5
upto " 1ti 3
•416stainlesssteel rotor shaft 5 2
•Permanently lubricated upper and lower ball bearing
•Epoxy powdercoat fnish 0 0
•Alifasteners-corrosion-resistant stainless steel 0510152025303540455055606570
U.S.Gallons Per Minute
•I W'Dischargge
•Stainless steel bottom screen-eash removable i -1— --,-
Y 0 38 78 114 166 192 228 270
•Maximum fluid tempe►atutre:14W F. Uters Per Min
280-Seder.Cord Lengths ff M®V
Dimensional Data:
Model 10' 255(-Z 3s(-3) 50'(-5) Weight:29 lbs. MAY 18 2026
280 Standard Optional Optional Optional Helght:l3" MASON COUNTY ENVIRONMENTAL HEALTH
281 Standard Optional Optional Optional Major Within 10"(model287) RET
283 Standard Optional Optional N/A Minimum Sump Diameters:
287 Standard Optional N/A N/A
10 con length standmdon all models.For oplional lengths. Model 281 283...14"
add"-z-aor-5"allxtn model ntmtber. Model 287 VMF...10"
Fxampte:tormode1 280talth W cant order2 D.3 JFactoryswfth I Model 2813 283 IModel 287
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Motor Specifications ITura on level I 13" s 5"
1c hp 60HZ 3450 RIM Turn off level T' 4.0"
Oil filed,thermally protected
(PSC)Permanent Split Capacitor The Model 283 feariues a fully adjustable wide-angle float.Differential
8.0 amps(1 15'J) adjustments can be made easily bytdheringthotloatto the dte-
4Q amps(208/230V) Ghatgepipe or other mounting point Vertloal float modo)257 is not
adjusta
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Model 280 Model 281 Model 283 Model 287
Manual,
no switch float switch float switch Vertical mmag-
with quick- j II with series netic float for
disconnect {piggy-back) smaller pits—
plug Will operate In
alt?'diameter
sump i: i c us Certified
Liberty Pumps•7000Appte TreeAvenue•Berson,New Mork 14416•Phone 800-5432550 Faxes(585)4 944839
wwwdtbortypumps com C0PV tpfitQubnty►PWW^hnc.2ot7
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Installation/Maintenance
Pressure Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 4ft. centers. Install the orifices (with orifice shields)pointing
straight up ( 12:00 o' clock).
7. Divert all storm water run-off away from septic system components.
8. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
9. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
11.Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
17. Locate all utilities prior to starting installation.
18. The Designer may have additional charges for redesign work and Final Inspection.
19.The installer must notify the designer-Dale L. Tahja—(360)463-8023) at least 48 hours .
prior to installation. .
APPROVED
MAY 18 2026
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5100214 %.
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LICENSED DESIGNER
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APPROVED f
MAY 18 2026
MASON COUNTY ENVIRONMENTAL HEALTH
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