HomeMy WebLinkAboutSWG2026-00166 - SWG Application / Design - 5/23/2026 MASON COUNTY 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 Tank Only Permit: SWG2026-00166
OWNER CUSICK DANIEL& PATRICIA Phone: 253-358-9859
Address: P 0 BOX 1019 WAUNA,WA 98395
APPLICANT Schoening Excavating LLC Phone: 3607422982
Address: 121 W Grizdale Dr Shelton, WA 98584
SEPTIC INSTALLER BRAYDEN SCHOENING* Phone: 360-742-2982
Address: 121 W GRIZDALE DRIVE SHELTON,WA 98584
Site Address: 110 N VARDEN WAY
Primary Parcel Number: 422165300010
Permit Description: Replace failed septic tank
Permit Submitted Date: 05/23/2026
Permit Issued Date: 06/01/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/01/2027 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: 1250g septic tank
Permit Conditions:
5 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 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
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
MASON COUNTY DATERECER/ED: 65/l�6 /�o --e C CO
COMMUNITY SERVICES AMOUNTRECEIVED: RECEIVED BY: m
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-75 /r
Public Health(Community Health/Environmental Health) V l Z y
360-427-9670,ext.400 or360-275-0467,ext.400
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415 N.6th Street-Sheltan,WA 98584 SV\IG C CO
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ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE r
Cusick, Daniel & Patricia 2533589859 z
MAILING ADDRESS-STREET CITY,STATE,ZIP CODE
__
PO Box 1019 Wauna Wa 98395 CD W
SITE ADDRESS-STREET C1fY,ZIP CODEliii P902
9 N I•-
110 N Varden Way HAY 7
NAME OF DESIGNER PHONE t 3 I N
Not Required I jEly
NAME OF INSTALLER PHONE
Schoening Excavating LLC 3607422982 : I
TYPE OF WORK(select one) DRINKING WATER SOURCE 0
❑ NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I O
COMPONENT(S)TO BE REPLACED/INSTALLED IJ PUBLIC WATER SYSTEM Cushman Maintanence
INI SEPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE (31
❑OTHER 3 .19 00 IC?:)
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST O
❑SURFACING SEWAGE I]EXISTING FAILURE ❑SHORELINE 11100FT+PUBLIC/COMMUNITY WELLS I
SUBMITTALS I] 50FT+PRIVATE WELLS.SURFACE WATERS,STREAMS,RIVERS
IN PLOT PLAN(REQUIRED) IN TANK CROSS SECTION(REQUIRED) I] I0FT+DRINKING WATER SUPPLY LINES I
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) I] 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST 0 I 0
I PROPERTY LINES AND EASEMENTS I] EXISTING/PROPOSED STRUCTURES I]EXISTING/PROPOSED OSS COMPONENTS AND LINES
❑ WELLS WITHIN 100FT M WATER SUPPLY LINES I]DRIVEWAYS/PARKING Cl SURFACE WATERS,STREAMS,RIVERS,ETC...
®DIRECTION OF SLOPE/CONTOURS ❑PERIMETER!CURTAIN DRAINS I]NORTH ARROW I]SCALE BAR I O
DIRECTIONS TO SITE AND SITE CONDITIONS:(ez locked gate)
APPROVED
JUN 01 2026
MASflN N)H FNV1RUH MENTAL HEALTH
OFFICIAL USE ONLY BELOWTHIS LINE C ET
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE El COMPLAINT ❑OTHER:
COMMENTS!CONDITIONS
Cq,,&ct -.W cgtt * -
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 I 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,!12015
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APPROVED
s ' JUN 0 1 2026
MASON COUNTY ENVIRONMENTAL HEALTH
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HAGERMAN PRE-CAST
fob & Anita Hagerman
PO Box 2842
Poalsbo WA 98370
360-598-6121 /360-509-3702 PAGE: t
2,500 L8.MAX.'MiEEEL LOAD
AT WORST CASE LOCATION
(I 6,000 lb FOR'-T'MODELS) H11�H 1d1N3 NOTAN3 k1Nf O3 NOSV�l
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HAGERMAN PRE-CASE FINAL 8" 2k" 40 24 8` 0
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GRADE o N
TANK MODEL: 1250 X-X d
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DATE MANUFACTURED:XX/XX/XX
MAX.DEPTH OF COVER: 3 FT. w (n
LIQUID CAPACITY: 1261 GAL 5011.COVER 3"THICK
36"MAX.
AT TOP OF ; 4 ✓O z Q O C9
WALL, TYP.
DETAIL OF I.D.TAG(LOCATE
TAG INSIDE RISER.OR __ _
ACCESS OPENING)
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4'DIA. PA55-THRU CAPACITIES(GAL.) = (1)
ACCESS AND RISERS i�OTES CEfNTERED IN V4 ALL OPERATING 482 4'CAST-A-SEAL GASKET M m Z
{5'MODEL 01•ILY) TOTAL(FLOOD) 557 OR EQUIV.WATER-TIGHT of (D O Z
I)MINIMUM ONE I8.0 ACCE55 OPENING PER COMPARTMENT. o O� CONNECTION AT EACH Ui
THE DISTANCE BETWEEN ACCE55 OPENINGS IS NOT TO a N I-- TANK PERFORATION.TYP. )-
I-
3) -
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EXCEED IC/-0'CENTER TO CENTER. „ , I-
2) I UJ LL J
RISERS MUST BE A MINIMUM OF 23'INSIDE DIAMETER. r O „-� Q Q
3)RISER-TO-TANK AND RISER-TO-ADDITIONAL SECTIONS OF O to y 5000 psi CONRETE = Q Q O
RISER CONNECTIONS MUST INCORPORATE JOINT GROOVES 'n O WALLS.FLOOR.AND (/)OR ADAPTERS TO PREVENT LATERAL MOVEMENT AND - N - LID,TYP. CAPACITIES(GAL.)
REMAIN WATERTIGHT. Z
4)ACCE55 AND RISER.OPENINGS MUST SE COVERED V✓1TI I A o ql . OPERATING I_719 O
LOCKABLE LID OR OTHER SECURED LID. O tf) TOTAL(FLOOD) 1598 29 112" S
5)ACCESS RISERS AND UDS MUST BE STRUCTURAU.Y SOUND In
TO WITHSTAND ANTICIPATED SITE-SPECIFIC LOADS. 'NOTE:CAPACITIES ARE I. (0
APPROX. 3 3/8'THICK ESTIMATES BASED ON A FLOW)
AT BOTTOM OF WALL METER TEST PERFORMED 5°F 00 �
HAGERMAN PRE-CAST. C) 00
SEALS AND GASKETS NOTES O y o
I)5EAL5 AND GASKETS FOR INLET,OUTLET,AND
INTERCOMPARTMENTAL FITTINGS MUST BE RESILIENT, 4 I/2"THICK 5000 PSI z �•
WATERTIGHT,CORROSION-RESISTANT,AND FLEXIBLE. 2 1/2'TAPER. CONCRETE FLOOR - STONE-FREE hlAT'VE SOIL
2)SEALS MEETINGS A5TM C-!G44 OR EQL.4VALENT MUST BE T T'ICA•L (3'THICK MIN.) OR COMPACTED SAND 0 X
USED AT TrE TANK WALL-TO-PVC PIPING INTERFACE TO OVER STONY SOIL }Y Q
PREVENT LEAKAGE. W C7
LLJ 00
INSTALLATION INSTRUCTIONS BAFFLE NOTES HIGH WATER TAaLE ANU I~-
TRAFFIC LOADING NOT€5 Z m ap
1)EXCAVATE TANK HOLE WITH VERTICAL WALLS TO 2 FEET LARGER THAN TANK ON ALL SIDES. BOTTOM OF 1)INLETS TO SEPTIC TANKS . ,• AT LEAST 8'BELO'I/TH'_LIQUID LEVEL. 1)FOR TANK MODELS 1 25054 1250 FI
HOLE MUST BE FLAT,LEVEL.AND FREE OF WAIER. HOLE MUST SLOPE DOWN 3" 10 CENT EK OF TANK. 2)OUTLETS TO SEPTIC TAtNK5 MUST EXl tr4D BELOW iHt LIQUID LEVEL Al LEAST A)MAXIMUM.WATER TABLE AT TOP OF LID r� p
2)INSTALL G`'MINIMUM OF 2'MINUS MATERIAL OR SAND ON BOTTOM OF EXCAVATED HOLE. 30%BUT NOT MORE THAN 4O 0. B)MAXIMUM TRAFFIC LOADING NOT TO EXCEED 2,500 ID M M
3)INSTALL TANK I14 CENTER OF HOLE,KEEPING MINIMUM I FOOT VOID SPACE ON ALL SIDES. 3)INLET AND OUTLET DEVICES MUST MAVE A MINIMUM INSIDE DIAMETER OF 4° CONCEN1KA1U)LOAD X
4)INSTALL REST OF SYSTEM.AND AFFIX RISERS AS REQUIRED BY LOCAL JURISDICTION. AND BE CONSTRUCTED OF PVC OR ADS CONFORMING TO OR EXCEEDING THE 2)FOR TANK MODELS 1250 5-T 4 1 250 P-T: Z 0
5)UPON APPROVAL TO SACKFILL,FILL VOID SPACE AROUND TANK WITH COMPACT GRANULAR(SANDY)SOIL STANDARDS OF ASTM 03034 OR A5Tt i D 2680.RESPECTIVELY. A)WATER TABLE AT GROUND LEVEL m W
FREE CF LARGE CLUMPS OF CLAY AND ROCKS OVER 2'1NCHES IN DIAMETER. BACKFILL CAREFULLY AND 4)INLETS AND OUTLETS MAY BE MOVED FROM THE LOCATIONS SHOWN PROVIDED B)MAXIMUM TRAFFIC LOADING NOT TO EXCEED I G,000-B L O z
EVENLY INN I5'LIFTS. MAXIMUM 501L COVER IS 3G'. THE HEIGHTS ARE NOT CHANGED AND THE PIPE CENTERS ARE LOCATED AT LEAST CONCENTRATED LOAD:AT 14•INTERVALS(11520 RATING) 0
G)IF REQUIRED,WATER TESTING TO BE DONE BY LOCAL JURISDICTION OR DOH SPECIFICATIONS. 8'FROM ANY EDGE AND AT LEAST 4'FROM ANY REBAR. 3)TRAFFIC RATED RISERS MUST MEET OR EXCEED THE !1
7)F INAl GRADE THE SURFACE TO AVOID CHANCLLING SURFACE WATER TOWARDS TANK. - STANDARDS OF ASTM,C478(1 2)AND',VSDOT STANDARD a_
PLAN 8-30.90.00. FRAME AND COVER MUST MEET OR
EXCEED THE STANDARDS OF A5TM A4B CL355. LJJ
' 1
4
HAGERMAN PRE-CAST
Bob & Anita Hagerman
P® Box 2842
Poulsbo WA 98370
360-598-6121 /360-509-3702
o��nNs,uNno��os�� PAGE: 5
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