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Home My WebLink AboutSWG225-00398 APPLICATION/DESIGN - SWG Application / Design - 5/22/2026 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: SWG2025-00398 APPLICANT GIVENS MICHAEL W&NORMA J Phone: 360-463-9134 Address: 661 SE BREWER RD SHELTON,WA 98584 OWNER GIVENS MICHAEL W& NORMA J Phone: 360-463-9134 Address: 661 SE BREWER RD SHELTON, WA 98584 SEPTIC DESIGNER BOB PAYSSE* Phone: 360-507-1498 Address: 3083 E Mason Benson Road GRAPEVIEW,WA 98546 Site Address: 240 E PEEBLES CT Primary Parcel Number: 321275400113 Permit Description: New 2bd OscarXO2 Permit Submitted Date: 10/01/2025 Permit Issued Date: 05/22/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $555.00 (additional fees may be required upon installation of system). Permit Expiration Date: 10/15/2028 (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 Drainfield 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 Must comply with conditions and site plan depicted in MEP2026-00006 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: ^ of — U N�C/1 CU) AMOUNT REC IVED: RECEIVED BY: W (6) Public Health & Human Services J 'D e o i v_ m Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 / �r 415 N.6th Street-Shelton,WA 98584 S WG _ O x Cl) !l Z (6) ON-SITE SEWAGE SYSTEM APPLICATION mn APPLICANT PHONE ITI MICHAEL GIVENS 360-463-9134 c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 661 SE BREWER RD SHELT0N WA 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE ' 240 E PEEBLES CT SHELTON WA 98584 NAME OF DESIGNER PHONE I ROBERT H. PAYSSE ] ® 360-426-1803 NAME OF INSTALLER PHONE v TBD R I1\) PERMIT TYPE(select one) DRINKING WATER SOURCE y O Rl RESIDENTIAL OSS bICOMMUNITY OSS II=IICOMMERCIAL OSS iW PRIVATE INDIVIDUAL WELL ]PRIVATE TWO-PARTY WELL Z I y TYPE OF WORK(select one) FMS PUBLIC WATER SYSTEM LAKE LIMERICK Mi NEW CONSTRUCTION/UPGRADES I-tJREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR SUB MI TTALS ❑ SURFACING SEWAGE ❑ EXISTING FAILURE ❑SHORELINE I3DESIGN FORM(REQUIRED) (ASEPTIC DESIGN(REQUIRED) BEDROOMS I LOT SIZE I WAS LOT CREATED AFTER4/1/2025? b I -P bWAIVER(S)(IFAPPLICABLE) 2 0.63 ❑ YES 0 NO 0 DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I O NORTH HWY 3, LEFT ON MASON LAKE RD. RIGHT ON OLDE LYME RD JUST BEFORE I I o RAILROAD TRACKS. LEFT ON PEEBLES CT, CONTINUE TO END/CULDASAC. LOT r I AHEAD. PDI SIGN POSTED. o ( - SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I W OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUM/PING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS /'- i' , COMMENTS/CONDITIONS- Q v0 - fti -ç\ a ' 2k it - çfiZQ ci SOIL CODES: RECORD DRAWING AND INSTAL PORT 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 -izr THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 5 } DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 7 - 5 4 - 0 0 1 1 3 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"X 17" PARCEL IDENTIFICATION Permit Number: SWG 2cQ-'J- Qy ,g 8 Designer's Name: ROBERT H. PAYSSE Applicant's Name: MICHAEL GIVENS Designer's Phone Number: 360-426-1803 Mailing Address: 661 SE BREWER RD Designer's Address: 3083 E MASON BENSON RD SHELT0N WA 98584 City State Zip GRAPEVIEW WA 98546 City State Zip Designer's Email pioneerdigging@yahoo.com DESIGN PARAMETERS Treatment Device ❑Glendon ❑Sand Filter O Mound ❑ Sand Lined Drainfield ❑Recirculating Filter 0 ATU OSCAR X02 ❑Other Treatment Level(check all that apply): 0 A El B 0 C 0 BL1 El BL2 0 BL3 El E ❑N Drainfield Type ❑Gravity O Pressure O Trench O Bed ❑ Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class NETAFIM Daily Flow: Operating Capacity 180 gpd Length PER MNF ft Daily Flow:Design Flow 240 gpd Diameter - in Septic Tank Capacity(working) X02 TANKS gal Number - Receiving Soil Type(1-6) Separation - ft Receiving Soil Appl.Rate 1.0 gpd/ft2 Orifices Required Primary Area 240 ft2 Total Number of Orifices 200 (4@50) Designed Primary Area 240 ft2 Diameter 0.42 GPH in Designed Reserve Area 400 ft2 Spacing 6 in Trench/Bed Width 10 ft Manifold Trench/Bed Length 24 ft Schedule/Class SCH.40 Elevation Measurements Length 10 ft Original Drainfield Area Slope 2 % Diameter 1 in New Slope,If Altered 2 % Preferred manifold configuration used? C 'Yes ❑No Depth of Excavation Up-slope PER MNF in Transport Pipe from Original Grade Down-slope PER MNF in Schedule/Class SCH.40 Designed Vertical Separation 24+ in Length 50 ft Gravel-based Drainfield Required? ❑Yes C✓J No Diameter 1 in Pump Required? Rf Yes ❑No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day PER MNF Diff.in Elevation Between Pump&Uppermost Orifice 12 ft Dose quantity PER MNF gal Drainfield Squirt Height/Selected Residual(head) NA ft Chamber Capacity(flood) X02 TANKS gal Uppermost Orifice G 'Higher ❑Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head PER MN gpm lI Timer Rf Elapse Meter ' Event Counter Calculated Total Pressure Head PER MNF ft If Timer: Pump on PER MNF ,Pump pump off PER MNF Comments APPROVED MAY 22 7mmfi MASON COUNTY ENVIRONMENTAL HEAU l wised:4/14/2025 RET r , DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 2 7 -- 54 -- 0 0 1 1 3 Permit Number: SWG Qp oo3r'►$' DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Ed Test hole locations Drainfield orientation and layout Reference depth from original grade: 66 Soil logs l?J Trench/bed dimensions and i1 Septic tank 21 Property lines critical distances within layout l Drainfield cover 66 Existing and proposed wells l9 D-Box/Valve box locations p p Reference depth from original grade within 100 ft of property 96 Septic tank/pump chamber and restrictive strata: GQ Measurements to cuts,banks,and locations 61 Laterals,trench/bed,top and surface water and critical areas 61 Observation port location bottom 671 Location and orientation of 61 Clean-out location 0 Curtain drain collector curtain drain and all absorption [6 Manifold placement 0 Sand augmentation components 21 Orifice placement Other cross-section detail: 66 Location and dimension of l?1 Lateral placement with distance i f Observation ports/clean-outs primary system and reserve area to edge of bed 21 Buildings Other Information 121 Audible/visual alarm referenced Yes No 61 Direction of slope indicator l Scale of drawing shown on scale ❑ Design staked out 61 Waterlines bar 0 121 Recorded Notices attached 61 Roads, easements,driveways, El Elevation benchmark and relative ❑ 121 Waiver(s)attached parking elevations of system components 9 0 Pump curve attached 66 North arrow and scale drawing 0 121 Evaluation of failure shown on scale bar Non-residential justification ❑ 121 Waste strength ❑ Flow DESIGN APPROVAL The undersigned designer must ben ti y Vller at time of installation if Yes 0 No Signature of esigner Date The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance with state and local on-site regulations: Environmental He lth Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health.v' TheI t (ti 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:4/14/2025 100% RESERVE AREA PRIMARY DRAINFIELD: 10'x 24' OSCAR X02 Lii MAY 202026 OSCAR X02 TANKS 259' 9 EASEMENT(PER pLAT f ) \ o � fl, do �� roo�.�. �F �F PEEBLES CT / *FUTURE �� Q� i WATERLINE-jam / Q- Q 7ss QQ �Q / .77. , Q. / **MAINTAIN 10'+ FROM / WATERLINE TO SEPTIC / COMPONENTS & LINES / APPROVED A222026 , • *INSTALL OSCAR X02 AS PER MY 2 2 2026 `' 5t�QS17 0, FOBAT H PAYSSE . .. ..... ............ MASON COUNTY ENVIRONMENTAL HEA' ` . Ns I MANUFACTURER INSTRUCTIONS. EXPIRES RET AN ASBUILT/INSTALL SIGNOFF FEE WILL BE CHARGED AT TIME OF INSTALLATION PIONEER DIGGING INC. CUSTOMER: MICHAEL GIVENS TEST HOLE I: TEST HOLE 2: TEST HOLE 3: PARCEL#:32127-54-00113 0-29 EGLS 0-33 EGLS 0-34 EGLS 29+TILL 33+TILL 34i-TILL SEPTIC DESIGNS ADDRESS: 240 E PEEBLES CT ROOTS-29 ROOTS-33 ROOTS-34 3083 E.MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE DISCLAIMER:THIS IS NOT A SURVEY.REFERENCES INCLUDE:APPIJCANT/COUNTY PROVIDED PLATS OR SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS.DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. PROPOSED MENT MAY BE SUBJECT TO OTHER OFFICE 36O-426-1803 FAX 360 427 2353 SHEET: SITE PLAN SCALE: 1"=40' DEPARTMENT AGENCY REVIEW.DESIGNER NOOTPRESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS. *INSTALL OSCAR X02 AS PER MANUFACTURER INSTRUCTIONS. I ( 2o'!J7-ILI (PE p�T�MENT 100% RESERVE AREA (400 SQFT) B/M TANK INLET - 100' PUMP ELE. - 96' DF ELE. - 108' 5' -- APPRO L 222 EN�RONl�EN�A�h�� 0 O_ N o o c/o O 05CAR X02 TANKS / W/ HEADWORKS c. / PEEBLES CT (5'+FROM HOME) I / � Gys WAg GOF 'v✓� I / 1 FUTURE WATERLINE // 51 0317 (10'-1- FROM COMPONENTS) // , ... .E!SE .... i ' / EXPIRES 1 I -\--1 I / i AN ASBUILT/INSTALL SIGNOFF FEE WILL / � BE CHARGED AT TIME OF INSTALLATION -\ / I 1 CUSTOMER: MICHAEL GIVENS TEST HOLE 1: TEST HOLE 2: TEST HOLE 3: PIONEER DIGGING, INC. PARCEL#:32127-54-00113 0-29 VGLS 0-33 VGLS 0-34 VGLS 29+TILL 33+TILL 34+TILL SEPTIC DESIGNS ADDRESS: 240 E PEEBLES CT ROOTS-29 ROOTS-33 ROOTS-34 DISCLAIMME THIS IS ROTA SURVEY.REFERENCES INCLUDE,SPPUCANT/COUNTY PROUTDED 3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE PLATS OR SURVEYS,FIELD MEASUREMENTS AND COUNTY GIIS.DESIGN INTENDED FOR SEPTIC OFFICE 3604261803 FAX 360 427 2353 PURPOSES ONLY. PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER SHEET: DF DETAIL SCALE 1"=10' DEPENTMENIAGENCY REVIEW.DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS. X02 Tanks Pre-cast Concrete Pre-cast Concrete Septic Tank Discharge Tank fr ,a,..a¢�c, a�--? 2/3 1 3 -r<. - PLAN VIEW Eyy VENTED LID Z ti) � tV Z O _ :g ^�.arr,. :•y,. :•ct,o.. � s: :•�, — -- °4.-�. o�„q:'4.• ..a. of v 2/3 1/3 1 qqq c OATS 11 . tttPPP�� P Z4, e,D& `RIFFU R 18"-27'� iJ f 9 A e (18"PREFERRED) p e. e� XXX111 .eg u � :•o•;r•: °:o≥: L'o•. :a°. Yo': :o, :4, 0: :v` .o•, Yo°: :07 :o :o: °•o: :o•: :•o: CROSS SECTION LOWRIDGE ONSITE TECHNOLOGIES DRAWING ID: XO2 Tanks SCALE: NTS DRAWN BY: DBM CK BY: DAVE LOWE DATE: rv: 02.22.2023 Thermoplastic Reinforced Thermoplastic motor bracket and discharge with built-in guide bearing.This 1/2 HP pump has a stainless u steel top bearing and motor coupling.These are assembled with our A.Y. McDonald stainless steel motors.Two wire single phase models include pump, motor, and 10' lead. This four inch submersible is supplied with grounded leads meeting the National Electrical Code(N.E.C.)specifications. The performance curve below will assist you in choosing the pump that meets your needs. A MODELS I E-30 GPM E - 30 GPM 300 W - 1/2 HP 122F1 • 53 P.S.I. W I i I I I 200 lU Q 100 I 1/2HP•4STAGES- --- I: : : : : : : : T : T T : : Simplex 0 5 10 15 20 25 30 35 40 Duplex 0 10 20 30 40 50 60 10 80 Fourplex 0 20 40 60 80 100 120 140 160 \J FLOW GPM PRO Specifications spy 2.2. 226 . MASON COUNTS RN�IRONMENTAI.HEAITH LOT-30 1/2 Plastic 115 1 10.94 9.53 23 F� EST.7856 MC.Donald SUBMITTAL INFORMATION - Stainless steel pump shell and pump shaft - Powered by A.Y.McDonald submersible motors 1/2 HP. - Reinforced Thermoplastic diffusers and impellers - 11/4"FNPT Discharge - Thermoplastic intake screen and cable guard NO-LEAD:The weighted average of the wetted surface of this no-lead product contacted by consumable water contains less than one quarter of one percent(0.25%)lead. Lowridge Onsite Technologies,Inc. Toll Free:1-877-476-8823 dave@lowridgetech.com P.O.Box 1179 Fax:1-425-335-3622 oscaronsite.com Lake Stevens,WA 98258 A.Y.McDonald considers the information on this assembly drawing correct when published.Item and option availability,including specifications,are subject to change without notice. Submitted by: 1/2022 Installation & System Notes 1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids, transport line,drainfield,and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if multiple visits are needed due to installation errors or inaccessible components. 2.This septic design must be installed by a certified installer with the local health department. All components shall be installed according to state,county,and manufacturer requirements. For Homeowner Installs,the owner must get approval from the designer and local health department prior to attempting installation. 3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately. 4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder,lot developer,or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design void. 5.The property owner and installer are responsible for locating all underground utilities (ex.water,gas,electric) prior to installation. Any utility locations shown within design drawings are likely approximate and may not be exact. 6.All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and maintenance. Component manufacturers (ex.ATU,Glendons,) may have other requirements not listed within this design. 7.All electrical wiring shall be done by a licensed electrician or homeowner(if allowed)and must be permitted through Labor and Industries. Designer not responsible for electrical permitting or other electrical specific code requirements. 8.The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet weather conditions may render this design void. 9. Maintain 10ft to waterlines with all septic components. If less than 10ft is required,sleeving in sch.40 pvc is required. If sewage transport lines and waterlines must cross,waterline must be 18"above sewage line with one of the lines sleeved in sch. 40 pvc 10ft in each direction of crossing. 10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and maintenance of the proposed components. 11.Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain, foundation,perimeter drains shall be installed 30ft downslope and 10ft upslope of drainfield areas. 12.This design is site specific and intended to meet state and county requirements that are related to the system components being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or may not meet other requirements. 13.All onsite septic systems require regular maintenance to verify satisfactory operation. The system owner/operator is responsible for the continuous operation and maintenance of the system per WAC 246-272A. For operation and maintenance information, refer to Mason County Public Health Homeowner's Manual,which should be receive fte sta I ti ppjo�. 14.System owner should be cautious of landscaping around septic components. Root intrusion can cause premature failure of the drainfield area. In addition, bushes and trees should be kept MAY 22 2026 away from lids and other septic maintenance points. MASON COU ENVIRONMENTAL HEALT I 15. Changes made at time of installation may impact designer calculations,pump sizing,and RET compliance w/county and state requirements. Contact designer prior to install w/any proposed variations from design. Changes may result in additional fees and permitting. '. PIONEER, DIGGING, INC. CUSTOMER. MICHAEL.GIVENS PARCEL#:32127 54 00ll3 f ' SSr,,0317 Q`�• fiOQERT H DAYSSE '�! SEPTIC DESIGNS ADDRESS: 240 E PEEBLES CT 3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER. ROBERT H.PAYSSE EXPIRES OFFICE-360-426-1803 FAX-360-427-2353 SHEET: NOTES SCALE NA