HomeMy WebLinkAboutSWG2026-00144 ASBUILT - SWG Application / Design - 5/11/2026 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 Permit: SWG2026-00144
APPLICANT PAULA JOHNSON* Phone: 360-898-2255
Address: 171 E VUECREST DRIVE UNION, WA 98592
OWNER EMPIRE HOME CONSTRUCTION LLC Phone: 360-751-8062
Address: P O BOX 241 KELSO, WA 98626
Site Address: 210 N Duckabush Dr W
Primary Parcel Number: 422045100015
Permit Description: 3BR Pressure Bed -NEW SFR
Permit Submitted Date: 05/11/2026
Permit Issued Date: 05/26/2026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $570.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/20/2029 (based on date of inspection)
Permit Conditions:
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 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.
MASON
np OFFICIAL USE ONLY
I!1 S E A S®® ® COUNTY DATE RECENED: I (/
/�
AMOUNT RECEIVED. RECEIVE BY:
Public Health & Human Services 'S ' ot,J l EVE
C C/)v m
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext 400 S W G O 0
415 N.6th Street-Shelton,WA 98584 l
44 ? O
APPLICATION
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ON-SITE SEWAGE SYSTEM APPLICATION
m n
APPLICANT PHONE m
Empire Home Construction (360)751-8062 ,- Z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE ~ 9
P.O. Box 241 N Kelso WA 98626 n M
SITE ADDRESS-STREET,CITY.ZIP CODE
210 N Duckabush Dr W Hoodsport WA 98548
NAME OF DESIGNER PHONE I
Arrow Septic Designs, Inc (360) 898-2255
NAME OF INSTALLER PHONE 0 I
Mason County Excavating c, " I (360)490-3144
PERMIT TYPE(select one) DRINKING WATER SOURCE-
RESIDENTIAL OSS u:COMMUNITY OSS, IL�ICOMMERCIAL OSS PRIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z -
TYPE OF WORK(selecrone) PUBLIC WATER SYSTEM
NEW CONSTRUCTION/UPGRADES bIIREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I
SUBMITTALS O SURFACING SEWAGE ❑ EXISTING FAILURE ❑SHORELINE
L]DESIGN FORM(REQUIRED) ISEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/12025? 0
L LIWAIVER(S)(IF APPLICABLE) 3 BR .24 ac n
❑ YES Q NO
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Take US-1 01 N to Hoodsport and turn (L) onto N Lake Cushman Rd. Turn (L) onto I
Duckabush Way. Turn (R) onto N Duckabush Dr W. Yellow sign: "<-220 Empire Homes o I o
210—>"
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1O1
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I U1
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
CS
SOIL CODES: I RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
IN PECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE ° LICATIONAPPROVED/ISSUED BY DATE
.c?0zc1
IS MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 0 4 - 5 1 - 0 0 0 1 5
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"
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Permit Number: SWG cl- .lp - 001 g 0i Designer's Name: Arrow Septic Designs, Inc
Applicant's Name: Empire Home Construction Designer's Phone Number: (360)898-2255
Mailing Address: P.O.Box 241 Designer's Address: 171 E Vuecrest Dr
Kelso WA 98626 City State Zip Union, WA 98592
City State Zip Designer's Email paulaj@hctc.com
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Treatment Device
❑Glendon ❑ Sand Filter O Mound O Sand Lined Drainfield ❑Recirculating Filter O ATIJ ❑Other
Treatment Level(check all that apply): ❑A ❑B ❑C ❑BLI ❑BL2 ❑BL3 0 E ❑N
Drainfield Type
❑Gravity i 'Pressure ❑Trench 1rBed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 40
Daily Flow: Operating Capacity 270 gpd Length 45 ft
Daily Flow:Design Flow 360 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 gal Number 4
Receiving Soil Type(1-6) 3 Separation 2.5 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices 36
Designed Primary Area 450 ft2 Diameter 3/16 in
Designed Reserve Area 450 ft2 Spacing 60 in
TrenchBed Width 10 ft Manifold
TrenchBed Length 45 ft Schedule/Class 40
Elevation Measurements Length 7.5 ft
Original Drainfield Area Slope 3 % Diameter 1.25 in
New Slope,If Altered 3 % Preferred manifold configuration used? 1 Yes O No
Depth of Excavation Up-slope 12 in Transport Pipe
from Original Grade Down-slope 9
in Schedule/Class 40
Designed Vertical Separation 24 in Length 50 ft
Gravel-based Drainfield Required? I 'Yes ❑No Diameter 2
in
Pump Required? Ed Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff.in Elevation Between Pump&Uppermost Orifice 8 ft Dose quantity 90 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice @'Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 21.24 gpm ' Timer O 13(apse Meter ❑d$vent Counter
Calculated Total Pressure Head 11.03 ft If Timer: Pump on 2 minutes ,Pump off 6 hours
Comments
EN
MASON COUNTY VIRONM
b� Revised:4/14/2025
ENTAL HEALTH!
,DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 2 0 4 - 51
-- 0 0 0 1 5
Permit Number: SWG� � —
DESIGN;CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
El Test hole locations 19 Drainfield orientation and layout Reference depth from original grade:
El Soil logs Ed Trench/bed dimensions and El Septic tank
Ed Property lines critical distances within layout 9 Drainfield cover
❑ Existing and proposed wells ❑ D-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property El Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations
� Laterals,trench/bed,top and
surface water and critical areas Ef Observation port location bottom
❑ Location and orientation of El Clean-out location ❑ Curtain drain collector
curtain drain and all absorption El Manifold placement ❑ Sand augmentation
components 19 Orifice placement Other cross-section detail:
E6 Location and dimension of El Lateral placement with distance El Observation ports/clean-outs
primary system and reserve area to edge of bed
El Buildings Other Information
E6 Audible/visual alarm referenced Yes No
El Direction of slope indicator l� Scale of drawing shown on scale !� 0 Design staked out
E6 Waterlines bar ❑ 9 Recorded Notices attached
E6 Roads, easements, driveways, D Elevate n t?encbmark and relative ❑ E6 Waiver(s)attached
ParOng elevd{io � ste c p e ' sf ❑Pump curve attached
El North arrow and scale drawing IflE i El Evaluation of failure
shown on scale bar '" � v . n-residential justification
�'1`� ' ' F 9�Waste strength
MASON COU N1MENTAL HE,L�l El Flow
DES!94 r:
The undersigned designer must be notified by ins mjj9ii El Yes ❑ No
PAULA JOY JOHNS 4'
Signature of Sill = r Date
EXRti7�S 9 7 u �'
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local o e regulations•
JA
—24
Envir Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
-VThe Onsite Sewage Permit has not expired,the Permit Expiration Date is: J —2 ' '
✓ 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
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Effluent Filter
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�. MAY 2 6 2023
kips MASON COUNTY ENVIRONMENTAL HEALTH
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30 4 of
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TOP VIEW 1 .25" sched 4Q laterals
DRAINFIELD ( ) pp++ O.C.
1 0 x 4,5' pressure bed (� ) 3/1611 orifices
3011 from bed ends
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LtL`Ms`dEtJL'ro��Pytt � SCREW ON CAP
EXf'! 91]
45 DEGREE ELBOW
NOTE, LATERAL
1O-OBSERVATION PORTS--TO BE 4 ' o� Ge
END OF
PVC PIPE FROM BOTTOM OF TRENCH
DITCH
TO FINISHED GRADE. REMOVABLE �� DETAIL
CAP SRALL BE INSTALLED ON 30 CLEAN OUT
OBSERVATION PORT PIPE. ANCHOR ON
BOTTOM WITH GLUED ON TEEa CLEANOUT TO BE FROM C
MINIMUM OF Z IN dSYSTEM. NOTE,
INCHES BELOW FINISHED GRADE
MARK ENDS WITH REBAR . CIJEA
REQUIRED AT END OF EACH LAT
[L T„ tee.
lb- l L (Zq-DE
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'" NVIRONMENTAI.HEA►-TH
MAS0NC0U .
Length Length Orifice # Distance from Distance from
Lateral# (In.) (Ft.) Spacing Orifices Feeder Line(In.) Cleanout(In.)
1 540 45 60 . 9 30 30
2 540 45 60 9 30 30
3 540 45 ' 60 9 30 30
4 540 45 60 9. 30 30
Total Lateral Length 180
Total#Orifices 36 -j GPM= 21.24
Dynamic Head Calculations
Selected residual pressure: 2 ft.
Length(Ft.) #Orifices
Transport Pipe 20 36 0.16 ft.
Feeder Total
Lateral Line Length
Lateral#1 45 4 49 9 0.22 ft.
Lateral#2 45 2 47 9 0.21 ft.
Lateral#3 45 2 47 9 0.21 ft.
Lateral#4 45 4 49 9 0.22 ft.
Total Elevation Lift 8,00. ft.
Total Dynamic Head 11.03 ft.
11
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ASON COUNTY�A� 6 (��
ENVIRONMENTAL HEALTH
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PAULA JOY JOHNSON
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EXPIRES b/ .SJ
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t, � r, Bronze construction available(139 series)
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. ,� - � High head version available(145 series)
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Double shaft seal versions available for added protection
Flow -mate on models 140/145.
2.0 For more information,see Technical Data Sheets FM2782,FM2783.
In high head dewatering or effluent
applications where pumping .a
performance is critical, this robust °C PUMP PERFORMANCE MWE
- MODEL 137!1!0!115
family of pumps is known for reliability, „
durability and performance. These - ,
pumps are especially suited for harsh 1 "
environments.ZoeLler's cool run design t
and corrosion-resistant,powder coated >.::r
epoxy finish add up to a long-Lasting, - ,5
trouble-free product. a '
APPLICATIONS: "
• STEP or onsite applications 912
• Water transfer
Light commercial dewatering +
SPECIFICATIONS: " c
• 1-1/2"NPT discharge ®® „
1/2 HP through 1 HP MADE IN THE USA „
• Available in automatic or nonautomatic USIAOAUJJORQI'OEU1COITEBi
• Model 137,139,140:1/2"(12 mm)spherical solids
capacity with vortex impeller Na o m v n v o m m m ,m
• Model 145:3/4'(19 mm)spherical solids capacity with a m >n
vortex impeller 0°`{^"^ 152656
PUMP PERFORMANCE CURVE
MODEL 1511152/153
50
This is our fastest growing Line of effluent 14 45 153
pumps.The 150 series is truly a workhorse
designed for reliability under extreme 12 ao
conditions in an effluent environment.
150seriespumpcurvescoverawiderang e < 10 35
< 152
of applications. They are well suited to 2 30
applications with low pressure pipe(LPP)
andenhancedflowSTEPsystems.Zoeller's o O 25 151
cool run design and corrosion-resistant,
powder coated epoxy finish, in addition s 20
to the hermetically sealed, oil-filled motor is
and non-clogging vortex impeller add up to 4
a long-lasting,trouble-free product. 10
APPLICATIONS: 2 5
• STEP or onsite applications 0
MADE IN THE USA 10 20 30 40 50 6D 70 80 9D 100
• Light commercial dewatering USL46A11AJIRQ1 0FUS[Od'1l'T GALLONS
SPECIFICATIONS: LITERS 0 40 60 1210 1610 200 240 280 320 3610
1-1/2"NPT discharge � FLg PE N . 014508
y} 'IE
• 3/10 HP through 1/2 HP wT ` m 1
•
Available in nonautomatic or with a variable Level "' .
piggyback mechanical switch
MAY G 6 sty- krsd
• 1/2"(12 mm)spherical solids capacity with vortex
thermoplastic impeller MASON COUNTY ENVIRONMENTAL HEALTH
For more information,see Technical Data Sheet FM2784. Jj B
@ All rights reserved. ZOELLER PUMP CO. 1502-778-2731 1800-928-7867 I zoellerpumps.com 9
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MASON COUNTY ENVIRONMENTAL HEALTH
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INSTALLATION & MAINTENANCE
Pressure Distribution Systems - Bed ,` �h�
1. Install Laterals with contour of the ground. "t PAULA JOY JOHNSON •t''i
2. Install bed bottom level. � �s � Fi �
3. Install locator tape or rebar at each end of all drainfield laterals.
4. Install observation ports as indicated on the plot plan. Minimum of 2 required in each
bed with bottom extending to the drainrock/native soil interface. Glue"T"to bottom so
Observation Port cannot be easily removed from ground. Install removable cap on top of
port at final grade level.
5. Install drainfield during dry weather and soil conditions; any soil smearing must be
eliminated by hand raking.
6. Install threaded clean-outs at the end of all laterals (cap must extend to within six inches
of finished grade and be marked with locator tape or rebar).
7. Install audio/visual high water level alarm.
8. Install 1/8" mesh non-corrosive pump screen(min. 12 sq. ft. surface area, not to interfere
with controls or floats.) Or pump screen may be substituted with Bio-Tube in septic tank
and block under pump. Pull bio-tube every 6-12 months and flush back into tank.
9. Install check valve in pump outlet line to prevent system from draining back into the
pump chamber.
10. Tee to Tee construction between laterals and manifold with orifices oriented at 6 o'clock.
Install laterals to the manifold with the orifices at 12 o'clock, (do not glue), after pressure
test and Environmental Health Dept. approval,turn orifices down (6 o'clock) and glue
laterals to manifold. Orifice shields may be used with orifices in the 12 o'clock position
in lieu of turning the orifices down to the 6 o'clock position.
11. Filter fabric required over drain rock prior to back filling. If the drain rock extends above
natural grade,run the filter fabric at least 2 inches down the trench wall.
12. Waterlines must be a minimum of 10' to any tank or drainfield (a reduction to 5' may be
obtained with a State waiver on lots that meet minimum lot size). Encase all water lines
within 10' of septic transport lines and under any driveway/parking areas.
13. Divert all storm water runoff away from on-site sewage system.
14. No curtain drains allowed within 10' of the up-slope edge or 30' of the down-slope edge
of the drainfield and reserve area.
15. Have the septic tank and pump chamber pumped or inspected every 3 years minimum.
16. No vehicular traffic over drainfield area or tanks.
17. Inspect floats, clean filters, and test high water level alarm every 6-12 months as needed.
18. All materials and workmanship must meet County and State regulations.
19. Deviation from this design without prior approval from the Designer and Mason County
Environmental Health Department will make this design null and void.
20. All manhole lids and access, sampling or inspection ports must have locking covers and
be located at ground level.
21. All pressure systems with a pump chamber outlet higher than the drainfield must have an
anti-siphon valve or a 1/8"hole drilled in the discharge pipe above the pump to prevent
siphoning. Ensure anti-siphon hole sprays down/away from tank opening.
22. Homeowner is responsible for all•property lines and easements.
V E
MAYZb '
°i �� MASON COUNTY ENVIRONMENTAL HEALTH