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HomeMy WebLinkAboutSWG2025-00477 - SWG Application / Design - 5/19/2026 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: SWG2025-00477 APPLICANT ROLER CADE RAYNE Phone: Address: 2238 W RAILROAD AVE SHELTON,WA 98584 OWNER ROLER CADE RAYNE Phone: Address: 2238 W RAILROAD AVE SHELTON, WA 98584 SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON,WA 98584 Site Address: 2238 W RAILROAD AVE Primary Parcel Number: 420241300290 Permit Description: Repair 3bd gravity trench Permit Submitted Date: 12/31/2025 Permit Issued Date: 05/19/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system). Permit Expiration Date: 01/05/2027 (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. 8 Maintain 10ft from newly installed septic components to waterline 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: • C > i i r AMOUNT RECEIVED: �, RECEIVED BY: W Cl) Public Health & Human Services -pIMw o�� v y Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 c� ≤ 415 N.6th Street-Shelton,WA 98584 S\/VG �1!V�� _ £3 `�/ I O X vV Z fl) ON-SITE SEWAGE SYSTEM APPLICATION IllAPPLICANT PHONE C) CADE ROLER 360-359-8312 z C MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 2238 W RAILROAD SHELTON WA 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE 2238 W RAILROAD O �d�� SHELTON WA 98584 I NAME OF DESIGNER PHONE I N CINDY WAITS ��Sj " 3620-701-0205 NAME OF INSTALLER PHONE DI TBD PERMIT TYPE(select one) �A DRI WATER SOURCE O I\N RESIDENTIAL OSS COMMUNITY OSS ❑ O INNKING ERCIAL OSS L IJ PRIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z -p TYPE OF WORK(select one) ICJ PUBLIC WATER SYSTEM CITY OF SHELTON NEW CONSTRUCTION/UPGRADES MIREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR —S SUBMITTALS O SURFACING SEWAGE G2( EXISTING FAILURE ❑SHORELINE DESIGN FORM(REQUIRED) 1SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I WAS LOT CREATED AFTER 4/1/2025? O I W k b}WAIVER(S)(IF APPLICABLE) 3 .32 AC ❑ YES NO n I DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I I GO NORTH ON RAILROAD, ADDRESS IS ON THE RIGHT SIDE OF STREET. HAS A I FOR SALE SIGN ON THE DRIVEWAY o I N Ico SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) 1r ❑VOLUNTARY O MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE DCOMPLAINT ❑OTHER: INSPECTOR SOIL LOGS • Q (�s COMMENTS/OONDITIONS _.. k , ,�tee;✓�. - . T z.a o t.& . , t25 �es� , o jr®¢ -,4f--ce _, �0000) `�rI ® . SOIL CODES: v'_'. ' fE "_ RECORD DRAWING AND INSTALLATION REPORT V=VERY:G=GRAVELLY S=SAND L=LOAM Si= ILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINALAPPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE " I 'f2=' 2 I THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 �^ DESIGN.FORM—PAGE ONE Assessor's Parcel Number: A design will be reviewed when 3 cop ies 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" _ _PARCELIENT.IFICATiOl Permit Number: SWG x"4-7-7 Designer's Name: CINDY WAITE Applicant's Name: CADE ROLER f Designer's Phone Number: 360-701-0205 Mailing Address: 2238 W RAILROAD Designer's Address: 80 E PICKERING LANE SHELTON ! WA 98584 City State Zip SHELTON WA 98584 City State Zip- Designer'sEmaildidYeWaite@msn.com _ DESIGN rpARA'METERS Treatment Device ❑Glendon ❑Sand Filter ❑Mound ❑ Sand Lined Drainfield ❑Recirculating Filter ❑ATU ❑Other Treatment Level(check all that apply) ❑A ❑B ❑C ❑BLI ❑BL2 ❑BL3 Y3 E ❑N Drainfield Type Ii(Gravity ❑Pressure l ❑Trench ❑ Bed, ❑ Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms i 3 Schedule/Class ASTM 2720 Daily Flow: Operating Capacity 270 gpd Length o ft Daily Flow:Design Flow 360 gpd Diameter 4 in Septic Tank Capacity(working) EXISTING 1200 gal Number 4 Receiving Soil Type(1-6) 3 Separation 9 ft Receiving Soil Appl.Rate .8 gpd/& Orifices Required Primary Area 450 ft2 Total Number of O çs ASTM 2729 PERF Designed Primary Area j 456 ft Diameter in Spacing Designed Reserve Area j 456 ft2 S r�' P g '#+ 1in Trench/Bed Width 3 ft �s� s � ��•"'y anifold Trench/Bed Length f 152 ft Schedule/ Nt �� �` •`• Elevation Measurements Length / LI . ft Original Drainfield Area Slope I <1 % Dia r u v�): •DESIGNER • in New Slope,If Altered % Pre err ma?id iiuration use . O Yes O No Depth of Excavation Up-slope 24 in Transport Pipe from Original Grade Down-slope 11 24 � in Schedule/Class 3034 Designed Vertical Separation 1 36+ in Length 4 ft Gravel-based Drainfield Required? Of Yes ❑No Diameter 20 in Pump Required? ❑`es 'No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Diff.in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal Uppermost Orifice 0 Higher ❑Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm ❑ Timer ❑ Elapse Meter ❑ Event Counter Calculated Total Pressure Head,,, 12.56 ft If Timer: Pump on ,Pump off Comments NOTIFY DESIGNER PRIOR TO INSTALLATION, RETRO FIT EXISTING SEPTIC TANK WITH 1� EFFLUENT FILTER Revised:6/1 1/2U 5 DESIGN FORM—PAGE TWO Assessor's Parcel Number: 412 10 12 14 11 13 10 I 0 2 jj Permit Number: SWG �c rj QO[ / DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Y Cross-Section Sketch vi Test hole locations ' Drainfield orientation and layout Reference depth from original grade: Soil logs it Trench/bed dimensions and ❑ Septic tank i ' Property lines critical distances within layout Drainfield cover Existing and proposed wells VI D-Box/Valve box locations within 100 ft of roe Reference depth from original grade property rh' Septic tank/pump chamber and restrictive strata: Measurements to cuts,banks,and locations P1 ''`, VI surface water and critical areas Laterals,trench/bed,top and � Observation port location bottom ocation and orientation of Clean-out location ❑ Curtain drain collector curtain drain and all absorption �,ILManifold placement ❑ Sand augmentation components i Orifice placement Location and dimension of ' Other cross-section detail: primary system and reserve!rea i� Lateral placement with distance VI' Observation ports/clean-outs to edge of bed Buildings I Other Information �INAudible/visual alarm referenced Yes No Direction of slope indicator ; Scale of drawing shown on scale VI' ❑ Design staked out VI' Waterlines bar ❑ ❑ Recorded Notices attached Roads,easements,driveways, ' Elevation benchmark and relative ❑ 0 Waiver(s)attached parking elevations of system components ❑ ❑ Pump curve attached VI' North arrow and scale drawing VI' ❑ Evaluation of failure shown on scale bar ; ��"'CG r'`' Non-residential justification C°'J 2 ❑ ❑ Waste strength _ ❑ ❑ Flow DESIGN APPR.OVAL The undersigned designer must be notified by installer at time of installation 1W'Yes ❑ No C " 12 1' 2v Signatur of Designer Date I 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: W Environmental Health Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health. ✓ The Onsite Sewage Permit h js not expired,the Permit Expiration Date is: ' I Zii ✓ 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 re uired. This form may be scanned and available for public view on the Mason County Web site. Revised: 6/11/2025 2238 W Railroad Ave, Shelton, WA 98584, USA, Shelton Township, Parcel Id: 420241300290 _ _ & j1 s r r ' �v 4 w.Je.Jt ri d d a s2 I 5 -1;L1k. a _{ - G,a of D� o • x /7' /'L / / /II 2 i _-- _ L.._ aS+t�Nc Q -` — J—___ f' e 1 ; 10 GIS Legend (' 1 WA Mason 10 It.Contours I '�� I a). Scale=> I in 30 fE ` ps ` L__ ti àl TAENCHEUPS©PE S ���EPER THAN: L @� DOWNSLOPE M l' I B / '- FaFd r. r'i:I.3- 'r)� - fLL/ 2 I� Nv APPROVED MAY 19 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET � T I ' t; Aactass MarTo Made Intet wtlh 45®f Fad aoNm � I _ _ j _ __ b Spew�,evgl 0 brup regwneal APPROVED MAY 19 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET Distribution Box(No Scale) pF)KAsy,9 51 Q_0418 S SIGAIE. EXPIRES' 5/101 Installation Notes GRAVITY OSS 2238 W Railroad 42024-13-00290 1. The prepared site plan is not a survey. It's the owner's responsibility to verify property lines, utility lines (water, sewer, power, phone and gas) prior to installation. 2. This is a repair. Existing system is black handcore pipe. Septic tank was installed in 1994 and retrofitted with an aquaworx remediator in 2008. We will use the existing tank and the remediator. When we dug into the handcore pipe, it did not look like it had been getting effluent. 3. Keep wheeled vehicles off the drainfield area before, during and after installation. Tracked equipment only, 4. All ground, surface jwater and roof drains must be diverted away from the septic tanks and drainfield. Ensure the final grade slopes away from these areas and water doesn't collect on or around them.;Use swales, berms, catch basin and tight lines, curtain drains, etc. to divert all waters. 5. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the drainfield 6. Exposed restrictivellayers, cuts, banks, etc. can be no closer than 50' downhill from the drainfield. 7. Install access risers on the septic tanks, valve box and ends of laterals. 8. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank. 9. Lids must form a water and gas tight seal with the access risers 10. Install effluent filter specified in this design at the septic tank outlet. 11. This system must b installed by a Mason County Certified installer. 12. Deviation from this design without prior approval from the designer and Mason County Health Department will make this design null and void. 13. This design was sized per Washington Administrative CodeWAC246-272A-0230. The operating capacity is based on 45 gallons per day per capita with two persons per bedroom. The minimum design flow per bedroom per day is the operating capacity of ninety gallons multiplied by 1.33. This results in a minimum design flow of one hundred twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety gallons per bedroom per day. 14. Install laterals with contour of the ground 15. Install trench bottoms level and always maintain a minimum of six inches into native soil 16. Install locator tape on top of all drainfield laterals. 17. Install threaded clean outs at the ends of all laterals (caps must extend to within six inches of finish grade and be in a valve box as shown on diagram. 18. Install audio/visual alarm 19. Filter fabric required over drain rock prior to backfilling. If the drain roc ends above the original(grade, run the filter fabric at least 2 inches down th re. wall. APPROVED 19 2 MASON COUNTY ENVIRONMENTAL NRALT LIC NSED DESIGNE�i ;`' iRET EXPIRES 51101 System Owner Responsibilities: 1. Operation and Maintenance is required by Washington State Department of Health and Mason County Health Department. 2. The septic tank should be pumped every three to five years or as needed. 3. System owners are responsible for having maintenance performed annually. 4. System owners are responsible for responding to septic issues in a timely manner. 5. System owner agrees to read and abide by information regarding their system in the User Manual pro tided by Mason County Public Health. 6. Keep the flow of sewage at or below the approved design operating capacity. 7. Keep waste strength at residential waste strength parameters. 8. Spread loads of laundry through out the week. 9. Do not use excessive bleach or detergents with added whiteners. 10. Do not shower, do laundry and dishwasher at the same time 11. Antibiotics can kill or impair the biological process in the septic tank. 12. Leaky plumbing can hydraulic overload your on-site septic system. iI tP APPROVED 1 .`' if.51GNE MAY 19 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET