HomeMy WebLinkAboutSWG2026-00182 - SWG Application / Design - 6/9/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,97 ,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: SWG2026-00182 (O Q g i
APPLICANT PAUL THOMAS J &SANDRA L TRSE Phone:
Address: T&S PAUL REV LVG TRUST SHELTON,WA 98584-7831
OWNER PAUL THOMAS J &SANDRA L TRSE Phone:
Address: T&S PAUL REV LVG TRUST SHELTON, WA 98584-7831
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON,WA 98584
Site Address: 2220 E ISLAND LAKE DR
Primary Parcel Number: 320065002104
Permit Description: Table X Repair 3bd pressure sandlined bed
Permit Submitted Date: 06/09/2026
Permit Issued Date: 06/15/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/10/2027 (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 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.
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`P I O9 C
} Public Health & Human Services AMOUNT RECEIVED: RECEIVED BY: W (n
8'�lrJ O�oIP6�FQy-e ° ch
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 ≤ Cl)
415 N.6th Street-Shelton,WA 98584 S W G ('f' _ Cl) 00
L V Z C,,
ON-SITE SEWAGE SYSTEM APPLICATION > v
APPLICANT m n
PHONE m
THOMAS/SANDRA PAUL 360-239-8163 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE �
C
2220 E ISLAND LAKE RD SHELTON WA 98584 m
SITEADDRESS-STREET,CITY,ZIP CODE
2220 E ISLAND LAKE RD ® SHELTON WA 98584 �^'
NAME OF DESIGNER PHONE 360-701-0205
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE v I c)
TBD
Io
PERMITTYPE(select one) DRINKING WATER SOURCE
RESIDENTIAL OSS COMMUNITY OSS ,COMMERCIAL OSS It�a PRIVATE INDIVIDUAL WELL ii PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(select one) I� PUBLIC WATER SYSTEM I
FFNEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 19 TABLE X REPAIR ICI'
SUBMITTALS D SURFACING SEWAGE I EXISTING FAILURE SHORELINE
DESIGN FORM(REQUIRED) Iwl SEPTIC DESIGN(REQUIRED) BEDROOMS ]�.W I S LOT CREATED AFTER4/1/20257 0 I
EFWAIVER(S)(IF APPLICABLE) 3 I
YES NO � I o
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
GO NORTH ON BROCKDALE RD, TURN RIGHT ONTO ISLAND LAKE DR, KEEP TO I
THE RIGHT, RESIDENCE IS ON THE LEFY AFTER 90 DEGREE RIGHT TURN. o
SHORELINE PARCEL. VERY LIMITED RESERVE -�
Io
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I -p
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT DOTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
1 , 0 -'i cS l - v\
SOIL CODES: U o`^�LL RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINALAPPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MAS N COUNTY WEBSITE Revised:4/14/2025
,DESIGN FORM-PAGE ONE Assessor's Parcel Number: 3 2 0 0 6 5 0 0 2 1 0 4
A design will be reviewed when 3 copies af 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 � lD — (�) Designer's Name: CINDY WAITE
Applicant's Name: THOMAS/SANDRA PAUL Designer's Phone Number: 360-701-0205
Mailing Address: 2220 E ISLAND LAKE DR Designer's Address: 80 E PICKERING LANE
SHELTON WA j 98584 City State Zip SHELTON WA 98584
City State Zip Designer's Email cindyewaite@msn.com
DESIGN PA1AMETERs
Treatment Device
O Glendon ❑ Sand Filter ❑Mound Sand Lined Drainfield ❑Recirculating Filter ❑ATU ❑Other
Treatment Level(check all that apply): ❑ lg IC O BL 1 YI rc BL2 YJ BL3 1[l E ❑N
Drainfield Type
O Gravity ❑Pressure I O Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms Schedule/Class SCHEDULE 40
Daily Flow: Operating Capacity 2V0 gpd Length 44,40,36,32 ft
Daily Flow:Design'Flow 3b0 gpd Diameter 1.25
in
Septic Tank Capacity(working) 1 050 gal Number 4
Receiving Soil Type(1-6) 1t Separation 2 ft
Receiving Soil Appl.Rate 1. gpd/ft2 Orifices
Required Primary Area 360 & Total Number` •4D ces 76
Designed Primary Area 30 ft2 Diameter 3/16 in
Designed Reserve Area VERY LIMITED ft2 Spacin ` .�' 24
Trench/Bed Width ti �i 2 ►,�c . in
1b ft y anifold
Trench/Bed Length 3 ", •
ft Sch' /Clan sa
II lnoala .. �..
Elevation Measurement I citIDY E.WAI'TE' '.:
LICENSED DreSIGNER r ft
Original Drainfield Area Slope <1 o/a — "
Exw'IRLS u5r101 in
New Slope,If Altered i % Preferred manifold configuration used? ❑ Yes I 'No
Depth of Excavation Up-slope 11/35 Bo-rr�E OF SANE in Transport Pipe'
from Original Grade Down-slope 11/35 BOTTOM OF SAND
in Schedule/Class SCHEDULE 40
Designed Vertical Separation. in Length 10 ft
Gravel-based Drainfield Required? I!.I Yes Q]No Diameter 2 in
Pump Required? If Yes I No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 6
Diff. in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1455 gal
Uppermost Orifice I f Higher ❑Lower than P'mp Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 44.14 gpm 09 Timer L7' Elapse Meter Rr Event Counter
Calculated Total Pressure Head 8.32 ft If Timer: Pump on ,Pump off
Comments
P P R 0 V b U
JUN 15 2026
•a U
A5MUi U r1 I R rnLir i
DESIGN FORM—PAGE TWO Assessor's Parcel Number. 3 2 9L 6 I.5 0 0 i 2 1 l 0 h4
Permit Number: SWG aD" -
DESIGN CHECKLISTS
Scaled.Plot Plan Scaled Layout Sketch Cross-Section Sketch
iff Test hole locations p -q,e Q( Drainfield orientation and layout y Reference depth from original.grade:
Soil logs P 4 Trench/bed dimensions and
Df Septic tank
l� Property lines g critical distances within layout Qf Drainfield cover
if Existing and proposed wells t / -BoxNalve box locations Reference depth from original grade
within 100 ft of property if Septic tank/pump chamber and restrictive strata:
1 Measurements to cuts,banks, an locations p/a,L M
10 Laterals,trench/bed,top and
surface water and critical areas
Observation port location bottom
Location and orientation of ' Clean-out location Q Curtain drain collector
curtain drain and all absorption If Manifold placement l Sand augmentation
components
Orifice placement Other cross-section detail:
l ' Location and dimension of ❑ Observation
primary system and reserve area if Lateral placement with distance ports/clean-outs
to edge of bed
l� Buildings Other Information
f� Audible/visual alarm referenced. Yes No
Qf Direction of slope indicator Qf Scale of drawing shown on scale 6f O Design staked out
Waterlines bar ❑ ❑ Recorded Notices attached
1 Roads,easements,driveways, Ur Elevation benchmark and relative ❑ ❑ Waiver(s)attached
parking elevations of system components F.( ❑ Pump curve attached
l2' North arrow and scale drawing ❑ ❑Evaluation of failure
shown on scale bar Non-residential justification
0 0 Waste strength
OF low
DESIGN APPROVAL
The undersigned designer must be no ified by installer at time of installation 17'Yes ❑ No
l� �c �1 •Zv z b
Sign tur of Designer Date
The undersigned has reviewed this deign on behalf of Mason County Public Health,and determined it to be in
compliance with state and local on-site regulations:
?iT1:\QA/v\JY2JCIV)
Envirgnmental He 4th Specialist Date
CAUTION: DESIGN APPROVAJ IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved'by Mason County Public Health.
✓ The Onsite Sewage Permit has no expired,the Permit Expiration Date is:
✓ Drainfield site conditions have no been altered to adversely affect conditions of design approval.
Please Note: The syst m must be installed by a certified installer,
unless prior authorizati n is obtained from. Mason County Public Health.
An Installation Fee is r uired.
This form may be scanned and av ilable for public view on the Mason County Web site. Revised:6/11/2025
2220 E Island Lake Dr, Shelton, WA 98654; USA, Shelton Town320065002104
ahip, Parcel Id:
GIS
Legend
°• - - --- -
> WA Mason loft Contours
cv� i
_z4, 1 _ •• e•..
b o m
IAbp ~•{
,'� 1 Residence ,, ro t -
2 1200 1 ' JJ
gallon septic tank ` . yy; .,
3 1200 gallon pump tank
v P .
` 4 lAudible/visual alarm
r `� a
\ 5 Outbuildings IIIi L\ / / ..,
6 Primary drainfield
7 Owners well �'; '>4 ,
8 Waterline 0y `� 3' 30'
9 Tranport line Uj
N
Clean outj I I It I IV?) 4.
11 Neighbors well
cr p
toy '� �'�/ ' b ' r
a
BENCHMARK !
y � , . r
Foundation '1 100.99 �' `�;
* \ Septic tank j 2 99.00 `�
b . ii
Pump Tank 1 3 09.09 j 4•f
Bottom of drainfiel 41 9L.00 ' d Pv!
d' 1
P' d 7
F
. 4 � •e to
1 in ; dOft
ORIFICE SPACING 2
Lateral# Length Length j Orifice # Distance from Distance from end Length#
# (Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 44 528 24 22 1 1 44
2 40 480 24 20 1 1 40
3 36 432 24 18 1 1 36
4 32 384 j 24 16 1 1 32
1
152 76
150
TRANS LENGTH { 1Q
GPM
K (2"SCHEDULEN 40) x.284;5'
FRICTION LOSS
Squirt 2
Elevation difference 6
TDH 8.3277398 : -- _________
C7t C> O Z l /, r /LQi ee
!7
APPROVED
JUN 15 2026 .t4
MASON COUNTY ENVIRONMENTAL
TRENCH CROSS SECTION LICENSEDDF;IGNEf2
c�- DRAINFIELD LAYQUT
APPROVED
JUN 15 2026
MASON COUNTY ENVIRONMENTAL HEAlTH
2s RET
'.n-,S<U�4Shi . ?yam
X1=CLEANOUT/OBS PORTS 4) . {
X2=D BOXIVALVE BOX
r X1004'18 'w,
X3=Check Valves j ' ' CINDY E.`WAITE' :- ';, 5 ≥
�
X4=Flow Control Valves C/
X5=Soil Logs EXPIRES.'051101 '' p
I S' t /0' i /S' A
II' _c/
a
APPROVED
JUN 15 2026
MASON COUNTY ENVIRONMENTAL HEALTH
RET
THREADED CAP OR PLUG
�'�' Ili \ / 6"PVC
\ / LAST ORIFICE;WITH
j ORIFICE SHIELDS IF
ORIFICE ORIENTATION IS
BACKFILL I I UPWARD
MATERIAL
�Op�3'oOpp8 'N_ PRESSURE LATERAL
P o 0 o I l.ogo0o o AS SPECIFIED
VC HOSE OR \\
LONG SWEEP \ o 2p
ELBOW / DRAIN ROCK; "
MIN.
\ -::\\ \\,�'\�ji BELOW PIPE
UNDISTURB OIL ---/
6"PVC WITH DRAIN
e� HOLES; EXTEND TO
` '` BOTTOM OF GRAVEL TO
/ n .
�y �_ MONITOR PONDING
�;�'' 5 �� INFILTRATIVE SURFACE
C N AITE
LICEN°4ED`Df::ICNER
_U. ITORINGICLEANOUT PORT
(EXAMPLE)
\10
I _
SECURED LID.WITH GASTIGHT SEAL.
i
�•DIAMETER
ACCESS RISER
FINISHORADIa__ 11I :: I (. ;•/ - --i -- — —_.-TO PUMP
CHAMBER
FROM SEWAGE
SOURCE LOATING MAT
APPROVED
EFFLUENT
FILTER ci �
SEDIMENTS
n
SERI r '2®
PICALI 1=('6 �V
rn
cm
SECURE ID WITH GAS TIGHT SEAL.
THREADED UNION
24 DIAMETER
ACCESS RISER
FINISH GRADE SERVICE
— / VALVE*
FROM SEPTIC ( 12 '�
TANK TO ORAINFIELD
EMERGENCY STORAGE
ANTI SIPHON
HIGH WATER ALARM LEVEL -- -— _-_- VALVE*
WOR ING VOLUME INDEPENDENT
NORMAL TIMER OFF LEVE. —__ _ .--- .-__ FLOAT;STEM.
— FOR FLOAT
EN LOBED PUMP MOUNTING
SEDI ENT SHROUD* CHECK VALVE
�•��Sti, 18"
, �.' SEDIMENTS SUBNER818LE
CENTRIFUGAL
PUMP
PUMP CHAMBER
GAD DF,3IGNFt TYPICAL I l9 q`0
ZZ *AS NEEDED
/ 2a ? aQ/.�
• �'1 C
hb er m s
LITERS PER MINUTE.
0 50 100 150 200 250
40 12
---
10
_ _ - -s -----
z _
30 -` r�°�•y
m �
8
- -- - b-- --
W W
W � g
20 6 0.
J =
� O
4
4100416: : t,
CINDY E.'WAI:J:
LICENSED DE3IGI ER
EXPIRES 05/10/
0 10. 20 30 40 50 60 70.
GALLONS PER MINUTE
280 PI 8010/7/2015 ®Copyright 2015 Liberty Pumps Inc. All rights reserved. Specifications subject to change without notice.
Installation Notes
Sand Augmented Pressure Distribution System:
32006-50-02104
Theprepared siteplan is n t a survey. It's the owner's responsibility to verify property lines,
P Y p Yp p Y
utility lines (water, sewer, power, phone and gas) prior to installation.
I a Pump(controls to be!set at tTh e of installation 2�i0 GPD
2. Install system during dy westlher With acceptable soil oondi"tlons
3. Gravel based drainf ld required.
4. Clean;course or required
S. Sepflc and pump to P�;`k must be concrete
6. Keep wheeled vehicle off the drainfield area before, during and after installation.
Tracked equipment only,
7. All ground, surface water 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 th m. Use swales, berms, catch basin and tight lines, curtain drains,
etc. to divert all waters.
8. Curtain drains can be ho closer than 10' upgradient and 30' down gradient of the
drainfield
9. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
10. Install access risers oq the septic tanks, valve box and ends of laterals.
11. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
12. Lids must form a wate and gas tight seal with the access risers
13. Install effluent filter specified in this design at the septic tank outlet.
14. This system must be installed by a Mason County Certified installer.
15. Deviation from this design without prior approval from the designer and Mason County
Health Department wil make this design null and void.
16. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is b sed 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 multipli d 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 p r day.
17. Install laterals with contour of the ground
18. Install trench bottoms I vel and always maintain a minimum of six inches into native soil
19. Install locator tape on op of all drainfield laterals.
20. Install threaded clean Quts at the ends of all laterals (caps must extend to within six
inches of finish grade ¶nd be in a valve box as shown on di m.
21. Install audio/visual ala9m
22. Filter fabric required over drain rock prior to backfilling. If dr `rock extends above
the original grade, run the filter fabric at least 2 inches,: ' r�k e ch wall.
APPROVEDJUN 152026 ;
LIC.NSI7Ftr;IGNER
MASON COUNTY EN14RONMENTAL HEALTH
_s 05,0r
RET
Sy tern Owner Responsibilities:.
1. Operation and Maintenance is.required by Washington State Department of Health and
Mason County Health epartment.
2. The septic tank and pt.mp tank should be pumped every three to five years or as
needed.
3. System owners are re ponsible for having maintenance performed annually.
4. System owners are re ponsible for responding to septic issues in a timely manner.
5. System owners shall n t at any time change or alter settings in the control box.
6. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
7. Keep the flow of sewn a at or below the approved design operating capacity.
8. Keep waste strength a residential waste strength parameters.
9. Spread loads of laundry through the week.
10. Do not use excessive leach or detergents with added whiteners.
11. Do not shower, do lau dry and dishwasher at the same time
12. Antibiotics can kill or i pair the biological process in the septic tank.
13. Leaky plumbing can h draulic overload your on-site septic system.
.r •'yJ� ns �9J,
p�' CINE ITE
LICENSED DE?3IGN.ER
APPROVED \ ft
JUN 15 2026 l�
MASON COUNTY ENViRONMENTAL HEALTH
RET