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Home My WebLink AboutSWG2026-00172 - SWG Application / Design - 6/17/2026 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: SWG2026-00172 APPLICANT FRENCH DOUGLAS G &KRISTIN L Phone: Address: PO BOX 54 SHELTON,WA 98584-0054 OWNER FRENCH DOUGLAS G &KRISTIN L Phone: Address: PO BOX 54 SHELTON,WA 98584-0054 SEPTIC DESIGNER DALE TAHJA* Phone: 360-463-8023 Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584 Site Address: 1481 E SHELTON SPRINGS RD Primary Parcel Number: 420122290084 Permit Description: Repair/upgrade to 3bd pressure sandlined bed Permit Submitted Date: 06/02/2026 Permit Issued Date: 06/17/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/03/2027 (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. 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 N • AMOUNT RECEIVE RECEIVED BY: Public,Health & Human Services y v N Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 0 415 N.6th Street-Shelton,WA 98584 S W G _ /p�1 �� 3 X pL z N ON-SITE SEWAGE SYSTEM APPLICATION m APPLICANT PHONE C) Doug French w cw,---�-, (360)490 8932 �q� i z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE P.O. Box 54 Shelton WA 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE si X 1483 E. Shelton Springs Rd. o Shelton WA 98584 NAME OF DESIGNER N PHONE Dale L. Tahja (360)463 8023 N NAME OF INSTALLER PHONE T.J. Goos (360)490 0217 �PERMIT TYPE(select one) DRINKING WATER SOURCE I O RESIDENTIAL OSS ❑ COMMUNITY OSS ❑COMMERCIAL OSS PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL z I N TYPE OF WORK(select one) ❑ PUBLIC WATER SYSTEM i NEW CONSTRUCTIO UPGRADES REPAI /REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I N ❑ SURFACING SEWAGE A EXISTING FAILURE ❑SHORELINE SUBMITTALS W Q DESIGN FORM(REQUIRED) Q SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I WAS LOT CREA1 ED AFT 1/20257 O N CJ❑ WAIVER(S)(IFAPPLICABLE) 3 2.6acres YES DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) Hwy 101 north to the Airport Grocery, right on Shelton Springs Rd. to address on the rignt. I o � Io O I00 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) ❑VOLUNTARY ❑MAINTENANCE/PUMPING❑ BUILDING PERMIT❑HOME SALE❑COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS 1 \ 0- cc? Lc �� - �' alb • � w� `70 s� RECORD DRAWING AND INSTALLATION REPORT SOIL-CODES 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 I iii - �___ THIS FORM MAYBES NNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:01/09/2026 .7 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 0 1 2 1 2 2 1 9 0 0 8 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"X17" Y e t "'�" ..` k„a�' °.q✓y. r w°�.-Us 'z N� 'z, s}tr+' -:f ,L .':: Ts Y.1`5'3y icy i y `qb.T � .n5..' yep ,` .�y �.'� } S..Fz Permit Number: SWG ap( _(.y - Designer's Name: Dale L.Tahja Applicant's Name: Doug French Designer's Phone Number. (360)463 8023 Mailing Address: P.O.Box 54 Designer's Address: I 2450 W. Deegan Rd.W. Shelton WA 98584 City State Zip Shelton WA 98584 City State Zii Designer's Email daletahja@gmail.com d2 ��.��-''c �:::�-��,% _L.vs t �.-f u��.*e�rs,�•sn�-�,�'+}`k,�.,��`�� =. - u-z �� _r � 'y-.{f "� Sr�s.'-`� 4--,-' $t3-t.r Tn i"��.d.�, Treatment Device ❑Glendon ❑Sand Filter ❑Mound Sand Lined Drainfield ❑Recirculating Filter O ATU ❑Other Treatment Level(check all that apply): ❑A (B G C ❑BL1 CI BL2 eBL3 'E ❑N Drainfield Type ❑Gravity ('Pressure O Trench "Bed O Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class Sch.40 Daily Flow: Operating Capacity 270 gpd Length 40 ft Daily Flow:Design Flow 360 gpd Diameter 1.25 in Septic Tank Capacity(working) 1,200 gal Number 3 Receiving Soil Type(1-6) 1 Separation 3 ft Receiving Soil App!.Rate 1_0 gpd/ft2 Orifices Required Primary Area 360 j{2 Total Number of Orifices 57 Designed Primary Area 360 ft2 V Diameter 1/8 in Designed Reserve Area 360 ft2 Spacing 24 in Trench/Bed Width 9 ft ✓ Manifold Trench/Bed Length 40 ft Schedule/Class Sch.40 Elevation Measurements Length 6 ft Original Drainfield Area Slope 2 % Diameter 1.5 in New Slope,If Altered 1 % Preferred manifold configuration used? O Yes fl+'No Depth of Excavation Up-slope 48 in Transport Pipe from Original Grade Down-slope 48 in Schedule/Class Sch.40 Designed Vertical Separation 24 in Length 20 ft Gravel-based Drainfield Required? O Yes a No Diameter 2 in Pump Required? I 'Yes ❑No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 4 Dif.in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 67.5 gal Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,000 gal Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head 30 gpm l Timer Ef Elapse Meter 19 Event Counter Calculated Total Pressure Head 18 ft If Timer: Pump on 2.25 min Pump off_5 hrs.57.75 min Comments APPROVED Il1PI 17 2U2R MASON COUNTY ENVIRONMENTAL HEALTH Revised:6/11/2025 RET DESIGN FORM—PAGE TWO Assessor's Parcel Numbers 4 2 0 1 2 . 2 2�9 0 0 8 4 Permit Number: SWG — t �DE y(S 1 CKLITS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch V Test hole locations ' Drainfield orientation and layout Reference depth from original grade: V Soil logs V Trench/bed dimensions and NY Septic tank 9 Property lines critical distances within layout ®' Drainfield cover V Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade within 100 ft of property 0 Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks,and locations 0d' Laterals,trench/bed,top and • surface water and critical areas 0 Observation port location bottom V Location and orientation of 9 Clean-out location ❑ Curtain drain collector curtain drain and all absorption V Manifold placement 0 Sand augmentation components 0' Orifice placement Other cross-section detail: lT Location and dimension of pj Lateral placement with distance V Observation ports/clean-outs primary system and reserve area to edge of bed Other Information vi Buildings Audible/visual alarm-referenced Yes No V Direction of slope indicator It Scale of drawing shown on scale V Waterlines ❑Design staked out bar ❑ ❑Recorded Notices attached V Roads,easements,driveways, 'Elevation benchmark and relative 0 0 Waiver(s)attached parking elevations of system components B' ❑Pump curve attached North arrow and scale drawing O O Evaluation of failure shown on scale bar Non-residential justification ❑ ❑Waste strength ❑ ❑Flow DESIGN APPROVAL The undersigned designer m be notified b stall at time of installation V'Yes ❑ No Signature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determin m w compliance with state and local on-site regulations: z Environmental Hea Specialist D CAUTION. DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CO ✓ The design is stamped"Approved"by Mason County Public Health. ` 1 � o 1' The Onsite Sewage Permit has not expired,the Permit Expiration Date is: P I 7/ ✓ 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: 6/11/2025 r r a a pa � \q 4 846dl-,{� LICENSED DESIGNER �� JUN 17 2026 MASON COUNTY ENVIRONMENTAL HEALTH Uc\ RAT Media Gallery X Liberty Pumps 280 - 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non- Automatic) Periórniance : , 80 Series �;�,„,a„�: � .�.��„�.. � ,� tea-•, .-..b._ ,..,.,..�i. �. 20 s.... t�..i...->.:., . 10 ot± ±i±itt:4i±L!±L:i±i±Lti ��z y 0 5 j:0 15 20 25 3035404550 55 60 65 70 U.S. Gallons Per Minute APPROVED JUN 172026 MASON COUNTY ENVIRONMENTAL HEALTH RET Installation/Maintenance Pressure Distribution/Bed Systems 1. Install bed bottom level and in contour with the ground. 2. Install drainfield during dry weather and soil;conditions.Any soil smearing must be eliminated by hand raking any areas that get smeared. 3. Install audio/visual high-water alarm. 4. Install effluent filter in septic tank outlet or pump vault with 1/16-inch maximum filtration mesh size. 5. Install check valve in pump outlet line to prevent back-flow into the pump chamber. 6. Install 1/8-inch orifices on 24-inch centers. Install the orifices pointing straight down(6:00 o' clock). 7. Divert all storm water run-off away from septic system components. 8. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and reserve area. 9. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield and reserve area. 10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years. 11.Inspect and clean pump screen as needed. 12.Inspect floats and test high water alarm every 6 to 12 months or as needed. 13.All material and workmanship must meet County and State requirements. 14.Install risers on septic tank and pump chamber. 15.Deviation from this approved design without%prior approval from the Designer and Mason County Health Department will make'this design null and void. 16.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property line locations prior to installation. Any;discrepancies must be reported to the Designer immediately. 17. Locate all utilities prior to starting installation. 18. The installer must notify the designer at least;48 hours prior to starting installation. 19. The Designer may have additional charges for redesign work and final inspection. APPROVED JUN 172026 MASON COUNTY ENVIRONMENTAL HEALTH RET 5100214 F� O Dale L.Tahja LICENSED DESIGNER 1 �r � ` / ,.fir ��. r''�� r / Gta N��" r 9 ;ç c - // ' • \ V ( II 1 " f y o i ; e/I - - - - / /c JUN 17 2026 ;iJi3 , G . ;j V( N