HomeMy WebLinkAboutSWG2026-00193-APPLICATION/DESIGN - SWG Application / Design - 7/2/2026 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: SWG2026-00193
APPLICANT SYLVAIN PIERRE C &AMANDA L Phone:
Address: 171 E ROADRUNNER DR SHELTON, WA 98584
OWNER SYLVAIN PIERRE C &AMANDA L Phone:
Address: 171 E ROADRUNNER DR SHELTON, WA 98584
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
SEPTIC INSTALLER B-LINE CONSTRUCTION Phone: 1.360.489.9169
Address: 2971 E PHILLIPS LAKE LOOP RD SHELTON, WA 98584
Site Address: 171 E ROADRUNNER DR
Primary Parcel Number: 421257790132
Permit Description: Repair-4BR Sand Lined Trench
Permit Submitted Date: 06/18/2026
Permit Issued Date: 07/02/2026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/24/2027 (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
DATE RECEIVED:
• . MASON; COUNTY l� c
AMOU CEIVE : RECEIVE B
Public Health,& Human Services Gj v M
Environmental S t e Health Shelt60 on,
27W-9670,ext.400 or 360-275-4467,ext.400 n -
415 N.6th Street-Shelton,WA 98584 U'�J
O
Z fA
ON-SITE SEWAGE SYSTEM APPLICATION v n
APPLICANT PHONE rn m
PIERRE/AMANDA SYLVAIN C/O B-LINE 360-426-4221 z
C
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE ic
171 E ROADRUNNER DR SHELTON WA 98584 OJ rn
SITEADDRESS-STREET,CITY,ZIP CODE r pq
171E ROADRUNNER DR SHELTON WA 98584 m I
NAME OF DESIGNER PHONE N
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE
B-LINE CONSTRUCTION 360-427-4221
PERMIT TYPE(select one) DRINKING WATER SOURCE
Uvl1 RESIDENTIAL OSS I�COMMUNITY OSS fi II COMMERCIAL OSS PRIVATE INDIVIDUAL WELL lu1 PRIVATE TWO-PARTY WELL Z 101
TYPE OF WORK(select one) j PUBLIC WATER SYSTEM
PE p a{NEW CONSTRUCTION/UPGRADES MIREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I
SUBMITTALS � ❑ SURFACING SEWAGE Z EXISTING FAILURE ❑SHORELINE
IVISDESIGN FORM(REQUIRED) UI!I]SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? O I
hWAIVER(S)(IF APPLICABLE) 4 1.37 AC ❑ YES NO 0 I
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
GO OUT BROCKDALE, TURN LEFT ONTO ROADRUNNER, PARCEL IS ON THE LEFT. I o
SOIL LOGS ARE AT THE REAR OF THE RESIDENCE o
C
q�r!i áU '44 , r a, 44 ►1� y r 1 ' P.P,-lWe
IW
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I N
OFFICIAL USE ONLY BELOWTHIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑H0ME SALE OCOMPLAINT D0THER:
INSPECTOR SOIL LOGS / COMMENTS/CONDITIONS
e�c5 7� �c5
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.
I CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLI TION APPROVED/ISSUED BY DATE
- i U k 242
THI MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE / Revised:4/14/2025
DESIGN r ORM±PAGE ONE Assessor's Parcel Number: 4 2 1 2 5 7 7 9 0 1 3 2
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 2na(p' p \c7 ) Designer's Name: CINDY WAITE
Applicant's Name: PIERRE/AMANDA SYLVAIN Designer's Phone Number: 360-701-0205
Mailing Address:
171 E ROADRUNNER DR Designer's Address: 80 E PICKERING LANE
SHELTON WA 98584 City State Zip SHELTON WA 98584
City State Zip Designer's Email cindyewaite@msn.com
DESIGN PARAMETERS
Treatment Device
❑ Glendon ❑ Sand Filter ❑Mound and Lined Drainfield ❑ Recirculating Filter O ATU ❑Other
Treatment Level(check all that apply): ❑A ❑ B ❑ C ❑ BL1 O BL2 O BL3 O E ❑N
Drainfield Type
❑ Gravity ❑ Pressure ❑ Trench ❑ Bed O Sub Surface Drip
Septic TanWDrainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class SCHEDULE 40
Daily Flow: Operating Capacity 360 gpd Length 60 ft
Daily Flow:Design Flow 480 gpd Diameter 1.25 in
Septic Tank Capacity(working) EXISTING 1200 gal Number 3
Receiving Soil Type(1-6) 1 Separation 9 ft
Receiving Soil Appl.Rate I gpd/ftz Orifices
Required Primary Area 480 ft2 Total Number of Orifices 90
Designed Primary Area 540 ft2 Diameter 3/16 in
Designed Reserve Area 540 ft2 Spacing 24 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 180 ft Schedule/Class SCHEDULE 40
Elevation Measurements Length 1-2 ft
Original Drainfield Area Slope <1 % Diameter 2 in
New Slope,If Altered % Pre e d m n ldtco`figul ation used? l 'Yes ❑No
f is ttL!
Depth of Excavation Up-slope BOTTOME OF SAND 42 in ' Transport Pipe
from Original Grade
Down-slope BOTTOM OF SAND 42 ln� Sddu�/ l SCHEDULE 40
Designed Vertical Separation 27 L S
1VIASON C '? NVIR0NMENTAL HEALTH 80 ft
Gravel-based Drainfield Required? L!I Yes ❑No DiamILTMAS 2 in
Pump Required? 06 Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 6
Diff.in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 80 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) EXISTING 1250 gal
Uppermost Orifice I!1'Higher O Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 53.1 gpm 9 Timer Rf Elapse Meter Gf Event Counter
Calculated Total Pressure Head 11.58 ft If Timer: Pump on ,Pump off
Comments
PUMP CONTROLS TO BE SET AT TIME OF INSTALLATION, INSTALL A DIVERSION VALVE TO BE ABLE TO SWITCH FROM
EXISTING SYSTEM TO NEW SYSTEM, RUN 30 MIL PVC LINER 6" INTO SAND, VERIBY PUMP WILL MEET TWO FEET OFSQUIRT.
Revised: 6/11/2025
DESIGN FORM-.PAGE TWO Assessor's Parcel.Number: 412[ I 12 15 1717 19 L9L' 13 i 2!
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
1 f Test hole locations 10 Drainfield orientation and layout Reference depth from original grade:
171 Soil logs Of Trench/bed dimensions and ❑ Septic tank
11 Property lines critical distances within layout Q( Drainfield cover
L4xisting and proposed wells ' D-Box/Valve box locations
within 100 ft of roe Reference depth from original grade
p p rty Septic tank/pump chamber and restrictive strata:
Id Measurements to cuts,banks,and! locations f I.d* m a-p
Laterals,trench bed,top and
surface water and critical areas
Observation port location bottom
'(ocation and orientation of ' Clean-out location ❑. Curtain drain collector
curtain drain and all absorption if Manifold placement f Sand augmentation
components
10 Orifice placement Other cross-section detail:
It Location and dimension of ❑ Observation
primary system and reserve area V Lateral placement with distance ports/clean-outs
to edge of bed
Buildings Other Information
Audible/visual alarm referenced Yes No
It Direction of slope indicator to 11 4,
Q( Scale of drawing shown on scale ❑Design staked out
Waterlines bar ❑ 0 Recorded Notices attached
It Roads,easements,driveways, ! 7 Elevation benchmark and relative ❑ ❑ Waiver(s)attached
parking P' pi �t It ❑ Pump curve attached
Ite evasions o .r ys`t
North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar ,. ' r
{ JUL 02 202b " J Non-residential justification
❑ ❑ Waste strength
MASON COUNTY ENVIRONMENTAL HEALTH ❑ 0 Flow
DESIGtOVAL
The undersigned designer must be notified by installer at time of installation 'es ❑ No
Z m ,
Signature4 Designer 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 o it regulations:
ALAI ( Aft
En, it ntal 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 has not jexpired,the Permit Expiration Date is: 27
✓ 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 avawlable for public view on the Mason County Web site. Revised:6/11/2025
171 E Rd Runner Or, Shelton, WA 98584, USA, Union-Grapeview Township, Parcel Id: 421257790132
GIS legend
V11A Mason 10 ft. Contours
Road Runner
r__H
2 Esixting 1200 gallon septic tank h
3 jExisting 1200 gallon pump tank � L xi: ,r!
4 'Audible/visual alarm :.r- c G O'
5 Transport line �_ � : z _> o
6 jPrima and r ` ' = o Ln
rN eserve area drainfir �`° o �, ; ` ;Z
7 Valve box �— �1sd ":u X
8 Waterline I -r:
drainfield �— - �, z r.
BEIV_CH MARK I Q Li A H1
y
Foundatc�r� 10 I
- 1
I � ----- �-
Pump Tank I ► 991001
---- - ------------- ------------ ---
Bottom of dralnf eI 4 9` (10 r
1
(0O' <J'
ty
' r---- -_- ------- ------ - v�
Scale _> 1 in : 50 ft + ,! {
ORIFICE SPACING
2
Lateral# Length Length , Orifice # Distance from IDistance from end Length#
# (Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 60 720 24 30 1 1 60
2 60 720 24 30 1 1 60
3 60 720 24 30 1 60
180 _ 90 178
TRANS LENGTH 80
GPM 53T
K (2"SCHEDULEN 40) •284.5'
FRICTION LOSS ' $..5847812
Squirt 2
Elevation difference 6
TDH 11.584781
540SF DIVIDED BY 6QUALS 90 ORIGICES REQUIRED�_`
X02"
MASON COUNTY ENVIRONMENTAL HEALTH }
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LICEN�tD Df,6IGNER
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DRAINFIELD LAYOUT
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MASON COUNTY ENNVIR0N',�9E.1";!
X1=CLEANOUT/OBS PORTS ( ) LI,C'EN$ED oe,�)�NER.
X2--DBeXJVALVE BOX CI ) EXPIRES 05„s,
X3=Check Valves I
X4=Flow Control Valves [3) i Ni ve/
X5=Soil, Logs
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SLOTS AS
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,MASON COUNTY ENVIRONMENTAL HEALTH
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Jj 1 TH,,READEDICAP;MPLUG.-,,
'F':1'' ;�? f
7 :6"PVc',
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r LA ST`ORIFICE;WITH'
ORIFICfSH1EL'DSIF
'I OR IFI.O,E:ORIENTATION IS:
1BACKFILL.
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MATERIAL. ,�.
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?LONG::SWEEP fo D' fl°Dp;
ELBOW
DRAIN,ROCK;;w-MIN.
UNDISTURBED SOIL
6"PVc WITH:DRAIN:
'i HOLES;,EXTEND�TO:
'BOTTOMS OF GRAVEL TO
MONITOR1PONDING.
INFIU RATIVVE:,SURFACE
iMON1TO:R N"GICI+�'EANO�U� PORT,
EXAMPLE)
HYDROMATIP® w
SP40 Wholesale Products Page g . 6140-1
SUBMERSIBLE SEWAGE EJECTOR RPM: 1750 i Date 2" olid 11/1
Discharge: 2" Solids: 1 /4
,;p I`,CIN Y E WAITE
J`;`',.; ;-I-ICENSFp DFGIGNER _
EXPIRES 05/10!
JULiUL02226
MASON COUNTY ENVIRONMENTAL HEALTH
'IT 1l ( ____ ____
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9 30
N w
6 020
SP50 & SP50AB
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= 3 010 SP40
0 t 0
Capacity-U.S.G.P.M. 0 20 40 60 80 100 120 140
Liters/Second 0 2 4 6 8
The curves reflect maximum performance characteristics without exceeding full load (Nameplate) horsepower. All pumps
have a service factor of 1.2. Operation is recommended in the bounded area with operational point within the curve limit.
Performance curves are based on actual tests with clear water at 70°F.and 1280 feet site elevation.
Conditions of Service:
►� PENTAIR GPM: TDH:
Installation Notes
Sand Augmented Pressure Distribution System:
42125-77-90132 171 E Roadrunner Dr
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.
t Pump con'tro'ls to beset,at time'of installation:270(CPD
2. install system during
'dry weather with acceptable soil Cr n n
3. Gravel 'based drainfield required. p
, }
4. Clean course or C-33 required Li JUL
202 rL
S. Install a 30 mu!I PVC liner`6'into sand aul- enta ion, MASON COUNTY IV(6. Keep wheeled vehicles off the drainfield area before, during and after insta�anMENTAL HEALTH
Tracked equipment only, E7
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 them. Use swales, berms, catch basin and tight lines, curtain drains,
etc. to divert all waters,
8. Curtain drains can be no 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 on;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 water;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 will((,make this design null and void.
16. 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.
17. Install laterals with contour of the ground
18. Install trench bottoms level and always maintain a minimum of six inches into native soil
19. Install locator tape on top of all drainfield laterals.
20. Install threaded clean outs at the ends of all laterals (caps m.'. .e end to within six
inches offinish grade and be in a valve box as shown on di am. ,,,
21. Install audio/visual alarm
22. Filter fabric required over drain rock prior to backfillin9 I �� W� �
�.,. extends above
the original grade, run the filter fabric at least 2 inches 1 II.
I I '
ooa,� .
O� CINDiE.iNAITEY':";
LICE j:L=[S DR
System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank and pymp 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 owners shall got at any time change or alter settings in the control box.
6. System owner agree to read and abide by information regarding their system in the
User Manual provided Eby Mason County Public Health.
7. Keep the flow of sewage 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 bleach or detergents with added whiteners.
11. Do not shower, do laundry and dishwasher at the same time
12.Antibiotics can kill or impair the biological process in the septic tank.
13. Leaky plumbing can hydraulic overload your on-site septic system.
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/�LICEf4 DESIGNER
EXPIRES 05/1