HomeMy WebLinkAboutSWG2026-00137-APPLICATION/DESIGN - SWG Application / Design - 7/9/2026 MASON COU NT V 415 N 6TH STREET,SHELTON,-967 ,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: SWG2026-00137
APPLICANT SYTSMA ET AL BEAU Phone:
Address: JESSICA LANMAN SHELTON, WA 98584
OWNER SYTSMA ET AL BEAU Phone:
Address: JESSICA LANMAN SHELTON, WA 98584
SEPTIC DESIGNER ALEX PAYSSE* Phone: 360-507-1546
Address: 3089 E Mason Benson Rd GRAPE VIEW, WA 98546
Site Address: 6401 W Skokomish Valley Rd
Primary Parcel Number: 521113290042
Permit Description: 3BR Gravity
Permit Submitted Date: 05/07/2026
Permit Issued Date: 07/08/2026
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:
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:
• AMOUNT RECEIVED: RECENED BY:
Public Health & Human Services v M
Environmental Health 360-427-9670,ext.400 or 360-275-4467,ext.400 Gn
415 N.6th Street-Shelton,WA 98584 SWIG _ /hf 17 O 0
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ON-SITE SEWAGE SYSTEM APPLICATION a a
APPLICANT PHONE m m
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
1530 - r D - S � - v w pr ^� M
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SITE ADDRESS-STREET,CITY,ZIP CODE (�
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NAME OF DESIGNER PHONE
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NAME OF INSTALLER PHONE v I
PERMITTY select one) DRINKING W ER SOURCE N I�
RESIDENTIAL OSS ❑ COMMUNITY OSS ❑COMMERCIAL OSS PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL z I®
TYPE OF WORK(select one) ❑ PUBLIC WATER SYSTEM �r
EW CONSTRUCTION I UPGRADES ❑ REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I'V
SUBMITTA ❑ SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? r
❑ WAIVER(S)(IFAPPLICABLE) 5 i C. . YES NO 0 r'f\�)
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) -
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
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
( L1 -'
SOIL CODES: 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.
INS CT R SIGNATURE DATE APPLICATION EXPIRATION DATE AP CATION APPROVED/ISSUED BY DATE
Sao ai ���- 14 2�
THIS R M E SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COU TV WEBSITE Revised:6/3/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 5 2 1 1 1 - 3 2 - 9 0 0 4 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
s�view
7 on7tthe Mason County Web site.Maximum a er size: 11"X17"
; AR CL i E 1F1l;; TIoN ;
Permit Number: SWG ��.lQ ' 00
Designer's Name: ALEX L. PAYSSE
Applicant's Name: BEAU SYTSMA Designer's Phone Number: 360-507-1546
Mailing Address: 1530 E ST.ANDREWS DR Designer's Address: 3089E MASON BENSON RD
SHELTON WA 98584 City State Zip GRAPEVIEW WA 98546
City State Zip Designer's Email alex@alpinesepticdesign.com
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s ,:DESGN PItA`MTERS ,
Treatment Device
❑Glendon ❑Sand Filter ❑Mound ❑Sand Lined Drainfield ❑ Recirculating Filter ❑ATU LI Other
Treatment Level(check all that apply): ❑A ❑B ❑ C El BLI ❑BL2 El BL3 0 E El N
Drainfield Type
('Gravity ❑Pressure ('Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729 PERF
Daily Flow: Operating Capacity 270 gpd Length 50 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 4
Receiving Soil Type(1-6) 4 Separation 10 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices -
Designed Primary Area 600 ft2 Diameter - in
Designed Reserve Area 600 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class 3034
Elevation Measurements Length 33 ft
Original Drainfield Area Slope 0 % Diameter 4 in
New Slope,If Altered 0 % Preferred manifold configuration used? l 'Yes O No
Depth of Excavation Up-slope 24 MAX in Transport Pipe
from Original Grade Down-slope 24 MAX
in Schedule/Class 3034
Designed Vertical Separation 36 in Length 7 ft
Gravel-based Drainfield Required? d Yes ❑No Diameter 4 in
Pump Required? O Yes 56No 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 O Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head - gpm ❑ Timer O Elapse Meter O Event Counter
Calculated Total Pressure Head - ft If Timer: Pump on - ,Pump off -
Comments
Revised:4/14/2025
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 5 2 1 1 1 -- 3 2 -- 9 0 0 4 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
BJ Test hole locations Gd Drainfield orientation and layout Reference depth from original grade:
66 Soil logs Trench/bed dimensions and [,Zf Septic tank
0 Property lines critical distances within layout 9 Drainfield cover
6d Existing and proposed wells 6f D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 6f Septic tank/pump chamber and restrictive strata:
6"d Measurements to cuts,banks, and locations
[;?( Laterals,trench bed,top and
surface water and critical areas 66 Observation port location bottom
91 Location and orientation of Gd Clean-out location O Curtain drain collector
curtain drain and all absorption [f Manifold placement O Sand augmentation
components O Orifice placement Other cross-section detail:
61 Location and dimension of O Observation ports/clean-outs
primary system and reserve area � Lateral placement with distance
to edge of bed Other Information
69 Buildings ❑ Audible/visual alarm referenced Yes No
66 Direction of slope indicator Qj Scale of drawing shown on scale d O Design staked out
66 Waterlines bar O iI Recorded Notices attached
66 Roads, easements, driveways, El Elevation benchmark and Jati ea. O gWaiver(s)attached
parking e e- atio s syste o }p net ; O Pump curve attached
66 North arrow and scale drawing s ❑ Rf Evaluation of failure
shown on scale bar t( o Non-residential justification
❑ i1 Waste strength
Cf
INi ENVIB0NME ❑ Flow
HEAL
tJ
DESIGN AB 'AL
The undersigned designer must be notified by installer at time of installation Ed Yes O No
5/28/2026
Sig ature of signer 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 on-site regulations:
C 7-9 -z6
irouriiptal Health Specialist Date
CAUTION: DESIGN APP VAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
V The design is stamped"Approved"by Mason County Public Health. �`�
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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
-
SKOKOMISH VALLEY RD
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EXPIRES
CUSTOMER: BEAU SYTSMA TEST HOLE I TEST HOLE 2 TEST HOLE 3 N
0-60 LOAM 0-60 LOAM 0-60 LOAM (/A�
PARCEL: 5 2 1 11 - 3 2 - 9 0 0 4 2 ROOTS @ 60 ROOTS @ 60 ROOTS @ 60
ALPINE SEPTIC SITE:6401 W.SKOKOMISH VLY.RD
-DESIGN-
ALEX L PAYSSE,DESIGNER SHEET:SITE PLAN SCALE: 1"=100 DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE:APPLICANT/COUNTY PROVIDED PLATS OR
3089 E MASON BENSON RD SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY.
GRAPE VIEW WA 98546 PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT
360.507-1546 0 0.5 ii 12. RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.
*MAX DEPTH 24" PER CROSS-SECTION DETAIL
1500 GALLON
SEPTIC TANK
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LATERAL 1 6.5" yl 5110393
LATERAL 2 7.5" = ALEX .PAY"'E��
LICENSED DESIGNER
LATERAL 3 10.0"
EXPIRES
LATERAL 4 12.5"
CUSTOMER: BEAU SYTSMA TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 N
__ 0-60 LOAM 0-60 LOAM 0-60 LOAM
......................I,,,,.,.,,,, PARCEL: 5 2 1 1 1 - 3 2 - 9 0 0 4 2 ROOTS @ 60 ROOTS @ 60 ROOTS @ 60
ALPINE SEPTIC DESIGN-
SITE:6401 W.SKOKOMISH VLY.RD
ALEX L PAYSSE,DESIGNER SHEET: DF DETAIL SCALE: 1"=10' DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE:APPLICANT/COUNTY PROVIDED PLATS OR
3089 E MASON BENSON RD SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY.
GRAPEVIEW WA 98546 I PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT
I
360-507-1546 1 0 I 12 5 1 RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.
OBSERVATION PORT RISER/LID
TO FIN.
ORIGINAL& FINISHED GRADE GRADE
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GLUED TEE ROCK ( FINISHED GRADE
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VERIFIED DEPTH/REST. LAYER (
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CLEANOUT 24"RISER&LID TO FINISHED GRADE
W/THREADED CAP (ENSURE RISER IS SEALED TO TANK 8 WATER-TIGHT CONNECTION)
FINISHED GRADE
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JOINTS 2 1500 GALLON SEPTIC TANK
: MUST BE STATE APPROVED TANK ai
INSTALL TANKS PER MANUFACTURER + {.•.
INSTALLATION INSTRUCTIONS
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ALEX L�PAY:'3E,�� MASON x UNTY ENVIRONMENTAL HEALTH
LICENSED DESIGNER > G
EXPIRES r,.h w vj i i ,��•';,, s.t...".tip!�s w,�y a y.raZfi' f.,} r t!# r r I!Ii R w ..v.G .
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CUSTOMER: BEAU SYTSMA TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 N\
0-60 LOAM 0-60 LOAM 0-60 LOAM
PARCEL: 5 2 1 1 1 - 3 2 - 9 0 0 4 2 ROOTS @ 60 ROOTS @ 60 ROOTS @ 60
ALPINE SEPTIC SITE:6401 W.SKOKOMISH VLY.RD
-DESIGN-
ALEX L PAYSSE,DESIGNER SHEET: DETAILS PG SCALE: NA DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE:APPLICANT/COUNTY PROVIDED PLATS OR
3089 E MASON BENSON RD SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY.
GRAPEVIEWWA 98546 I I PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT
360-507-1546 0 0.5 II 2. RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.
General Installation & System Notes
1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,transport
line, drainfield, and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the inspection of the
installation and creation of the record drawing. The designer reserves the right to charge additional fees if multiple visits are needed
due to installation errors or inaccessible components.
2. This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state, county, and manufacturer requirements. For Homeowner Installs,the owner must get approval from the designer
and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any confusion or
conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior to installation to
confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer, or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not remove or
disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design void.
5.The property owner and installer are responsible for locating all underground utilities(ex.water, gas,electric)prior to installation.
Any utility locations shown within design drawings are likely approximate and may not be exact.
6.All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original soil
to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and maintenance.
Component manufacturers(ex.ATU, Glendons,) may have other requirements not listed within this design.
7.All electrical wiring shall be done by a licensed electrician or homeowner(if allowed)and must be permitted through Labor and
Industries. Designer not responsible for electrical permitting or other electrical specific code requirements.
8. The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet weather
conditions may render this design void.
9. Maintain 1 Oft to waterlines with all septic components& lines, unless approval within design/permit provides a reduced setback.
Additional sleeving&install details may apply on reduced setbacks granted.
10. This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11. Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,foundation,
perimeter drains shall be installed 30ft downslope and 1 Oft upslope of drainfield areas.
12. Field staking and measurements taken are approximate. Installer may need to re-stake/layout drainfield laterals/beds prior to
installation, level w/contours using a laser level in order to maintain the approved depth of excavation. Contact designer w/any
problems related to drainfield layout prior to attempting installation.
13.All onsite septic systems require regular maintenance to verify satisfactory operation. The system owner/operator is responsible
for the continuous operation and maintenance of the system per WAC 246-272A. For operation and maintenance information, refer to
Mason County Public Health Homeowner's Manual,which should be received after installation approval.
14. System owner should be cautious of landscaping around septic components. Root intrusion can cause premature failure of the
drainfield area. In addition, bushes and trees should be kept away from lids and other septic maintenance points.
15. Changes made at time of installation may impact designer calculations, pump sizing, and compliance w/county and state
requirements. Contact design prior to install w/any proposed variations from design. Changes may result in additional fees&
permitting.
16. This design is site specific and intended to meet state and county requirements that are related to the system
components being proposed. Any placement of proposed buildings pr ç/ s
on these drawings may or may not meet other requirements. {; r ;
0 2026 r ¢ �o
CUSTOMER: BEAU SYTSMA JUL 8
`
PARCEL: 5 2 1 1 1 - 3 2 - 9 0 0 4 2 MASON COUNTY ENVIRONMENTAL HEP4T. 7
ALPINE SEPTIC ,
SITE:6401 W.SKOKOMISH VLY.RD '` �;� s+�o3s3
—DEsiGN— ALEX LYE
ALEX L PAYSSE,DESIGNER SHEET: NOTES SCALE: NA LICENSED DESIOf d
3089E MASON BENSON RD
GRAPEVIEW WA 98546 I I I EXPIRES
360-507-1546 0 0.5 , 2