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HomeMy WebLinkAboutSWG2026-00209-APPLICATION/ASBUILT - SWG Application / Design - 7/9/2026 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: SWG2026-00209 APPLICANT GLORIOUS DAY PROPERTIES LLC Phone: Address: 3543 DILEUCA ST PUNTA GORDA, FL 33950 OWNER GLORIOUS DAY PROPERTIES LLC Phone: Address: 3543 DILEUCA ST PUNTA GORDA, FL 33950 SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON, WA 98584 Site Address: 141 NE WAGON WHEEL RD Primary Parcel Number: 222025402004 Permit Description: Repair 3BR gravity-no reserve Permit Submitted Date: 07/02/2026 Permit Issued Date: 07/09/2026 Issued By: Jeff Wilmoth Current Permit Fees Paid: $845.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/08/2027 (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/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON �OUNTY DATE RECENED: • ` I (f� AMOUNT RECEIVED: RECEIVED BY: Public Health & human Services g -t5 Ord Environmental Health 360-427.9670)ext.400 or 360-275-4467,ext.400 0 415 N.6th Street Shelton,WA 98584 S W G Du, — c2Of �4_ 0� °� Cl) ON-SITE SEWAGE SYSTEM APPLICATION m n APPLICANT PHONE I- MIKE BACON/ GLORIOUS DAY PROP I 206-819-3827 z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE PUNTA GORDA FL 33950 3543 DILEUCA ST 0 SITE 141ADDRESS N ESTREET, CODE WAGONWHEEL R4 BELFAIR WA 98528 N NAME OF DESIGNER ® PHONE I N CINDY WAITE _ J 360-701-0205 .� PHONE I NAME OF INSTALLER � � < T Q,p o PERMIT TYPE(select one) 2J DK4IG WATER SOURCE O N is RESIDENTIAL OSS L!JCOMMUNITY OSS IICOMMERCIAL OSS PRIVATE INDIVIDUAL WELL f PRIVATE TWO-PARTY WELL Z I N TYPE OF WORK(select one) 7 PUBLIC WATER SYSTEM f NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR I Cii SUBMITTALS 0 SURFACING SEWAGE Eg EXISTING FAILURE W SHORELINE 911DESIGN FORM(REQUIRED) IMI9SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I WAS LOT CREATED AFTER 4/112025? ® I jWAIVER(S)(IFAPPLICABLE) 3 .16 AC ❑ YES /► ❑� NO R I O DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate ✓�� �((d / C 0 s`tN110 GO TO BELFAIR, TURN LEFT ONTO NORTHSHORE ROAD, TURN LEFT ONTO I iv WAGON WHEEL,(PAST BELFPIIR STATE PARK), PARCEL IS ON THE LEFT SIDE OF 10 STREET �'G� ' ��tP /raI Baas r'SP,. , /4J � @�av 6 S I _FA a• a j �-- o�V 196 4 � �'"���®� ��>� ®� �Arn ec 1e4 kl� O SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NU BERS. 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 ( O '% 3 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. IN C R SIGNATURE DATE APPLICATION EXPIRATION DATE AP TION APPROVED/ISSUED BY DATE T 1 F R MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:4/14/2025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 2 0 2 5 4 0�2 0 0 14 A design will be reviewed when 3 copies f each of the —..Lfollowing are submitted: Completed design form that has been signe and dated. Scaled layout sketch,including all applicable items on checklist. Scaled plot plan,including all applicable it ms on checklist. Cross-section sketch, including all applicable items on checklist. This form may be scanned and avai able for public view on the Mason County Web site.Maximum paper size: 11"X 17" PARCEL,IDENTI aICA IONL _ Permit Number: SWGJA2JJQ - QO Designer's Name: CINDY WAITE Applicant's Name: MIKE BACON/GLORIOUS DAY P Designer's Phone Number: 360-701-0205 Mailing Address: 3543 DILEUCA ST Designer's Address: 80 E DICKERING LANE PUNTA GORDA FL 33950 City State Zip SHELTON WA 98584 City State Zip Designer's Email cindyewaite@msn.com DESIGN==PARAMETERS`. Treatment Device O Glendon O Sand Filter ❑Mound ❑ and Lined Drainfield ❑Recirculating Filter 0 ATU ❑Other Treatment Level(check all that apply): ❑k ❑B ❑C ❑BL1 ❑BL2 ❑BL3 >1cl E ❑N Drainfield Type ItGravity ❑ Pressure ❑Trench ed O Sub Surface Drip Septic Tank/Drainfield Speci ications Laterals Number of Bedrooms 13 Schedule/Cl �' � ASTM 2729 Daily Flow: Operating Capacity 270 gpd Length �S' osh,2,' 45 ft Daily Flow:Design Flow 360 gpd Diamet � r a �� 4 in Septic Tank Capacity(working) EXISTING 1300 PREMIER gal Num' r `�" 3 Receiving Soil Type(1-6) 1N r C�AITE > Se a CE ER 3 ft Receiving Soil Appl.Rate 8 gpd/ft2 es Required Primary Area 40 ft2 Total Number of Orifices ASTM 2729 PERF Designed Primary Area 40 ft2 Diameter in Designed Reserve Area VERY IMITED ft2 _Spacing ( 4..i; in Trench/Bed Width 10 ft Ik ir i U ) Manifold Trench/Bed Length 45 j}� l ft j S hedule/ sb 9 2Q26 -� a Elevation Measurements Length Original Drainfield Area Slope 4 a/o �' 'Diameter ENVIRONMENTAL HEALTH ft �p1„fir in New Slope,If Altered % Preferred manifold configuration used? ❑Yes O No Depth of Excavation Up-slope SEE NOT$1,PAGE 4 in Transport Pipe from Original Grade Down-slope SEE NOTE 1,PAGE 4 in Schedule/Class ASTM 3034 Designed Vertical Separation 6 in Length 10-15 ft Gravel-based Drainfield Required? if Yes No Diameter q in Pump Required? ❑Yes No Dosing and Pump Chamber Pump/Siphon Specificati ns Number of doses/day Diff.in Elevation Between Pump&Uppermos Orifice ft Dose quantity gal Drainfield Squirt Height/Selected Residual(had) ft Chamber Capacity(flood) gal Uppermost Orifice❑Higher O Lower than Pimp Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm ❑ Timer O Elapse Meter ' ❑ Event Counter Calculated Total Pressure Head ft If Timer: Pump on ,Pump off Comments STAKE OUT DRAINFIELD AFTER AREFUL CLEARING, VERIFY LIFT FROM PUMP TANK TO OSCARS, R auiour7• it 1 DESIGN FORM—PAGE TWO Assessor's Parcel Number:{ 2 i 2 12 i 012 2j5 [ 4 + 0 2 0 0�4 I Permit Number: SWG -0 p_l©-1 DESIGN CHECKLISTS . - Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch l� Test hole locations 10 Drainfield orientation and layout Reference depth from original grade: if Soil logs Vf Trench/bed dimensions and ❑ Septic tank �"x e r,t j v l ' Property lines critical distances within layout 1 Drainfield cover 44"xisting and proposed wells Of D-Box/Valve box locations within 100 ft of roe Reference depth from original grade property rty ( Septic tank/pump chamber and restrictive strata: 4Measurements to cuts,banks,an locations 91.4 rn&^ 10 Laterals,trench/bed,top and surface water and critical areas Observation port location bottom 0f ocation and orientation of 091a€lean-out location ❑ Curtain drain collector curtain drain and all absorption +!'Manifold placement ❑ Sand augmentation components [H'i'9'rifice placement Other cross-section detail: V Location and dimension of Lateral placement O Observation ports/clean-outs primary system and reserve area to edge of f with distance bed Buildings •• . Other Information Audible/visual alarm referenced Yes No l I Direction of slope indicator l� Scale of drawing shown on scale 6f ❑ Design staked out l Waterlines bar ❑ ❑ Recorded Notices attached lI Roads,easements,driveways, ' Elevation benchmark and relative ❑ ❑ Waiver(s)attached parking elevations of system components ❑ ❑ Pump curve attached V North arrow and scale drawing O ❑ Evaluation of failure shown on scale bar Non-residential justification ❑ ❑ Waste strength ❑ ❑ Flow DESIGN APPROVAL___ __ _ ________ ____________________ _ , The undersigned designer must be no ed by installer at time of installation yyka ,r Yes ❑.�N : �r�k Li `t 11 oi,t JUL 0 9 2026 MA, ONCOUNTYE Sign tore of Designer Date NVIRONMENTAL HEs The undersigned has reviewed this de ign on behalf of Mason County Public Health and determined it to be in compliance with state and local on- 't regulations: I � If 7 i - Env'ro4,, n1 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 expired,the Permit Expiration Date is: ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. Please Note: The syst rn must be installed by a certified installer, unless prior authorization is obtained from Mason County Public Health. An Installation Fee is r guired. This form may be scanned and available for public view on the Mason County Web site. Revised: 6/11/2025 141 NE Wagon Wheel Rd, Belfair, WA 98528, USA, Belfair-Tahuya Township, Parcel Id: 222025402004 CIS Legend V V VV V V V Measure Area V . WA Mason 10 ft. Contour BENCH lislARK I r Top of tank 1 100.001 V VV Septic outlet 2 98.75 ��._-____.- . -y r Botttom of drainfiel 3 97.25 SL1 1 Residence/decks p7 f' ►� 2 Existing1300 gal Primiertank r _ 3 Tranport line 4 D=Box � ` __✓_e 5'o i Primary-drainfield V . - -6 Failed drainfield f; Vp Of 1 7 Reserve drainfield Q C S�Oqe a� 8 l Waterline I 1 9 Tranport line ' o,.,n,r�c. So i / ,n -s• � I a C+ / / //i .. /9J I Scale => 1 in : 20 ft V N xL __L \f !n ' Zo' 3Ui n0 Co //uj... c .1 .'.S100418 11' „��/ I 11 © Or LICEI�F5ED DYSIGNER �� �� EXPIRES U5ho, tart �a ,c VIRONMENTALHEAITN L✓� _ts MASON riI2 & d lowTO Qmdo INS w�h 45 EN Fact�p LQv&i:P. • Distributtc,11 BOX(No •Sc 1e) s 9u� CINDY E.WAITS "�;• MASON S�NN�Y Nv`R�NM �TA�H. LICENSEDD�SIGNER EXPIRES 05/t0i Installation Notes Gravity System 22202 54-02004 141 NE WAGON WHEEL 1. The prepared site plan is not a survey. It's the owner's responsibility to verify property lines, utility lines (wat r, sewer, power, phone and gas) prior to installation. 2. Two observation pots to be installed on both ends of bed 3. Gravel based drainf Id required 4. Install system during cry weather with acceptable soil conditions 5. Keep wheeled vehicle off the drainfield area before, during and after installation. Tracked equipment only 6. All ground, surface wa er and roof drains must be diverted away from the septic tanks and drainfield. Ensure he 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 7. Curtain drains can be o closer than 10' upgradient and 30' down gradient of the drainfield 8. Exposed restrictive lay rs, cuts, banks, etc. can be no closer than 50' downhill from the drainfield. 9. Install access risers on the septic tank, D-box and observation ports. 10. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank. 11. Lids must form a water and gas tight seal with the access risers 12. Install effluent filter at t e septic tank outlet. 13. This system must be installed by a Mason County Certified Installer. 14. Deviation from this des gn without prior approval from the designer and Mason County Health Department will make this design null and void. 15. This design was sized er Washington Administrative CodeWAC246-272A-0230. The operating capacity is b sed on 45 gallons per day per capita with two persons per bedroom. The minimu design flow per bedroom per day is the operating capacity of ninety gallons multiplie 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. 16. Install laterals or bed w th contour of the ground 17. Install trench bottoms I vet and always maintain a minimum of six inches into native soil 18. Filter fabric required ver drain rock prior to backfilling. If the drain rock extends above the original gra e, run the filter fabric at least ches down the trench rali 1 UNjY EN�IR�NME J :31GNER '• IlL'a JJ 01 S stem Owner Responsibilities: 1. Operation and Maint nance is required by Washington State Department of Health and Mason County Healt Department. 2. The septic tank shoulI be pumped every three to five years or as needed. 3. System owners are r sponsible for having maintenance performed every three years as per WAC246-272A. 4. System owners are r sponsible for responding to septic issues in a timely manner. 5. System owner agree to read and abide by information regarding their system in the User Manual provide by Mason County Public Health. 6. Keep the flow of sew ge at or below the approved design operating capacity. 7. Keep waste strength t residential waste strength parameters. 8. Spread loads of laun ry through the week. 9. Do not use excessive bleach or detergents with added whiteners. 10. Do not shower, do lau dry and dishwasher at the same time 11.Antibiotics can kill or i pair the biological process in the septic tank. 12. Leaky plumbing can h draulic overload your on-site septic system. UN E. AITE LIC DVSI �EXPIRE5 051101 � � f ill iJ4\ JUL09 76 l MASON COUNTY ENVIRONMENTAL HEALTH