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HomeMy WebLinkAboutSWG2026-00192 - SWG Application / Design - 6/18/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,7 ,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: SWG2026-00192 APPLICANT DIMITRATOS ET UX DON Phone: Address: ADRIANNE COTE SHELTON, WA 98584 OWNER DIMITRATOS ET UX DON Phone: Address: ADRIANNE COTE SHELTON, WA 98584 SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON,WA 98584 Site Address: 831 E STRONG RD Primary Parcel Number: 221287790120 Permit Description: Repair-3BR Gravity Permit Submitted Date: 06/18/2026 Permit Issued Date: 07/01/2026 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 MASON COUNTY DATE RECEIVED: f I /, f Vim( AMOUNT EIVE '^J / C[D RECEIVED BY: C Public Health& Human Services lbq Environmental Health 360-427-9670,ext.400 r 360-275-4467,ext.400 (_ 415 N.6th Street-Shelton,WA 98584 S W G aO Q�K.J — 0 0 ON-SITE SEWAGE SYSTEM APPLICATION C) APPLICANT PHONE Fri DIMITRATOS/COTE 209-814-0223 c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E 831 E STRONG RD SHELTON WA 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE 831 E STRONG RD SHELTON WA 98584 N) NAME OF DESIGNER PHONE N) CINDY WAITE 360-701-0205 NAME OF INSTALLER PHONE TBD PERRMMMITTYPE(select one) DRINKING INi WATER SOURCE - I N Lv RESIDENTIAL OSS COMMUNITY OSS I�IICOMMERCIAL OSS Ml PRIVATE INDIVIDUAL WELL L to PRIVATE TWO-PARTY WELL Z I Oo TYPE OF WORK(select one) PUBLIC WATER SYSTEM 1 s NEW CONSTRUCTION/UPGRADES MlREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE X REPAIR SUBMITTALS ❑ SURFACING SEWAGE G1 EXISTING FAILURE ❑SHORELINE M1DESIGN FORM(REQUIRED) ISEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 4/1/2025? Q IJ WAIVER(S)(IF APPLICABLE) ❑ YES NO 3 2.76 AC ❑ 0 ' ✓ DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) GO NORTH ON HIGHWAY 3, TURN RIGHT ONTO PICKERING RD, TURN LEFT ON O STRONG ROAD, GO TO ADDRESS ON THE LEFT SIDE OF STRONG ROAD. AS YOU ARE GOING UP THE DRIVEWAY, DRAINFIELD ENVELOPE STARTS ABOUT 25' FROM ENTRANCE GATE ON THE LEFT. SEPTIC TANK IS ABOUT 200' UP DRIVEWAY FROM I N ENTRANCE. /<-to � Li Peri SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLA ED WITH TESfHOLE NUMB IP e7 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 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. INSP TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICA1ION APPROVED/ISSUED BY DATE THIS f OR AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE / Revised:4/14/2025 1` f DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 1 2 8 7 7 9 1 2 A design will be reviewed when 3 conies 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" ._PARCEL IDENTIFICATION Permit Number: SWG�('�r'�.��- Qfl 3 Designer's Name: CINDY WAITE Applicant's Name: DIMITRATOS/COTE Designer's Phone Number: 360-701-0205 Mailing Address: 831 E STRONG RD 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 ❑ Sand Lined Drainfield ❑ Recirculating Filter ❑ATU Treatment Level(check all that apply): ❑Other PP1Y ❑A ❑ B 0 ❑ BL1 ❑ B.[.2 ❑ BL3 YJ 11 E 0 //Drainfield Type El Gravity 0 Pressure 1 Trench ❑Bed ❑Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class ASTM 2729 Daily Flow: Operating Capacity 270 gpd Length 50 ft Daily Flow: Design Flow 360 gpd Diameter 4 in Septic Tank Capacity(working) EXISTING 1200 gal Number V3 Receiving Soil Type(1-6) 3 Separation V 9 ft Receiving Soil Appl. Rate .8 V gpd/ft2 ''fives Required Primary Area 4;50 ft2 Total Number of QV: s �� ASTM PERF Designed Primary Area 450 ft2 Diameter h� %J�SH� y . in Designed Reserve Area 450 ac 3 ft Spacing ft2 S in N z V . Trench/Bed Width �.. LICENSED DF,e� Ffo Trench/Bed Length 150 ft Schedule/ Elevation Measurements Length EXPIRES i;5;10( ft Original Drainfield Area Slope <1 % Diameter in New Slope,If Altered o /o Preferred manifold configuration used? 0 Yes 1'No Depth of Excavation Up-slope 12 in Q V k from Original Grade z nsport Pipe Down slope 12 r, }a in• -.� Schedule/Class j ASTM 3034 Designed Vertical Separation 36 in LeWgt�h 01 202 bi 100 ft Gravel-based Drainfield Required? 0 Yes 9No MASON i.ttiLfeWRONMENTAL HEALTH 4 in Pump Required? ❑ Yes ❑No J S W 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 I �� Uppermost Orifice D Higher 0 Lower than Pump Shutoff Pump controls: Please check those required. Capacity @ Total Pressure Head gpm © Timer 0 Elapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on ,Pump off Comments STAKE OUT DRAINFIELD AFTER CAREFUL CLEARINGS'fNSTALL A TWO WAY CLEANOUT AT THE HALFWAY MARK IN THE TRANSPORT LINE. Revised:6/11/2025 DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 121 1 ( 2 J•81 71 71 9 101 1 L2.j 0 i Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch if Test hole locations Qf Drainfield orientation and layout Reference depth from original grade: if Soil logs Trench/bed dimensions and ❑ Septic tank I Property lines critical distances within layout Q( Drainfield cover 1 ' Existing and proposed wells i1' D-Box/Valve box locations Reference depth from original grade within 100 ft of property 12(Septic tank/ptimhamber and restrictive strata: dtWeasurements to cuts, banks, and locations hf,�,N y Laterals,trench/bed,top and surface water and critical areas Observation port location bottom. 4a j ocation and orientation of JGG}ean-out location ❑ Curtain drain collector curtain drain and all absorption t&Manifold placement ❑. Sand augmentation components 10 Orifice placement Other cross-section detail: Qf Location and dimension of id Observation iii Lateral placement with distance ports/clean-outs primary system and reserve area to edge of bed Buildings Other Information 14A Audible/visual alarm referenced Yes No Direction of slope indicator Qf Scale of drawing shown,on scale If O Design staked out i� Waterlines bar O ❑Recorded Notices attached Roads,easements, driveways, Elevation benchmark and relative ❑ ❑ Waiver(s)attached parking elevations of system components ❑ © Pump curve attached North arrow and scale drawing 4f ❑ Evaluation of failure shown on scale bar 17�,.,�✓�'-r I'. b" Il Non-residential justification ❑ ❑ Waste strength ❑ ❑ Flow swb a DESIGN APPROVAL The n Osf� �fil l�8i i i t1b cM1 d by installer at time of installation El Yes ❑ No M Signaturpof 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 on-site',Fegulations: Enyironme�n al 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: —.2L(` 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 831 E Strong Rd, Shelton, WA 98684, USA, Timber Lake-Flarstine Island Township, Parcel Id 221287790120 VVA M8son 10 ft. Contours '3 �� . � (;: . ' .StfpF}(J 3 F ..— ,� Wd 1 f +d✓' q� , " �S C7w �' ft. Q(l,,j y1aQI�(j(:C�- p, �� 4t'_ —.e I e i 1 / G .. , . .'& . _: -I I . l Residence 1._>_ 1� IO 1 2 1 Existin 1200 gallonseptic tank ?,` 11 ransport linel ' 4 Failed drainfield 5 I BENC9-IIUTAK i 'o i rPrimary/reserve envelope Outlet of s pglc tan I' 1 100 00 6 Existing line to septic tank Bottom of draanfieid 2— 97.00 , 7 Owner well ' - ---_. I j L- 8 Waterline — _ I - I 1 ° 9 Neighbors well — ` �' - . Scale=> I In : 100 ft N1 r. IFS O CINDY SL/ ° LICEN;,,F-D DF SIGNER ado MASON COUNTY ENVIRONMENTAL HEALTH I ri 1 rw l. i{} j H' - o'' ,!p R i.S fbufo 'r l + x 'hh le ). ` `� e 's3' Or CIA `WADE �?i Lj Y� Jug. LICENSED DMG!4rR �' UIRONMRNTAL HEALTH � ., . COUNTY EN LXf,lkc$ os;,o, MASON ,low Installation Notes Gravity System 22128-77-90120 831 E STRONG RD 1. 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. 2. Observation.ports to,be Ii stallled on both ends fof iat:e'rais 3. 'Gravel ibased drainfi 'ld irequired 4. install two way'clean out in the middle of the transport sine 5. Install system during dry weather with acceptable soil conditions 6. Keep wheeled vehicles 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 them. Use swales, berms, catch basin and tight lines, curtain drains, etc. to divert all waters., 8. Curtain drains can be rho 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 tank, D-box and observation ports. 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 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 or bed with contour of the ground 18. Install trench bottoms level and always maintain a minimum of six inches in tive soil 19. Filter fabric required ever drain rrock pror•to backfiRing. If The cdrain!rktends above the original grade,!run the•fitter fabric at least 2 inches-dew _ 'try` "h'w.all <v-I j4 �E�WJ11T �pLt'aIGNER JI f L 0 Y 2x026 y , .` E\t,I" 05/10i MASON COUNTY ENVIRONMENTAL HEALTH System Owner Responsibilities: 1. Operation and Maintenance is required by Washington State Department of Health and Mason County Health)Department. 2. The septic tank should be pumped every three tofive years or as needed. 3. System owners are responsible for having maintenance performed every three years as per WAC246-272A. 4. System owners are responsible for responding to septic issues in a timely manner. 5. System owner agrees to read and abide by information regarding their system in the User Manual provided by Mason County Public Health. 6. Keep the flow of sewage at or below the approved design operating capacity. 7. Keep waste strength at residential waste strength parameters. 8. Spread loads of laundry through the week. 9. Do not use excessive bleach or detergents with added whiteners. 10. Do not shower, do laundry and dishwasher at the same time 11. Antibiotics can kill or impair the biological process in the septic tank. 12. Leaky plumbing can hydraulic overload your on-site septic system. CINDY E WRITE LICE\SFp Or:GNER jr yak 3. MASON COUNTY ENVIRONMENTAL HEALTH P