HomeMy WebLinkAboutSWG2026-00202-TANK ONLY - SWG Application / Design - 6/29/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,97 ,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 Tank Only Permit: SWG2026-00202
APPLICANT Caliber Septic Design Phone: 3605097900
Address: 165 NW Tupelo Way Poulsbo,WA 98370
OWNER BOUDREAU JEFFREY Phone: 206-250-2750
Address: 90 NE PINE CAMP RD BELFAIR,WA 98528
SEPTIC DESIGNER RICHARD BAZZELL* Phone: 360-509-7900
Address: 165 NW TUPELO WAY POULSBO, WA 98370
Site Address: 90 NE PINE CAMP RD
Primary Parcel Number: 223117600390
i Proposed lift station to serve new 2 bed SFR,to existing/permitted
Permit Description:
OSS .
Permit Submitted Date: 06/26/2026
Permit Issued Date: 06/29/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/29/2029 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: Pump Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Two-Party Well
Additional Details: New 1000g septic tank with pump in 2nd comp.
Permit Conditions:
2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
5 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
4 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/OR 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
d sQ� MASON COUNTY DATE RECEIVED: ° f b°
Cn D
co{mga,r,�y4
9i COMMUNITY SERVICES AMOUNT RECEIVED: RECEIVED BY: W rn
X15 ,N
=s ° Public Health(Community Health/Environmental Health) 6t'l Cl)U)
360-427-9670,ext.400 or 360-275-4467,ext.400
415 N.6th Street-Shelton,WA 98584 SWG ®a� _ no acD;;:! Z N
ON-SITE SEWAGE TANK ONLY APPLICATION
APPLICANT PHONE m M
Raymond Boudreau 5092624360 Z
- c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
90 E Pine Camp Rd, Belfair, WA 98528 N m
SITE ADDRESS-STREET CITY,ZIP CODE
Same as mailing address I Ni
NAME OF DESIGNER PHONE I N
Caliber Septic Design - Richard Bazzell 3605097900
NAME OF INSTALLER PHONE O v I W
To Be Determined n/a
TYPE OF WORK(select one) DRINKING WATER SOURCE O
I] NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL El PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM
❑ SEPTIC TANK ❑9 PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I 1J
❑� OTHER Proposed lift station to serve new SFR to existing/permitted OSS 3 5.10
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q
❑ SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE I9 100FT+PUBLIC/COMMUNITY WELLS C) I t
SUBMITTALS ❑� 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
O
❑� PLOT PLAN(REQUIRED) El TANK CROSS SECTION(REQUIRED) IN I0FT+DRINKING WATER SUPPLY LINES I O
❑� PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ❑g 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST
El PROPERTY LINES AND EASEMENTS El EXISTING/PROPOSED STRUCTURES El EXISTING/PROPOSED OSS COMPONENTS AND LINES
El WELLS WITHIN 100FT El WATER SUPPLY LINES El DRIVEWAYS/PARKING 19 SURFACE WATERS,STREAMS,RIVERS,ETC... I CD
El DIRECTION OF SLOPE/CONTOURS El PERIMETER/CURTAIN DRAINS El NORTH ARROW IN SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
See attached design.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE!FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
COMMENTS/CONDITIONS i, �54
4}_. ' rte)
uO Z--u pI Q -t c- WI pip 2JOJ4
SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS".TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE
4 ) 174
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
GENERAL CONSTRUCTION NOTES PROJECT INFORMATION: CALIBER
PIPING REQUIREMENTS Owner: Ray Boudreau c/o Jeffrey Boudreau SEPTIC DESIGN
Feasibility-New Construction-Repair
90 NE Pine Camp Road
1. Use only Schedule 40 or ASTM D 303,or as approved by the local health Belfair,WA 98528
jurisdiction.
2. To be installed on native soil or a compacted base to avoid settling. Septic Designer: Caliber Septic Design,Ilc
3. Include one double sweep cleanout between the building stub-out and lift station. 165 Tupelo Way
4. Ensure sufficient grade(1/4"per foot towards the tank)to prevent ponding or Poulsbo,Wa 98370
backflow of sewage in the pipe. C.360.509.7900
5. Check valves required when applicable. e.rbazzell@calibersepticdesign.com
LIFT STATION REQUIREMENTS Site Address: 90 NE Pine Camp Road
Belfair,WA 98528
1. Use tanks approved by Washington State Department of Health on the"List of
Registered Sewage Tanks." Tax ID#: 223117600390
2. All tanks must be installed on a level,compact base,pea gravel or sand may be
required. Follow tank manufacturer installation requirements. Lot Size: 5.10 acres
3. Tanks are required to be installed within 36"of finished grade.
System type: Alternative-Pressure Distribution
PUMP&PANEL REQUIREMENTS
Water System: Private Well(2-Party) 21037126
1. Grinder pumps are not allowed, use only sewage solids pumps capable of pumping o'RIcHARO L BAZZELL
up to 2"solids from the pump basin to the septic tank. See Page SD-3 for pump Vicinity Map& LICENSE00ESIGNER
specifications. Driving directions: Follow WA-3N into Belfair,then take NE Old Belfair Hwy
2. Install a control panel with an audio visual alarm, in an easily accessible location and NE Bear Creek Dewatto Rd to reach Pine Camp Rd.
within the line of sight of lift station.
3. Install control panel in an easily accessible location within line of sight of pump Haima� -
basin.
Ha m O" i<90sv t jp �,
Destination in Belfair,
Bethel f r � r
SPECIAL CONSIDERATIONS 4 ) Lilliwaup,}f ,4 l
Lake shman >l` 246 mm 1
Burley
1. Concrete tanks approved by Washington State Department of Health on the"List 3. I E'
2 55 min '
of Registered Sewage Tanks."is required 'l miles 1..-�} Allj,'
2. Water lines are to maintain a 10'-0"setback to all sewage components. Potlatch_ Imo ; Wa
nto I Vaughn
3. RV holding tank chemicals are strictly prohibited from discharging to the onsite U �=�_ �; • r
Skokomisfij 7 _ };. Key Centers -,
septic system. i j I Gig Harbor,; REVISIONS
4. All sewage vessels are required to maintain the following setbacks:5'to building t iOhrweis !_ ' { NO. DESCRIPTION DATE
foundations, 5'to property or easement line, 10'topressurized water supply lines, Artondale ,3.y ,
P P Y PP Y -� "'' "orsture r '
50'to surface waters(ordinary high-water mark), and 50'to wells. ,�{ .' Horn'\ °�-1 '' _
5. In the event of a power outage there will be limited emergency storage capacity — Fr — { a LF,oxlsland .,
9 9 Y 9 P Y Shelton s s" univers
for wastewater generated by the residence. It is recommended that a backup Startmq po,i l� , ' i Flao
he on ' i 1
power source(generator)be installed when interruptions to the main power supply , 1t . Longhran h Project.
occur. BOUDREAU SITE PLAN
����OVE0 90 NE PINE CAMP ROAD
BELFAIR, WA 98528
JUN 29 2026 Tax ID#: 223117600390
MASON COUNTY EN�IRONMENTAI HEALTH Date: June 22,2026
RET Sheet Name
Project Information and
General Notes
Sheet Number
SD-1
PAGE 1 OF 3
LEGEND CALIBER
---- PROPERTYLINE SEPTIC DESIGN
Feasibility-New Construction-Repair
PROPERTY CORNER
WH ASSUMED WATER HYDRANT
PWR1®
CONTROL PANEL ASSUMED POWER 1(IN-USE)
EL 420.00' EXISTING 1200 GALLON TWO PROPOSED TRANSPORT LINE PWR2 ASSUMED POWER 2(NOT IN-USE)
COMPARTMENT SEPTIC TANK AND EXISTING TRAVEL TRAILER/TINY HOME
• 1000 GALLON PUMP TANK (PROPOSED CONSTRUCTION LIVING
(INLET EL.+2.0)
QUARTERS)
�\
N
\ \ EXISTING RV STUBOUT, SEE SD-1 EXISTING STORAGE SHED
FOR ADDITIONAL DETAILS
�` STING TRANSPORT LINE PROPOSED 1000 GALLON TWO
COMPARTMENT LIFT STATION PLAN NOTES
\ SLEEV UDDER DRIVEWAY (INLET EL.+0'-6") 1.THIS IS NOTA SURVEY. SITE FEATURES,
�. TOPOGRAPHY,ELEVATIONS,AND
L 420.00' \ J� CLEANOUT STUBOUT EL.00
' " BENCHMARKS ARE BASED ON DATA ,%? ,
N _
-
N\ X66 PROVIDED BY THE OWNER. CALIBER g st
\6, CONTROL PANEL SEPTIC DESIGN LLC RECOMMENDS THAT
A LICENSED PROFESSIONAL LAND 21037126
PROPOSED TWO BEDROOM RESIDENCE SURVEYOR ALWAYS BE USED TO SET O'RICHARD L BAZZELL
\ s - CORNERS,ESTABLISH LOT LINES,AND LICENSED DESIGNER
VALIDATE ELEVATIONS.
EXISTING DRIVEWAY i i i7
APPROXIMATE POWER LINE \3� C �i ,i� %/!/ '`I•° ' -
p0, —
.5 'S.,- . f 34e0,,
� �' EL 435.00'
EXISTING 50'ATTENUATION ZONE
EXISTING RESERVE DRAINFIELD '--
AREA(900 SF) EXISTING STORAGE SHEDS REVISIONS
NO. DESCRIPTION DATE
EXISTING PRIMARY DRAINFIELD, EXISTING PRIVATE
THREE(3)50'-0"LATERALS @ 5'-0"O.C. TWO PARTY WELL o
PERMIT#SWG2019-00330 0
A XI MATE EXISTING N
EXISTING GARDEN AREA WATER LThtE
EXISTING GREENHOUSE Project:
BOUDREAU SITE PLAN
EXISTING 10'X12'STORAGE SHED
EL 425.00' 90 NE PINE CAMP ROAD
BELFAIR, WA 98528
APPROVED Tax ID#: 223117600390
Date: June 22,2026
JUN 2 9 2026
Sheet Name
MASON COUNTY ENVIRONMENTAL HEALTH Site Plan
QSITE PLAN RET
0 50' 100' 200,
Sheet Number
SD-1
PAGE 2 OF 3
CONDUIT TO CONTROL PANEL CALIBER
FIBERGLASS GASKETED RISER
SEPTIC DESIGN
&LID WITH STAINLESS STEEL Feasibility-New Construction-Repair
INSPECTION ACCESS RISER FASTENERS. SECURE TO TANK
AND LID(AT OR NEAR GROUND WITH MANUFACTURER
SURFACE),OPTIONAL RECOMMENDED FASTENING
SYSTEM.(TYP) Pump Selection for a Non-Pressurized System-Single Family Residence Project
SLOPE GROUND / '
AWAY FROM RISER DISCHARGE ASSEMBLY Boudreau-90 NE Pine Camp
FINISH GRADE
E`11t IiI Ilf Ili=: 1 I iil Ilf ut iJE'jir iJ UJ�'ll=[Ll I.1j.I t Li 111° Parameters
II ILl r 1�iL t E W LHL•1t I fl L Tt 1J I� I i i 70
, ,�? � ] } LI, , �,_, �� Discharge Assembly Size 2.00 inches I I I
p F F EP �I n i TO EXISTING Transport Length 105 feet
r r SEPTIC TANK Transport Pipe Class 40 i I i
1 -- - Transport Line Size 2.00 Inches I I
iI FI1
1f _p-I Distributing Valve Model None I
Ill- ;ii1-11 lt-�, CI-fl. 60
fl . Max Elevation Lit 5 feet I I -
I NLET [> Design Flow Rate 10 gpm I I I
. W.L. ,-1 i
Flow Meter None inches -
I 'Add-on'Friction Losses 0 feet
I W.L --LEVEL CONTROL(HIGH Calculations 50 I i i I
. f-
p_fll WATER ALARM)FLOAT I I -
'11 fl ASSEMBLY Transport Velocity 0.9 fps I ii ii iiiI i _1ii
it I 1 V
LEVEL CONTROL(ON/OFF) Frictional Head Losses xo I i = = =
FLOAT ASSEMBLY Loss through Discharge 0.2 reef f- 40 I I I 1 -
1 ailr Loss in Transport 02 feet -./-1 fl — � 21437126 9,
n LOWLEVELALARMI LossthroughValve o.o reef x dRICHARDLsAZZELL
4 1 REDUNDANT OFF FLOAT LossthroughFlowmeter 0.0 reel —g i LICENSEDDESIGNER
- - ', 111- 'Add-on'FdcLon Losses 00 foot 230
EFFLUENT PUMP
L t 1 f �I tI Pipe Volumes I !
i Ti—iii"T�7 T 71=11_11"f' n1 i_i T i'�i�- iii Tr.-�Ti 1 fTaT Waif`-'i--ii.T' .'N7�
Vol of Transport Line 18.3 gals lo— — I —
I
Minimum Pump Requirements 20 ( I
I t
1000 GALLON 2 COMPARTMENT LIFT STATION Design Flow Rate 10.0 gpm , I f
2 NTS SECTION Total Dynamic Head 5.4 feet
I i
10
_ I I
I I i
I i i
I I
00 40 SO 120 160
Net Discharge(gpm)
REVISIONS
PumpData Legend NO. DESCRIPTION DATE
PFSW50 Sewage Pump System Curve:-
12HP,1151230V 10
Pump Curve:--
Pump Optimal Range:—
o Project:
Operating Point:
o BOUDREAU SITE PLAN
Design Point:
90 NE PINE CAMP ROAD
BELFAIR, WA 98528
EQUIVALENTOR Tax ID#: 223117600390
p p ®\f D ®relnco
Date: June 22,2026
JUN Z 9 2026 Sheet Name
SEE PUMP&PANEL REQUIREMENTS ON SHEET SD-1 System Component Details
MASON COUNTY ENVIRONMENTAL HEALTH
RET
Sheet Number
PUMP CURVE
SD-3
NTS
PAGE3OF3