HomeMy WebLinkAboutSWG2026-001136 - SWG Application / Design - 7/3/2026 415 N a SHELTTONT3fi0A27.O9670,EXT 400
MASON COUNTY BEE MA 3602754467.27-ao6
F92-5269,EXT 400
Public Health & Human Services
On-Site Sewage System Permit: SWG2026-00136
HOMES AND DEVELOPMENT
Phone: 253-514-3915
APPLICANT NORTHWEST INC WA 98322
P0 BOX 565 BURLEY, Phone: 253-514-3915
Address: HOMES AND DEVELOPMENT
pWNER NORTHWEST INC PO BOX 360-620-8857
p 0 BOX 565 BURLEY,WA 98322 phone:
Address: FRANKLIN CLARK*
1954 SILVERDALE,WA 98383
SEPTIC DESIGNER 360-801-5681
Phone:
Address: JASON SCHAUER*
SEPTIC INSTALLER
pO BOX 3118 BELFAIR,WA 98528
Address:
XXX NE Gladwin Rd
Site Address. 223365500006
Primary Parcel Number.
REVISION: New SFR waiver
Nu Water
6-00036)BNR 500 ATU to sand-hne
bed drainfield with local waiver
Permit Description: 05/06/2026
Permit Submitted Date: 0713112026 �dm1
David Anderson admuo,al leis mav°e`e°wre6 uu�n�oszlleno�or ws
Permit Issued Date: $1,455.00
Issued By: �soenioN
Current Permit Fees Paid'. $1455.00
051J912029 (based ofl axle of
Permit Expiration Date:
the building location. Building location is
Permit Conditions: ulations.
Approval of this septic permit does not approve royal by the planning
subject to approval from all applicable ngpartments and rng
2 proposed development subject to zoning requirements and app
department staff per Mason County Title 17.
3 permit must be installed by a Mason County Certified Installer unless prior wn en
on
is obtained.
designed ups lope and downslope depth specified
authorization from Mason County
4 Grainfield installation not to exceed desiy installation approval prior to backfill of
design form. Mason County
5 Installer is res for obtaining onenible
system comp
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPER N LINE AND EASEMENT LO
or call:
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APP
wa. ov loss-inspection•request.phP
S.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORAR>'OR FINAL OCCUPANCY OF ANY RELATED STRUCTURE
360427-9670,extension 400.
For Final Inspection visit: masoncounty irealthienvirOnmentallOnna 9
415 N 6TH SHELRON�360427 96 0,ENT 400
BE FAIR 360262-5269,EXT 400
MASON COUNTY 15 ''EXT 400
AX 360A277787
public Health &Human Services
Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
6 stem components. and Installation fee must be submitted for
backfill of sy Asbuilt Form, Record Drawing,
Mason County roval.
final installation app
WILL require fees and Goo Checklist at time of BLD submittal
THIS PERMIT MUST BE ON5ITE DURING INSTALLATION OF 055.
pNCY OF ANY RELATED STRUCTURES.
SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATI
ection-reRuest.P S. or call:
THIS PERMIT MAY BE REVOKED IF THE
a, ovthealthlenvironmen400.nstteloss-insp
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OC
360-427-9670,extension
For Final Inspection visit: masoncountyw
* Vi; rbVl1YZo rIALUSE„NLY—
R D
MASON COUNTY D4 0 PNW Ni BECFIVP
Lpublic Health & Human Services N o
LS � �e-_ ool Z
415 N.6th Street Sh 360- 27.670,eM 400 or 350-2)5.4467,e .400
-�_tl.:_._-. Z D
TO A
ON-SITE SEWAGE SYSTEM APPLICATION m
HONE
APPLICANTCp C
HOMES AND DEVELOPMENT NORTHWEST INC 360.830.4765 (0)/360.620.8857 (c) m 3
n m
MNLINGADDRESS-STREEL CIIv,STATE.ZIP CODE w .
POB 565 Burley,WA 98322 `^ �N
In SITE ADDRESS-STREET,CITh,ZIP CODE
XXX NE GLADWIN RD,BELFAIR WA 98528 ) pp TD k
PHONE 620Th
Iv
NAME OF DESIGNER 360.620.8857 MAY 6 - U IW
Franklin Clark PHONE a �tJ
360.801.5681 B II 11
NAME OF IUD W
Jason Schauer oellaaNGw-I oTwURCE a W
PERMITTYPRESIDE E TAcne) O PRIVATE INDMDUALWELL 0 PRIVATE TVN}PARTY WELL Z U)
0 OF .CRiNTIALO55 ❑ COMMUNITY 055 ❑CGMMERGIAL OSS . PUBLIC.VATERSYSTEM_� IJ II^
TYPEO NEW
ONSTT wee) VI
W I.1
❑ SURFACING SEWAGE ❑ EXISTING FAILURE ❑SHORELINE IR
ANEW CONSTRUCTIONIUPGRADES ❑ REPAIRIREPIACEMENT CTHER DETAILS(sdaumal app N) ❑ TPBLE XREPH
SOBMITWS COT 512E WAS LOT CREAT 1 11,112025' o VI
BCOROOMS D F
■ DESIGN FORM(REQUIRED) ■ SEPTIC DESIGN(REQUIRED)• 2 Acres:0.18 YES
WAIVERS)OF APPLICABLE)
DIRECTIONS TO SITE AND SITE LONDIT10H5(c'-11.Vale) ��� '�
� 7
Mason County Community Services,415 N 6th St,Shelton,WA 98584 RF�F, 1oZ� Q
Take W Alder St to E Pine St �0
Follow WA-3 N to WA-300 W in Belfair I0
Continue on WA-300 W. Drive to NE Gladwin Rd
SITE MUST BE FLAGGED FROM MAIN ROAD ANO TEST HOLES MUST BE FLAGGED WITH TESTHOLENUMBFA5. --- --- '�
---OFFICIAL USE ONLY aELGW THIS TINE >......_- —
uPORADE I FAILUR g rpQSe
f UVOLUNTARY Q MAINTENPNCEIPUMPING ❑6UILDING PER MIT ❑HGME SALE ❑DOMPLAINT 0OTMER:_____________
OI,IMENi6ICQNOIIlOK5 4�YG p/f
lu u^ 6rMll
O fO27ORG L R Ihtd 5 (f1Pe3) a.plcia3 "IP°j 1M4K 50
Z5�' T81:4 b� r (1 (oa5 Cljfct) to boflont yg SelavC/F
.
R 403.0 26 wkd5�4v hotlo+✓f
�l Iw,tsc y�3) +� �� m Q�
TM3 dh4/1�16 Tµ3 o be Q
(p� ///��T7h3 ffi( s Te5Fhole jZ'_ dmm dow�� R D$,AVJ�NGANDINSTPLLATIONREPORI
110`Mf� FEODIRFDFOR FINPLAPPROVPL DATE
SOIL CODES. '•l LOAM $I=SILT C=CLAY E=FMRFM9Y R=ROOio' e
gPPD0 11011 APPROVEOI ISSUED BY
V=VERY SIGNATURE
R"S4O L OATS APPLICATIONE%PIRATIONDATE FP REIGNATDRE
Si wz / 1zC _
l�� 12� F Revised 6/312025
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
DESIGN FORM-PAGE ONF
Assessor's Parcel Number: 223365500006
"gaaled layout sketch,including all applicable items on checklist.
A design will be reviewed when 3 cu ies each of the following are submitted;
layous items on checklist.
(ompleted design form that has been signed and dated.,bee Crossaecnou sketch,including all applicable
public view on the Masan County Web site. M1farirniun to er see: I) V I-
a scaled plot plan. including all applicable items on checklist.
This form may be scanned and available farARCEL IDENTIFICATION
Designer's Name: FranklinJClark -- --
SwG 1.0 �Q 3 _•__ - - _ 60830.4765_- _— -- --
PerniitNumbe° goaE5An D5vtOc n Designer's Phone Number 3 _ —
tionmwt=_snnc __ _— --
Applicants Name — — Devgner's Address: SlverdaI wA _ — 98383
mailing Address: POB 565 _—_— __ City State Zip a e — _IN _
BurIey_WA 98322 _ Designers Email a lusonsite liv om_—
City Stale
DESIGN PARAMETERS
Enviro-Flo
Treatment Device t1
❑cke,d.in 09aid fi mr Omoand ■Saw m h
Li u ', dd ❑ R nlau„g1ate All
Treatment Level tchcckall that apply)- ❑ A ■ R U O6t,1 ■ IL2 Urn 3 O ON
Drainfield Type ■Bed O Sub Se/kvj]rIP
O Pressure O Trench
❑Gravity Laterals
Septic Tank/Drainfield Specifications schd 40
2 Schedule/Class ft
Number of Bedrooms Length
ed in
240 _P
Daily Flow:Operating CapacityDiameter
29
240 Balpd 4
Daily Flow'. Design Flow ]umber -
1,2 gal 12"!32"/ 32'!32"/ 12 On Center.
Septic rank Capacity hvorking) 3 Separation
Receiving Soil Type l l-6) 8 Orifices
pri:. 8Pd/It- 32
Receiving Soil Appl. Rate 300ft Total Number 0forilices
in
Required Primary' Area fC Diameter
300 24 in
Designed Pdmery Area 300 00 tt, Spacing
reneted Reserve,1r ca Manifold
10 It Scher
Elevation Measurements
TrenchiBcd Width 30 fl Schedule/Class
2 ft
Trenclu'Red Length �� Length —��
2in
1 0 Diameter
Original Drainfield Area Slope 2 2 preferred manifold configuration used'? ❑Yes 0 No
New Slope. If Altered N/A
Transport Pipe
n -skopt in Schd 40
Depth of Excavation in Schedule/C lass
from Original Grade p+rigs-.lope 36 14
in Length 2 in
Designed Vertical Separation Dimnemr ��
Pump Required?
Drainneld Required? ■Yes No
Dosing and Pump Chamber
■icat Yes ❑No
Pump Required? Number of doses/day 12
pomp/Siphon Specifications 20 gal
sal
ft
Dill'. in Elevation Between Pump&OPpermost Orifice 5 Dose quantity (flood)
5 ft Chamber Capacity
Dreinfield Squirt Height'Selected Residual(head) — - Pump controls: Please check those required. ■ Event Counter
Pump ■ timer ■ Elapse Meter 02/00/00
Uppermost Orifice ■Higher O Lower[han2t grit 00/01/00 ,pump on'
Capacity n Told Pressure Head i ft If Timer: pomp on_
Calculated Total Pressure I lead
Dose timing to be determined by draw down test and adjusted as necessary.
c°R1n1e"t'
Revised:6/11'2025
2233 . 55OOOp6
Assessor s Parcel Number'.
C 3-
FOR '—PAGL r\ O oZl7
UESIt N
PennitNumbec SWG -
DESIGN CHECKLISTS Sketch
Cross-Section- rade.
Stated Layout S
ketch Referent,depth from original g
Id orientation and layout
■ Sept tank
■ ti"Infie ■ grainfield cover
Plot Ylan nstons and
Scaled ■ dime soul Cade
Ie locations 'Irenchlbed on final g
-fast ho istances within la; €
■ eriiieal d Reference depth
from
■ Sob ■ g_Ro�vabebellocatic"s
chamber and cestrictive stratanchlbed.top and
■ Property Imes tic ranklpumP ■ Laterals,
m osed wells ■ Sep bottom
■ p,�isting andp Pro etty -NIA locations
P cation (;urtuin drain collector -N
0oit" tion port to ❑
tvlthin 1 banks and ■ uiionentation
to cats,ba Obsecva ■ Sand u
■ Measurements etail'.
and critical areas ■ out location
utface water Clean- tion d
-NP splacement Other cron o6s-s� nrtslclean-outs
orientation r Manilold p ■ Obsenro on P
❑ certain Brand all absorption ■ lacemcnt
-NIA ■ OriGceP formation
-NIA curtain drain and placement with distance
components ■ Lateral p" Other In
ed No
area to edge of b staked out Location and dintznsion o
■ stem and reserve Ivisual alarm refer ❑ ■ Design
primary s ■ Audible ❑ ■ Recorded Notices attached
drawing shown on scale
■ Buildhtgs Scale of ■
❑ V ewer(')attached
find ■Pump curve attached
mamr ■
■ -NIA bar _ and relative ❑ ffailure
Direction ofsloP' ,hmark'
■ Elevation hen' components ❑ ■ gvaluation o
❑ Waterlines stem
crvewa}s, hat�usfiricafion
ts.d elevations of s}'-
■ Roads,Basemen en
Non-rwi
parking ❑ ■Waste strength
and scale drawing ❑ ■ Row
North arrow e
■ hown on scale bar
DESIGN APPROVAL 0 No
installer at time of Installation
■Yes
designer must be notified b}'
07/Date 6
C 00. Date Q^g
The undersigned
gignamtc of D�on public f-Iealth and
determine
w dthis design on behalfofMason Coum}' �� 3
med has reviewe . z re€ulanons: [ MASOh'�oL„f'Y
The understg / ( F
_____vim Date ' SNVra�h„2026
complimt,e v"th state and local on-s > / st
1 G CONUITA�HEAL7
f:nvirontnental i1cal P alist OWIN
VAL lS VALIU ONLY UNDER THE POLL
th
CSIGN APPROoved`by Mason County Publuiatioo Date as'.__J!- gn rove/.
CALTION: U cd"App 'ned,the Permit C xi
v The design's stamp' not esp
�/ The Onsite Sewage PCOnit has ller,
a certified
Insta lth.
d to adversely a{teet wrrd't1O°s°f
esi
,� Drain9eld site conditions have not been altct�
from Mason County public Hea
The system must be installed by
Please Note:
riot authorization is obtained
unless p vlsed' 6 1112o25
n fee is re
uired.
the Mason County Web Site. Re
available for Public view on
An Installatio
This for may be scanned and
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