HomeMy WebLinkAboutSWG2026-00135 - SWG Application / Design - 7/31/2027 MASON COUNTY 415N6SHELTON. 60427-9670,E9B584
SH STREE 3fi0-02TON EXT400
BELFAIR'.360-275-4467,EXT 400
Public Health & Human Services ELMA.360-082-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2026-00135
APPLICANT HOMES AND DEVELOPMENT Phone: 253-514-3915
NORTHWEST INC
Address: P O BOX 565 BURLEY, WA 98322
OWNER HOMES AND DEVELOPMENT Phone: 253-514-3915
NORTHWEST INC
Address: P O BOX 565 BURLEY, WA 98322
SEPTIC DESIGNER FRANKLIN CLARK* Phone: 360-620-8857
Address: PO BOX 1954 SILVERDALE, WA 98383
SEPTIC INSTALLER JASON SCHAUER* Phone: 360-801-5681
Address. PO BOX 3118 BELFAIR, WA 98528
Site Address'. XXX NE Gladwin Rd
Primary Parcel Number: 223365500005
Permit Description. REVISION: New SFR 2-bedroom NuWater BNR 500 ATU to sand-lined
bed drainfield with local waiver(WA12026-00035)
Permit Submitted Date'. 05/06/2026
Permit Issued Date: 07/31/2026
Issued By: David Anderson
Current Permit Fees Paid: $1,455.00 (additional ees may be required upon installation or system).
Permit Expiration Date'. 0511812029 leased on dare onn,nAmwo)
Permit Conditions:
1 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 Grainfield 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.
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/healthienvironmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
MASON COUNTY 415 NfiSHELTON 0427-9N ,EXT 400
SH STREE.36042TON A98584
BELFAIR.360-275-4467,EXT 400
Public Health & Human Services ELMA.360482-5269,EXT 400
FAX:360-427-7787
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.
8 WILL require fees and Geo Checklist at time of BLD submittal
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF 055.
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/environmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
/ 6 _ oFICIrLI)5FGM
paiEF6EIVED
CO
MASON COUNTY M
a +.aecNVE� ECDVEo ee m0 T
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Public Health & Human Services �O 135 0 O
Environmental Health 3604PA96]0,ext.400,300 275 RI ex900
415 N.5th Street -Shelton,WA 95584 .R"���..�— N
2 •0
ON-SITE SEWAGE SYSTEM APPLICATION m
r
„DITE
HOMESAPPLICANT AND DEVELOPMENT NORTHWEST INC 360.830.4765 (0)/360.620.8857 c
w �
m m
MAILING ADDRESS STREET.CRY.STATE.ZIP CODEni
A
PO8 565 Burley,WA 98322 SITE to
O
�N
ADDRESS STREET,CITY.ZIP CODE C
XXX NE GLADWIN RD, BPI FAIR WA 98528 (.f1 �IV p ONE
NAME OF DESIGNER 360.620.8857 II f
Franklin Cl Clark P„ONE 0 �tJ
NAME OF INSTALLER 360.801.5681 n I' 1W1
N
Jason Schauer DRINKING WATER SOURCE
O IV^1
PERMIT TYPE Isef""a)
• RESIDENTIAL OSS ❑ COMMUNITY OSS O COMMERCIAL ass ' PUBLIC WATER SYSTEM LL PRIVATE
-�WELL I J I V
TYPE OP WORK CONSTRUCTION!
� NEWCONSTRUCTIONJ UPGRADES ❑ REPAIR(REPLACEMENT OT�S SURFACING SEWAGE P D EOISTINGF FAILURE ❑SHORELINE IVI
SU6M'DESI LOT SIZE WAS LOT CREATED AFTER 41920]5'
UI
R
BEDROOMS■ DESIGN FORM(REQUIRED) ■ SEPTIC DESIGN(REQUIRED) 2 Acres:0.18 YES NO
• WAIVER(5)(IF APPLICABLE) I O
DIRECTbONST0 SITE AND STE CONDITIONS(e .lockedge'I
Mason County Community Services,415 N 6th St `-1 r;'_: to
,Shelton,WA 98584
Take W Alder St to E Pine St C
Follow WA-3 N to WA-300 W in Belfair �'F�Fr7 Ul' I to
Continue on WA-300 W. Drive to NE Gladwin Rd II n
SITE MVST9E FfAGG EO FROM MLIN ROAD FND TEST HOLES MUSTBE FLPGGES WITH TEST HOLE NUMBERS
OFFICIAL USE 0IdL1'BFLOw TN I5 LINE— — --e--
UPGRADE I FAILURE SOURCE to m9 vm0eseyl
❑VOLUNTAFY D MAINTENANCEIPUMPING OBUILDMG PERMIT OH0ME SALE ❑COMPLAINT GDOETERI comolname
INSPECTOR SOIL LOGS �� �4pP/e2 V! b/II( 4Y- elaG'4t d!F
T1:o G C4CO45iobHOn (T 9)
5aL o yZ mua 1o1er 6,,K 1( ww oll
(L oaf 4o5�t+om
nwd 5 M gafloM.
2elN5f 1ff) 6R4(WZ6 : i1ti. Or6o"nscy/C.T7P v f o d+Wf EGGRDDRA NGANDINRIAL TIDN REPORT
ry fir5(hol` 26`t t0 ` ow,- REOOIRED FOR AINAL APPROVAL.
SOIL CODES: IICC DATE
V=VERY G=GRAVELY 5=SAND L=1DAM E1=91LT LII, A, E=E IO R=RD APPLICA N PPROVE II UFDB
DATE APPLICPIRATIO DATE /'�
INSPECTOR SIGfNATU/Re uzo S 217 9iZ_
N )/'"�' i' . `/ Revised.6)312025
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
DESIGN FORM-PAGI,ONE Assessor's Parcel Number: 223365500005
A design will be reviewed when 3 cosies of each of the following Scaled le out sketch,including all applicable items on checklist.
v tiittetl
Completed design form that has been signed and dated.
Scaled plot plan.including all applicable items on checklist. v Cross-section sketch,including all applicable items on checklist.
�
This form may be scanned and available for public view on the Masan County Web site. ?-lueimum fxlptr sin II V/?
PARCEL IDENTIFICATION Frdnk in 1 Clark _ --
Applicant's
Designer's Name: n Cl - —errnitNumber: S a c eu — Designer's Phone Number: _360.83O4765 _ ----
Name: eaarmnssr we _— _ -- -- P.O.Box 1954-- --- --
-
POB 565 Designers Address: -- — — — WA 98383
--
tailing Address: — --- - -- Silverdale
City State 7.ip
BudeY.WA98322 Cit State Li Designers email a lusonsite live.com —
DESIGN PARAMETERS
Treatment Device Enviro-Flo
O Other
❑elende ❑sacid gilt r ❑Mound ■sand In,d Dry �afield ❑Re ' r i ng Fitter ■A nt BNR500
Treatment Level(,ills II that apply)'. ❑ A ■B ■C ❑BI.1 ■Bl ■ Bl3 ❑ 1- ❑b
Drainfield Type ace s
❑Gravity O Pressure
❑Trench ■ Bed
Laterals
Septic Tank/Drainfield SpecificationsSChd 40
2 Schedule/Class
Number or Bedrooms 29 it
enuth
Daily Flow: Operating Capacity 240 gPd 1-1/4 in
240 gpd Diameter
Daily Flow: Deslen Flow 4
Septic Tank Capacity leorking) 1,264.21 gal
Numhcr
3 Separation 12'!32"!32"/32"/ 12"On Center.
Receiving Soil Type f I-6) Orifices
Receiving Soil Appl.Rate Prl:.8/Res: .8 gpd/R' 32
300 K- Total Number of Orifices
Required Primary Area 1/8^ in
300 (ti Diameter
Designed Primary Area 24 In
300 If= Spamng
Designed Reserve AreaManifold
10 (1
Dreach/Bcd Width Schedule/Class Scher
T reach/Bed Length
30 ft2 n
engrth 2 .
Elevation Measurements 2 m
Original Slope.
f cld Area Slope
1 2 Diameter 2
N/A % Prcferr d manifold configuration used? ❑ Yes Na
New Slope If Altered Transport Pipe
Depth of Excavation 1=P. to 36 SCE
from Onginal Grade prnm-slop, 36 in Schedule/Class
14 ft
Uaigned Vertical Scpam 18 in Length tion 2 in
('suet-based Di ainficld Required? ■ Yes O No Diameter
Dosing and Pump Chamber
Pump Required^
■ Yes O No
N umber of doses/day
Pump/SiphonPompquantity& Uppermost Orifice_ $ 1200 gal
5 (t Chamber Capacity(floodl
Dome field Squirt Height,Selected Residual(head) --pemmA Orifice ■ Higher O Lower than Pump Shutoff Pump controls:Please cheek those required.
Ca
■ event Counter
Timer ■ Elapse Meter 02/00/00
Capacity d total Pressure Heed 25.9 =p�u 00/01/00 ,Pump offCelculated'rotal Pressure Head
1T 6 fi If Timer Fulton
Comments Dose timing to be determined by draw down test and adjusted as necessary.
Revised:6/11,202`
DESIGN FORM—PACE TWO Assessor's Parcel Number: 223365500005
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch
Cross-Section Sketch
■ Test hole locations • Drainfield orientation and layout Reference depth item original grade:
• Soil logs ■ 1snc l hed dimensions and ■ sepDimin lank
critical distances within layout ■ Drainfield cover
• Property lines Reference depth from original grade
❑ Existing and proposed wells
• D-Uox/Valve box locations
within lot)ft of property -N/A • Septic tank/Pump chamber and restrictive strata:
■ Measurements to cuts,banks,and
locations ■ I aterals.trench/bed,top and
bottom
surface water and critical areas ■ Observation port location Curtai
■ Clean-out location O Curtain drain anon or-N/A
❑ Location and orientation of ■ Sand augmentation
curtain drain and all absorption E Manifold placement
components -N/A ■ Orifice placement
Other cross-section detail:
� Lateral placement with distance
■ Observation ports/clean-outs
■ Location and dimension of
primary system and reserve area to edge of bed Other Information
■ Buildings ■ Audible/visual alarm referenced Yes No
O ■ Design staked out
■ Direction of slope indicator • Scale of drawing shown on scale Recorded Notices attached
❑ Waterlines -N/A bar ❑ Waivers)attached
■ Roads, easements,driveways, N Elevation henchntark and relative attached
parking elevations of system componen O 0 Pump curve ts ❑ 0 Evaluation attached
■ North arrow and scale drawing Non-residential justification
shown on scale bar ❑ 0 Waste strength
❑ ■ Plow
DESIGN APPROVAL
The undersigned designer must be notified by installer at tiiiie of installation U Yes ❑ No
07/282026 Date
Signature of Designs
it
The undersigned has reviewed this design on behalf of Mason County Public Health and determined 3
compliance with state and local o • regulations: )
alist
Date
,nvironntental H pee ,r
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped Approved by Mason County Public Health. Z
✓ The Onsite Sewage Permit has not expired.the Permit Expiration Date a_
94 2 -
✓ 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:G'I I/zn?s
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