HomeMy WebLinkAboutSWG2026-00184 - SWG Application / Design - 7/20/2026 MASON COUNTY 4,5N6SHELTON SHELTO70,EXT400
SH STREE.360-02TON, EXT400
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: SWG2026-00184
APPLICANT ANDERSON ET VIR CHARLES MARK Phone:
Address: SAMUEL JAMES ROSALES TUCSON, AZ 85737
OWNER ANDERSON ET VIR CHARLES MARK Phone:
Address: SAMUEL JAMES ROSALES TUCSON, AZ 85737
SEPTIC INSTALLER CINDY WAITS* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 155 N TERRACE RD
Primary Parcel Number: 323312190870
Permit Description: Repair/upgrade 3BR SFR -pressure
Permit Submitted Date: 06112/2026
Permit Issued Date: 07(0112026
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $845.00 (additional fees may be required upon Installation of system).
Permit Expiration Date: 06/16/2027 teased on date of inspection)
Permit Conditions:
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
2 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
4 Drainfield installation not to exceed designed upslope and downslope depth specified on
design form.
5 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
6 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
7 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/healthlenvironmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY—
MASON COUNTY °°rE"E`lvEQ o I la N
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Public Health & Human Services AMoorvr nerncr nvm r$� CO
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Environmental lNalrr 35CLve 61.ext.400 or 360-775.416].ext.400 (''
415N.6th Street - Shelton.WA 9$5$4 SWG —
ON-SITE SEWAGE SYSTEM APPLICATION ' A
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APP MLICANT IPNONE r
ANDERSONIROSALES IC 480-8484972 c
MAILING ADDRESS-STREET CITY STATE ZIP CODE
11283 N SAWTOOTH RD = = TUCSON AZ 85737
SITE ADDRESS
155 N TERRACE RD f i 71 - HOODSPORT WA 98548
NAME Of DESIGNER PHONE N
CINDY WAITE jJ� �_----��_ 360-701-0205
NAME OF INSTALLER I) PHONE O w
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PERMIT TYPE(IDleer one) DRINKING WATER SOURCE Q
RESIDENTIAL OSS I r p COMMUNITY OSS TT COMMERCIAL 055 ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
PUBLIC WATER SYSTEM_ _
TYPE or WORK rselcel one)
hNEWCON5TRUOTIONIUPGRADES 9f REPAIR,REPLACEMEiNT RHER DETA'LS RRecl 8)1 001 a 'or . 0 TABLE A REPAIR
G SURFACING SEWAGE El EXISTING FAILURE O SHORELINE W f
susMD TALS _ -- r
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIREOI FILL uTMS LOT SIZE WAS LOTGREmEC AFTER"-O01& O
5WAIVER(S) IF APPLICABLE) 3 .35 AC _o YES p+ NO
DIRECTIONS TO SITE AND CITE CONDITIONS Ir< boxed gore;
GO NORTH ON US 101, TURN LEFT ONTO TERRACE RD, KEEP TO THE LEFT, I o
DRIVEWAY ON THE LEFT SIDE OF TERRACE. NEW DRIVEWAY WITH NEW CRUSHED r 10,
ROCK. S
to
SITE MUST BE FLAGGED FROM MA IN ROAD AND TEST HOLES MUSTRE FLAGGED WITH TEST HOLE NUMBER$.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE IFA reooning Ppusezl
❑VOLUNTARY O MAINTENANCE/PUMPING []BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER._
INSPECTOR SOIL LOGS f CCMMEN 61 CONDITIONS
RECORD DRAWING AND INSTAI LATION NE ORI
SOIL CODES.=VERY c=GRAVELLY s=SAND L LOAM s.=siT c=CLAY r=ExT RLnELr R=Roots REQUIRED rop FINALAPPROVAL
•
ECTOR SIGNATURE DATE APPLICATION IxpiAYbONnArE A2P 'CATION SPPROVEDI ISSUED 5V DATE
IS MMAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
Revised 4/1412025
DESIGN FORM—PACE ONE Assessor's Parcel Number: 3 2 3 3 : 1 2 1 9 0 8 7 0
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. 0 Crots-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: 17"X17"
PARCEL IDENTIFICATION
Permit Number: SWG 202e- PL / qy Designer's Name: CINDY WAITE
Applicant's Name: ANDERSON/ROALES Designer's Phone Number: 360-701-0205
Mailing Address: 11283 N SAWTOOTH RD Designer's Address: 80 E PICKERING LANE
TUCSON AZ 85737 City State Zip SHELTON WA 98584
City State Zip Designers Email cindyewaite@men.com
DESIGN PARAMETERS
Treatment Device
❑ Glendon 0 Sand Filter ❑Mound ❑Sand Lined Drainfield 0 Recirculating Filter ❑ATU ❑Other
Treatment Level(check all that apply): ❑ A ❑B 0 C ❑ BLI 0 BL2 ❑ BL3 IE ❑N
Drainfield Type
❑ Gravity iPressure Trench fl PeA O Sub Surface Drip
Septic Tank/Drainfield Specifications terals
Number of Bedrooms 3 Schedule/ SCHEDULE40
Daily Flow: Operating Capacity 270 gpd Length N 40 ft
Daily Flow: Design Flow 360 gpd Diameter LULL I 1.25 in
Septic Tank Capacity(working) 1200 gal Number --cl - 5
Receiving Soil Type(1-6) 4 Separatio , 5 ft
Receiving Soil Appl. Rate .6 gpd/ft2 -'_ '£ices
Required Primary Area 600 ft' Total er o ces 40
Designed Primary Area 600 ft2 Di r,-`n�'�'° �e'yr 3/16 in
Designed Reserve Area 600 ft2 g 60 in
Trench/Bed Width 3 ft ManifoldUCENSEDC
Trench/Bed Length 200 ft SCHEDULE 40
cxvwas uv�a
Elevation Measurements Length 1-2 ft
Original Drainfield Area Slope <5 % Diameter 2 in
New Slope, If Altered % Preferred manifold confi oration used? Gd Yes 0 No
Depth of Excavation Up-slope 28 i ;, 2l V E ansport Pipe
from Original Grade Dowmslope 26 Schedule/Class SCHEDULE 40
Designed Vertical Separation 24 [r},I{kth2 3 /l 30 ft
Gravel-based Drainfield Required? 1'Yes 0 N - Diameter: H. - " 2 in
Pump Required? if Yes O No JS1W Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 6
Diff. in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1 tL7./ gal
Uppermost Orifice f Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 23.6 gpm 9 Timer R1 Elapse Meter ' Event Counter
Calculated Total Pressure Head 8.29 ft If Timer: Pump on ,Pump off
Comments
CONTACT DESIGNER TO STAKE OUT DRAINFIELD AT TIME OF INSTALLATION. DOUBLE SLEEVE
TRANSPORT LINE UNDE DRIVEWAY, PUMP CONTROLS TO BE SET AT TIME OF INSTALLATION
Jul ✓a f"''U ;: vn ) aY"•-1r,. RevicedR/1lnmc
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 3 3 1 2 1 9 0 8 7 0
Permit Number: SWG 2G2G- #- Oo / yy
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Rf Test hole locations 10 Drainfield orientation and layout Reference depth from original grade:
Qf Soil logs Qf TrenchTed dimensions and Rf Septic tank
9f Property lines critical distances within layout Drainfield cover
❑ Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations
Laterals,trench bed,top and
surface water and critical areas Observation port location bottom
❑ Location and orientation of Qf Clean-out location ❑ Curtain drain collector
curtain drain and all absorption I! Manifold placement O Sand augmentation
components
Orifice placement Other cross-section detail:
if Location and dimension of Q( Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
Q Other Information
f Buildings
V Audible/visual alarm referenced Yes No
♦�f Direction of slope indicator
Scale of drawing shown on scale ❑ Design staked out
it Waterlines bar 0 ❑ Recorded Notices attached
Qf Roads,easements,driveways, ❑ Elevation benchmark and relative ❑ ❑ Waiver(s)attached
parking el v ons�pofy�y ants L( ❑ Pump curve attached
Qf North arrow and scale drawing g ❑ ❑ Evaluation of failure
shown on scale bar irf
S Non-residential justification
JUL 20 r ❑ ❑ Waste strength
O ❑ Flow
DESISB%VPROVAL
The undersigned designer must be notified by installer at time of installation RYes ❑ No
( 'YJ2zL
Signat of Designer TDate
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(-sit g/)regulations:
�f✓l�F. t If
En ro tai ealth S ecialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. // y
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: — - 2!
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
2
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
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ORIFICE SPACING 5
Lateral# Len th Length Orifice # Distance from Distance from end Length#
(Feet) (Inches) Spacing" Orifices feeder line of end of lateral
1 40 480 60 8 2.5 2.5 40
2 40 480 60 8 2.5 2.5 40
3 40 480 60 8 2.5 2.5 40
4 40 480 60 8 2.5 2.5 40
5 40 480 60 8 2.5 2.5 40
200 40 200
TRANS LENGTH 30
GPM I 23.6
K (2"SCHEDULEN 40) 284.5
FRICTION LOSS
Squirt I 2
Elevation difference 6
TDH 8.299886
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X1=CLEANOUTIOBS PORTS (5� e
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X2=B-B61XIVALVE BOX CI)
X3=Check Valves (s ) 1 *) valve bo, 1'
X4=Flow Control Valves(5 j a v o Ive I �/liceIN5E1 D' �
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LAST ORIFICE;WITH
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PVC HOSE OR �° gQoo0o AS SPECIFIED
LONG SWEEP
ELBOW \ 0� DRAIN ROCK;6"MIN.
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UNDIBTUR SOIL
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Installation Notes
Pressure Distribution
32331.21-090870 156 N Terrace 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. lea-_— to ' 'le o deaigrnetr peter b sfrsee i ses,,
3- Ywt N 10CrUasftlrsds 19 forthukrpes0--
& ConnMstadstsgabsd
5. Qarst bsasd dralrield esgaisd
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 no 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 tanks, valve box and ends of laterals.
11. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
12 Septic fsnk can bs mo sd but mat mat rsgried setbacks.
I&Pump etu6!adat270GPD
14. Lids must form a water and gas tight seal with the access risers.
15. Install effluent fitter at the septic tank outlet.
16. This system must be installed by a Mason County Certified installer.
17. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
18.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.
19. Install laterals with contour of the ground.
20. Install trench bottoms level and always maintain a minimum of six inches into native
soil..
2.1.Pali debt¢rsquoed ow drann rock prior to bscldSrergg.If rock extends
above the ort$tS grade,rein the 011e'fabric at bast 2 the tn.4i rraH
kite guadc, ,�r p
p` C.iN 5100 wef�TP1 �2� `tpl
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System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank and pump tank should be pumped every three to five years or as
needed.
3. System owners are responsible for having maintenance performed annually.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owners shall not at any time change or alter settings in the control box.
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 some 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.
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