HomeMy WebLinkAboutSWG2026-00080-APPLICATION/DESIGN - SWG Application / Design - 4/15/2026 415 N6T
MASON COUNTYH STREET, HEL9670.WA E 7400
SHELTON,
9 484
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:3603825269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2026-00080
APPLICANT Jim Zimny Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck,WA 98380
OWNER ESTEBAN-MARTIN ET VIR LUCIA Phone:
Address: SEBASTIAN GASPAR BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287
Address: 7178 windflower pl nw Seabeck,WA 98380
Site Address: 480 NE MISSION CREEK RD
Primary Parcel Number: 223364200041
Permit Description: New 2bd gravity trench with local waiver for reserve drainfield
Permit Submitted Date: 0312012026
Permit Issued Date: 04/15/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $570.00 (addnldnanees may be required aaoa L,staliatbn of system).
Permit Expiration Date: 04/01/2029 (based on date of nspecuon)
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.
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 The minimum buffer/setback from the stream is 165 No clearing or tree removal in the
stream buffer.
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.govlheahhlenvironmentaYonsiteloss-inspection-requestphp or call:
360.4279670,extension 400.
OFFICIAL USE ONLY
• MASON COUNTY 3 ao/&oato
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MNUNG ADDRESS-STREET COY.5TATF-DPCgOE C
PO BOX 138, Belfair Wa 98528 rn
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480 NE Mission Creek Rd, Belfair WA 98528 o s
NAME OF OESIGNEA PHONE
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NAME OF INSTALLER FNONE
PERMIT ttPE(fecfone) ORINpNG NNTFR SOURCE W
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NEW CDNGTRUCTION/UPGRADES O REPAIR/REPlAC0.1ENT OTHER DETAILS(uay.eWM.Ppy/ ❑ TABLE X REPAIR
911&AITtgL5 U SURFAONG SEWAGE 0 EXISTING FAILURE O SHGREUNE r
D DESIGN FORM REWIRE (R D7
(REQUIRED) DESIGN(REQUIRED) BEDROOMS I LOT sZE OT CREATED A 1/2025?.❑ WAIVER(S)OFAPPLICABLE) 2 2.5 acres S f. . 5
OIRECTONS TO SITE AND SITE CQYLMIONS(er./xMNYefe) 10.
beginning in Belfair take Northshore rd west for 3.1 miles to Mission Creek rd and takerjI I
Follow .5 miles to address on mail box and pink ribbons on there, '
Test holes are flagged and marked. p I Q
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FNLURE 90URCE(lot epwting pueponm)
❑VOLUNTARY QMAINTENANGE/PUMpING❑ BUILDING PERMIT❑HOME SALE❑Cg4PLNNT O OTHER:
INSPECTOR SOIL LOGS
COMMENTS)CONDITIONS
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�-ORAYELLY 5=9,WU L-LOAM 5I:SILT C=CLAT EXTREMELY R=ROOTS REQUIREDDDFOR NALAPFROyALRWNGANO NON REPORT
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE
APPLICATRMI ROVED/ISSUED Y DATE
THIS FORM MAYA!SC ANNEOANDAVAB.ABLE FO PUBLIC VIEW ON THE MASON COUNTY WEBSrFE
• DESIGN FORM—PAGE ONE Assessor's Parcel Number 2 2 3 3 6 4 2 0 0 0 4 1
A design will be reviewed when 3 conies of each of the following am 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 �D� ( — OOOH Designer's Name: Jim Zimny
Applicant's Name: Sebastian Gaspar Designers Phone Number: 360 516-7287
Mailing Address:
PO BOX 138 Designer's Address: 7178 Windtlower PI NW
eeilali WA9d52a City Stale Zip SP.abeck WA 96390
City State Zip Designers Email
APDdesigns@ieaud.com
DESIGN PARAMETERS
Treatment Device
❑Glendon ❑Sand Filter ❑Mound ❑ Sand Lined Drainfield ❑Recfcalating Filler ❑AT0 ❑Oder
Treatment Level(check all that apply). 0 A 011 ❑C ❑DLI ❑BL2 ❑BL3 !'IE ❑N
Drainfield Type
WGravity ❑Pressure M'Trench ❑Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 3034
Daily Flow: Operating Capacity 180 gpd Length 25 ft
Daily Flow:Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1000 gal Number 4
Receiving Soil Type(1-6) 3 Separation 5' CTC ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 300 ft' Total Number of Orifices NA
Designed Primary Area 300 ft' Diameter in
Designed Reserve Area 300 ft2 Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 100 ft Scledul NA
Elevation Measurements Len "
Original Drainfield Area Slope 3 % Di ENS erys�'en in
New Slope,If Altered 3 % Preferred mato d`configuration used? D Yes O No
Depth of Excavation lip-slope 2t. in Transport Pipe
from Original Grade ulope 20 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 5' ft
Grovel-based Drainfield Required? O Yes El No Diameter in
Pump Required? ❑Yes EfNo Dosing and Pump Chamber
Pump/Siphon Specifications Ntunber ofdoses/day NA
Diff,in Elevation Between Pump&Uppermost Orifice_ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) _ft Chamber Capacity(flood) gal
Uppermost Orifice 0 Higher O Lower than Pump Shutoff Pump controls:Please check those required.
Capacity rD Total Pressure Head gpm ❑ Timer ❑ Elapse Meter O Event Counter
Calculated Total Pressure Head ft If Timer: Pump on
Comments
APR 15 2026
MASON COUNTY ENVIRONMENTAL HEALTH
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 3 3 6 4 2 0 0 0 4 1
Permit Number: SWG Qca. -ncryo
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
E'f Test hole locations Rr Drainfield orientation and layout Reference depth from original grade:
g Soil logs t' Trench/bed dimensions and V Septic tank
46 Property lines critical distances within layout
p Y V Drainfield cover
V Existing and proposed wells l2( DBBox/Valve box locations Reference depth from original grade
within 100 ft of property V Septic tank/pump chamber and restrictive strata:
fd Measurements to cuts, banks,and locations Laterals,trench bed,top and
surface water and critical areas V' Observation port location bottom
fd Location and orientation of 9 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption a Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
er Location and dimension of Observation
primary system and reserve area Laeera placement with distance ports/clean-outs
edge of bed Other Information
er Buildings ❑ Audible/visual alarm referenced Yes No
V Direction of slope indicator
fC Scale of drawing shown on scale ❑ Design staked out
Waterlines bar ❑ ❑ Recorded Notices attached
V Roads,easements,driveways, ✓ Elevation benchmark and relative ❑ ❑Waiver(s)attached
parking elevations of sys a comp ents O O Pump curve attached
e North arrow and scale drawing
shown on scale bar a Non-residential justification
P
❑ ❑ Waste strength
x ❑ ❑ Flow
A
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The undersigned designer must be notified by ns ller t u elot installation O Yes ❑ No
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Signature of igne 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 regulations
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped "Approved"by Mason County Public Health. 2 y., 4
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:_ J t 4 c� t
✓ 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 folm niWbe filled and available for publk'vlew on the Mason County Web site. Revised:6/112025
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l Irnely-Re,asona b 'e•30 Years of Local Experience
Construction Notes for Gravity 2 Bedroom System:
Equal Distribution w/graveless chambers (Rock and pipe may be substituted)
Install 4-25' Lateralsw/6 hole d-box.
Install on 5'foot centers.
Install 20"deep on low side of trench maintain 36"of vertical separation
Install level and along contours.
Install in dry weather only.
Use 1000-Gallon septic
System designed for typical residential waste strength sewage only.
System designed for 240 Gallons Per Day
APR 15 2026
MASON COUNTY ENVIRONMENTAL HEALTH
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