HomeMy WebLinkAboutSWG2026-00280 - SWG Application / Design - 8/31/2026 I
MASON COUNTY 415"'SHELTON , 0427-9 70 EXT400
BELFAIR:360-275-4467. EXT 400
Public Health & Human Services ELMA:360182-5269,EXT400
FAX:350-427-7787
On-Site Sewage System Permit: SWG2026-00280
APPLICANT DUPLECHIN KAITLIN L Phone:
Address'. 15431 CLEAR CREEK RD NW POLJLSBO, WA 98370
OWNER DUPLECHIN KAITLIN L Phone:
Address'. 15431 CLEAR CREEK RD NW POULSBO, WA 98370
SEPTIC DESIGNER FRANK MARCINKO* Phone: 360-801-0147
Address. 5677 Minnig LN NW SEABECK, WA 98380
Site Address: 737 NE BEAR CREEK DEWATTO RD
Primary Parcel Number: 123093304040
Permit Description: New 4bd gravity trench
Permit Submitted Date 08/24/2026
Permit Issued Date'. 08/31/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $570.00 (additional fees may be required upon instaiIaI,or,of syseri0.
Permit Expiration Date: 08125/2029 (based on date of Inspecton)
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.
I of Z
THIS PERMIT MUST BE ONSITE DURING INSTALLATION crass.
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/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
MASON COUNTY N6THSTREELSHELTON WA995d0
SH STREE.360LLTON EXT400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA 360-482-5269,EXT 400
FAX:360-427-7767
8 The approval of this project is subject to the recommendations and specifications outlined
in the attached geotechnical report or assessment. All applicable recommendations and
specifications shall be applied to the development on this site. Any deviation requires
stamped written approval from the registered design professional responsible for the
report/assessment. and may require special inspection by same. Structures and/or land
modifications (grading, cuts, fills, etc.) required in the geotechnical report/assessment,
may require a separate permit. The geotechnical report/assessment shall remain
attached to the approved building plans.
pas , 2o L
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/healthienvironmental/onsitefoss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
( j4 MASON COUNTY DATERECBVED � If �
AMOUNIRECBVE _ RECEIVED BY:
Public Health & Human Services 570
Environmental Health 360-427-9670,ext 000 or 360275-4467,ext.400 I - LA
415 N.6th Street-Shelton WA 9S584 SWG c; W- —
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT , '_ PHONE r
Kaitlin Duplechin z
z
MAILING ADDRESS-STREET.CITY STATE.ZIP CODE Iii �+
15431 Clear Creek Rd NW — Poulsbo WA 98370 z
SITE ADDRESS-STREET,CITY.ZIP CODE k I 737 NE Bear Creek Dewatto T _, Belfair WA 98528
NAME OF DESIGNER D O C, c' r PHONE
Frank Marcinko � 360-801-0147
NAME OF INSTALLER -- - rnPHONE I
O
PERMIT TYPE(select one) DRINKING WATER SOURCE
® 2
RESIDENTIAL 055 0 COMMUNITY OSS 0 COMMERCIAL OSS q PRIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL
TYPE OF WORK(sektl one) ❑ PUBLIC WATER SYSTEM
NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT OTHER DETAILS(select an lnal apply) ❑ TABLE X REPAIR w
BUBMmAL5 ❑ SURFACING SEWAGE ❑ EXISTING FAILURE 0 SHORELINE
El DESIGN FORM(REQUIRED) 17 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED AFTER 411/2025? 0 I0)
❑ WAIVER(S)(IF APPLICABLE) 4 4.8 acre YES NO I O
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex. cNed gale)
Come up the hill from the Old Belfair Hwy and as you feel you are reaching the top take a a
hard left into the driveway as you are going through a sharp righthand curve. 733 shares r
the same driveway. Go down the common driveway past a house on the left and after oI 0
dropping down through a right curve the property is on the right before entering 733's a
driveway.
SUE MUSYBE RAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FAGGED WITH TEST ROLE NUMBERS. I 0
OFFICIAL USE ONLY BELOW THIS LINE — - - - -- ----- --
UPGRADE I FAILURE SOURCE por reponmg purposes)
VOLUNTARY Q MAINTENANCE/PUMPING Q BUILDING PERMIT Q HOME SALE❑ COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
RECORD DRAWINGAND INSTALLATION REPORT
SOIL CODES'.
V=VERY G=GRAVELLY S=SAND L=LOAM Si SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPE PSIGNATURE ^11 DATE APPLICATION EXPIRATION APPLICATION APPROVED/ISSUED BY M DATE
I W k ((a�/ZS ''I 8
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:0110912D26
DESIGN FORM— PAGE ONE Assessor's Parcel Number: 1 2 3 0 9 3 3 0 4 0 4 0
A design will be reviewed when 3 copies of each of the following are submitted:
e Completed design form that has been signed and dated. 0 Scaled layout sketch, including all applicable items on checklist.
♦ 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 Mason County Web site.Maximum paper size II"R 17"
PARCEL IDENTIFICATION
Permit Number: SWG X0,1-1P Designers Name: Frank Marcinko
Applicant's Name: Kaitlin Duplechln Designer's Phone Number 360-801-0147
Mailing Address: 15431 Clear Creek Rd NW Designer's Address: 5677 Minnig LN NW
POULSBO WA 98370 City State Zip Seabeck WA 98380
City State Zip Designer's Email alliedsepticdesign@gmailom
DESIGN PARAMETERS
Treatment Device
O Glendon O Sand Filter O Mound O Sand Lined Drainficld O Recirculating Filter ❑ ATU O Other
Treatment Level(check all that apply): ❑A ❑ B ❑ C O BLl O RL2 O RL3 ❑ E ❑N
Drainfield Type
Gravity O Pressure Trench O Bed O Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 3034
Daily Flow:Operating Capacity 480 gpd Length 68 min ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1,200min gal Number 4
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl.Rate .6 gpd/ftc Orifices
Required Primary Area 800 ft' Total Number of Orifices -
Designed Primary Area 816 ft' Diameter - in
Designed Reserve Area 800 ftc Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 4 @ 68 ft Schedule/Class -
Elevation Measurements Length - ft
Original Drainfield Area Slope 7 % Diameter - in
New Slope,If Altered % Preferred manifold configuration used? O Yes O No
Depth of Excavation tip-slope 23. in Transport Pipe
from Original Grade Down-slope 20 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 80+ ft
Gravel-based Drainfield Required? O Yes C1 No Diameter 4 in
Pump Required? ❑ Yes Ef No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal
Uppermost Orifice O Higher O Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head gpm O Timer O Elapse Meter O Event Counter
Calculated Total Pressure Head R If Timer: Pump on ,Puny off
Comments - u
Resubmission of expired design
Revised: 6/11/2025
DESIGN FORM —PAGE TWO Assessor's Parcel Number: 1 2 3 0 9 3 3 0 4 0 4 0
Permit Number: SWG 9L84.c
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
❑ Test hole locations 9 Drainfield orientation and layout Reference depth from original grade:
(f Soil logs 9 Trench/bed dimensions and V Septic tank
Property lines
critical distances within layout lid Drainfield cover
x/Valve box locationsBo
V Existing and proposed wells D- Reference depth from original grade
within 100 ft of property V' Septic tankipump chamber and restrictive strata:
19 Measurements to cuts, banks,and locations V Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
❑ Location and orientation of El Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
Pr Location and dimension of ❑ Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
er Buildings ❑ Audible/visual alarm referenced Yes No
V Direction of slope indicator ' Scale of drawing shown on scale O eDesign staked out
V Waterlines bar ❑ eRecorded Notices attached
Roads, casements,driveways, Elevation benchmark and relative ❑ VWaiver(s) attached
parking elevations of system components O VPump curve attached
❑ ❑ Evaluation of failure
North arrow and scale drawing
shown on scale bar Non-residential justification
❑ D Waste strength
❑ Cl Flow
DESIGN APPROVAL
The undersigned designer must be notified by install rat time of costa Lion Z Yes ❑ No
Signature of Designer to
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:
((�fi�uAlVvj` o
Environmental Health S cialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped "Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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: 6/112025
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