HomeMy WebLinkAboutSWG2022-00100-ASBUILT - SWG Application / Design - 8/31/2026 MASON COUNTY 415 N 6TH STREET, 04279N,WA98584
SHELTON:360427-9670. EXT 400
Public Health & Human Services BELFAIR:360-2754467,EXT 400
ELMA,360-482-5269,EXT 400
FAX 360-427-7787
On-Site Sewage System Permit: SWG2022-00100
APPLICANT HAUENSTEIN LLC Phone: 1.317.697.7553
Address: 14781 HORSESHOE AVE SW PORT ORCHARD, WA 98367
OWNER HAUENSTEIN LLC Phone: 1.317.697.7553
Address: 14781 HORSESHOE AVE SW PORT ORCHARD, WA 98367
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 36O-698-8488
Address: PO Box 2954 SILVERDALE, WA 98383
Site Address: UNKNOWN
Primary Parcel Number: 322325208013
Permit Description: New 3bd Oscar X02 revision and extension
Permit Submitted Date: 0310112022
Permit Issued Date. 04/19/2022
Issued By: Luke Cencula
Current Permit Fees Paid: $640.00 (admeo,iel fees may oe rega„ed upon installation of system).
Permit Expiration Date: O3/O7/2O27 tbased o.,n,m of inspection)
Permit Conditions'
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drain field installation not to exceed designed upslope(6")and downslope(6) depth
specified on design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted far
final installation approval.
7 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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.
OFFICIAL USE ONLY
MASON COUNTY oiA.i
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Publi RMc Health & Human Services 70 c cn
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EnWmnmens Health 36O427-%TO.ertCW or 360-3)5416],at 400 ≤ 0
415 N.6MStr.t-511tRmn,INA INS" SWG
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ON-SITE SEWAGE SYSTEM APPLICATION a '>
RPPLIfaNT PNPVE m m
CLD Group LLC z
MAILWG ALMEss-STREET CITY,STATE.IIP CODE
301 E Wallace KneelaniBJvf1 Ste 224 Shelton WA 98584 GO
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srrEwOREss-STREETcm.ZIP caDE I =
130 E Tacoma St JfL'( LH. S H Union WA 98592
LASIEOFOESIGNER
Rod Left �i PHONE AEG 2 ` %i 360-698-8488 ni
NMIE OF I NGRUER
PRONE CJ1
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PERMTT TYPE rseNrv+l - OR y
NG WATER SOURCE
CC pp I O
I�RESIDENTALOSS LLCOMMUNTTYOSS LMCOMMERCIALass 6]PRIVATE ( ]PRIVATE TWO-PARTYWEu.
TTE OF WORK(stn) j PUBLIC WATER SYSTEM w
]NEW CONSTRUCTION/UPGRADES E.REPAIR/REPLACEMENT OTNER DETAILS(fWCMnat s4 C TABLE X REPAIR
SUB�MTITTALS O SURFACING SEWAGE ❑ EXISTING FAILURE CSHORELINE
[El DESIGN FORM REQUIRED) I)SEP1C DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATED LATER 1/112025? 0
I]WAIVER(5)(IF APPLICABLE) 3 .25 acre O YES E NO O I '
DIRECTIONS TO SfTEANO Stir CONOTONS;(v. naked5abJ
Client is extending original design expiration & changing system to an XO2 to achieve
higher treatment level
0
SITE MUST BE RAGGED FROMWN ROAD AMO JEST HOLES MUST BE RAGGED TWIR TEST HOLE MS.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(b IMnMN PSpo eu
O VOLUNTARY O MAINTENANCEIPUMPING C BUILDING PERMIT OH0ME SALE OC0MPLAINT O0THER:
INSPECTOR SOIL LOGS COMAENTS/CONDITIONS
� (�1/ L1t1� 15 so ( Cal(S
SOIL CWE!_ RECORD DMWINGPND INSTALLATION REPORT
V-VERY G=GRAVELLY S=90X0 L=LOAM 5=SILT C-CLAY E=EXTREMELY R=ROOTS REOMRED FOR FINAL APPROVAL
INSPECTOR SIGNANRE GTE MPLCATIGN EPIRAMIN DATE APPLIGTON PPPROVEW ISSUED BY DATE
317121 u� gl3l f7,6
THIS FORM MAY BE SCANNED MD AVAILABLE FOR PUBLIC YEW ON THE MASON COUNTY WEBSTTE Revised 4/14/2025
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 32232-52-08013.
A design will be reviewed when 3 copies 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. v Cross-section sketch,including all applicable items on checklist.
This form may be sunned and available for public view on the Mason County
,,va Web salt Minimum size: Il"X!7"
Permit Number. SWG �f-�,a-elt —ci1.Cc) Designer's Name: Rod Left
Applicant's Name: CLD Group LLC Designer's Phone Number 360-698-8488
Mailing Address: 301 E Wallace Kneeland Blvd STE Designer's Address: PO Box 2954
Shelton Wa 98584 City State Zip SilvertWle We
City State Zip Designees Email info@acmeseptic.com
Treatment Device
❑Glendon O Sand Filter 0 Mound ❑Sand Lined Drainfield O Recirculating Filter 0 ATU X02
u otherTreatment Level(check au that apply):
DA OB OC BLI OBL2 OBL3 OE ❑N
mvi Drainfield Type
C
tY ❑Pressure ❑Trench ❑Bed
F1Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class OS-100 Coils
Daily Flow: Operating Capacity 277.2 gpd Length ft
Daily Flow:Design Flow 360 gpd Diameter.
Septic Tank Capacity(working) 1500 gal Number 3 in
Receiving Soil Type(1-6) 4 Separation ft
Receiving Soil Appl,Rate 0.6 gpd/& Orifices
Required Primary Area 600 ft2 Total Number of Orifices N/A
Designed Primary Area 600 ftr Diameter
in
Designed Reserve Area 600 ft2 Spacing
in
Trench/Bed Width 18 ft Manifold
Trench/Bed Length 33.5 ft Schedule/Class N/A
Elevation Measurements Length ft
Original Drainfield Area Slope 3 a/o Diameter
in
New Slope,If Altered 3 / Preferred manifold configuration used? O Yes ❑No
Depth of Excavation up-slope _(v in Transport Pipe
from Original Grade Do»a elope
in Schedule/Class 40
Designed Vertical Separation 18 in Length 57 ft
Gravel-based Drainfield Req ❑Yes El No Diameter 2 in
Pump Required? I f Yes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 360
Dill in Elevation Between Pump&Uppermost Orifice 9 ft Dose quantity 0.77 al
g
Drainfield Squirt Height/Selected Residual(head) n/a ft Chamber Capacity(flood) 1500 gal
Uppermost Orifice RrHigher O Lower than Pump Shutoff I'1'nP controls:Please check those required.
Capacity @ Total Pressure Head 2.1 gpm Er Timer ❑ B(apse Meter ❑s$vent Counter
Calculated Total Pressure Head 6.87 ft If Timer: Pump on 22 Sec pump off 3min 38 Sec
Comments
1500 Gallon 2-Compartment Treatment Tank & 1500 Gallon 2-Compartment Discharge (pump) Tank.
Revised'1/1afmG
DESIGN FORM—PAGE TWO Assessor's Parcel Number. 32232-52-08013-
PermitNumber: SWG i l
=id
BSIQV CHECKLISTS
Scaled Plot Layout Sketch Cross-Section Sketch
d Test hole linfield orientation and layoutSoil toReference depth from original grade;
PSnch/bed dimensions and E1 Se tan
ptic k
8 Property lical distances within layout B Septic tan cover
❑ Existing aoxNalve box locations
within 100 ft of oReference depth from original grade
pr perty � Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations
surface water and critical areas V Observation port bottom
❑ Curtain drain locationLaterals,tnmch/bed,top and
❑ Location and orientation of V Clean-out location
curtain drain and all absorption collector
Pl Manifold placement 0 Sand augmentation
on
components
Observation
Location and dimension of ❑ Orifice placement Other cross-section detail:
primary system and reserve area ❑ Lateral Placement with distance gObservation ports/clean-outs
of Buildings to edge of bed Other Information
9 Audible/visual alarm referenced Yes No
V DirDirectectiinesion of slope indicator I Scale of drawing shown on scale 0 If Design staked out
bar 0 tRecorded Notices attached
V Roads, easements,driveways, a Elevation benchmark and relative ❑ PY Waiver(s)attached
parldng elevations of system components 0 I f Pump curve attached
V North arrow and scale drawing 0 V Evaluation of failure
shown on scale bar
Nan-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by taller at time of installation 19 Yes 0 No
st orD��� FS h d�F
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:
bji*ioccti f J JL6
Environmental Health%ecialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. �J /�/
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 71 1 Z
✓ 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:4/14/2025
Mason County WA GIS Web Map
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