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HomeMy WebLinkAboutSWG2026-00241 - SWG Application / Design - 9/1/2026 ® MASON COUNTY 415"6 SHELTON , 0427-9 70 EXT400 SHELFAIR 360-22]-96]0,EXT 400 BELFAIR'360-2]5-446],EXT 400 Public Health & Human Services ELMA:360492-5269,EXT 400 FAX'.360427-7797 On-Site Sewage System Permit: SWG2026-00241 APPLICANT FREEDOM LANE LLC Phone: 1.253.230.5202 Address: 2226 EASTLAKE AVE, SUITE 310 SEATTLE, WA 98102 OWNER FREEDOM LANE LLC Phone: 1.253.230.5202 Address: 2226 EASTLAKE AVE, SUITE 310 SEATTLE,WA 98102 SEPTIC DESIGNER TONY GODAT Phone: Address: 2708 WESTMOOR COURT OLYMPIA,WA 98502 Site Address: UNKNOWN Primary Parcel Number: 319075000320 Permit Description: Upgrade from Bbd to 9bd pressure sandlined trench Permit Submitted Date: 08/03/2026 Permit Issued Date: 09/0112026 Issued By'. Rhonda Thompson Current Permit Fees Paid: $845.00 (additional fees may be required woo installation of system) Permit Expiration Date: 08/20/2029 based on date or 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 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.govlhealthlenvironmentallonsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY j4MASON COUNTY DATL°"`"`° c 0 Public Health & Human Services 0n..REEEIVE Iq o m Envlronmen2l Health 360-42]5670,en.400 or 360-275-M67,en.40D �r�)(\ y (00 0 IMINM 415 N. eet-Shelton,WA 98584 — ✓ v I SWG I Z Co ON-SITE SEWAGE SYSTEM APPLICATION 3 A m APPLICANTMadrona Park HOA P(2HONE53) 905-9858 Ii z MAILING A]DRESS-STREET,CITY STATE.ZIP CODE rL 2226 Eastlake Ave E #310, Seattle, WA 98102 o z SITEADDRESS-STREET CITY ZIP CODE C:..: _" 31 W Freedom Ln., Shelton, WA 98584 I� NAME OF DESIGNER PHONE Q (- Tony Godat (360) 870-7052 NAME OF INSTALLER PHONE CT C- � a_ TBD oERMIT TYPE(seleIX one) DRINKING WAIEH SOURCE S ❑ RESIDENTIAL 055 COMMUNITY 055 ❑COMMERCIAL OSS ❑ PRIVATE INDIVI DUAL WELL ❑ PRIVATE TWO-PARTY WELL 'j I 1 TYPE OF WORK UP111 al ❑ PUBLIC WATER SYSTEM PUD I I KNEW CONSTRUCTION LPGRAOES ❑ REPAIR/REPLACEMENT OTHER DETAILS(seI t1A that applyl ❑ TABLE I REPAIR Ir 11 -Al5 ❑ SURFACING SEWAGE 0 EXISTING FAILURE O SHORELINE SUBMI V 1 DESIGN FORM(REOUIREDI N SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I WAS LOT CREA,EDAFrER 4)1)20159 o In ❑ WAIVER{S}OF APPUGAB_E) 1-9 total 4IotsI3 YES NG ) 0 9I REGIONS TO SITE AND SCE CONDITIONS:(e IxkeegatE) HWY 101 to Taylor Town to Kamilche Ln. to W Freedom Ln. ID o I C,v SITE MUSITIEFIAGGEO FROM MAIN ROAD AND TEST HOES MOSTBE FLAGGED W TH TEST HOLE NUMBERS. 1° OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE SOURCE(tor rewrng poryoseg o VOLUNTARY ❑MAINTENANCEIPUMPING❑ BUILDING PERMIT Q HOME SALE❑COMPLAINT ❑OTHER'. INSPECTOR SOIL LOGS COMMENTS/CONDITIONS no sl' Kk 5 - RECORD ORAVMNG AND INSTALLATION REPORT SOIL ERY G S v-vERr =GRAVELLY s=samo Lao.AN E=SILT c=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINALAFPRowL INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED)ISSUED BY DATE THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:6132025 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 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. "Cross-section sketch,including all applicable items on checklist. This form may be scanned and available for public view on the Masan County Web arm Maximum papersize: II"X 17" PARCEL IDENTIFICATION Permit Number: SWG a-C7--(a -C)C) 1 signer's Name: 7øy ,Cjcpjrr Applicant°s Ngroe: Fon LFa/EL1L.- 'Designer's Phone Number 3( 870 7oSZ Mailing Address: flZ ' A✓t AGsorIE5I0 Designer's Address: •O- SO)' e, __— Wk 98/UL City State Zip L/]4'6i0C�'r WP • 9 (� City State Zip Desigoefs Email &OOfr1 /, . DESIGN PARAMETERS J Treatment Device r'� r, n / i. e ❑Glendon 0 Sand Filter 0 Mmmd yO Send Lined Dminfield ❑Recirculating Filter ❑AT kV k V " !`+_ ófheF�' Treatment Level(check all t at apply): ❑A ❑B ❑C ❑BLI ❑BL2 ❑BL3 ❑E ❑*-g Winfield Type ❑Gravity Pressure �Treoch 0 Bed ' . O.sib Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms i - 9Tc7f�iL. Schedule/Class Daily Flow:Operating Capacity ê'IQ gpd Length 2 ft Daily Flow:Design Flow loe6 gpd Diameter '1*" in Septic Tank Capacity(working) 3 X \\GO gal Number Lj Receiving Soil Type(1-6) j,- Separation 9.0' ft Receiving Soil Appl.Rate I. gpd/fl Orifices Required Primary Area /Of 7 ft" otal Number of Orifices (pj , Designed Primary Area /OHO ft Diameter 3�/(.> in Designed Reserve Area ft2 Spacing P I% m TrenchBed Width 3.0' ft Manifold ��--``�� rt Trench/Bed Length ft Schedule/Class - x •4O Elevation Measurements Length 36 ft Original Drainfield.Area SI Q % Diameter Z in New Slope,If Altered % Preferred manifold configuration used? Yes ❑No Depth of Excavation Upsbpe h1/4/1J- in Transport Pipe from Original Grade D %wo- N �,(.+ C7 MP� in SchedWe/Ckus �- Designed Vertical Separation ( rlj7 in Length /10 ft Gravel-based Drainfield Required? %Yes 0 N Diameter Zrr in Pump Required? 1Yes ❑No - Dosing and Pump Chamber Pump/Siphon Specifications ( Number ofdoses/day 6 Diff.in Elevation Betwt/S emp&Uppeal(head) Orifice /_ ft Chae ber gal Drahtfield Squirt Height/Selected Residual(head) ___ ft Chamber Capacity(flopd) 2100 1 gal Uppermost Orificedliigher 0 Lower than Pump Shutoff Pump controls:Please check those required. ± Capacity @ Total Pressure Head 79 gpm sErTim er iB Elapse Meter v21 Event Counter Calculated Total Pressure Head 37_12_ R If Timer: Pump on2nN15 ,Pump off Commcnta f u 15 7D AD© (L WVOP1 ON Tt hN UrD4 S Rcbr n '9y5 t! Tf1,47 WiK 1/JS7L+/1EE ) 1 N t5 . Revised:6/11/2025 DES'GN FORM-PAGE TWO Assessor's Panel Numbr..:,j1 . / Permit Number. SWG )-CL,- Oo,2y I .y DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch ttl Test hole locations tZ Drainfield orientation and layout Reference depth from original grade: Soil logs Trench/bed dimensions and 10 Septic tank 0 Property lines critical distances within-layout �' D,ainfield cover Existing and proposed wells r6l 1)-Box/Valve box locations Reference depth from original grade within 100 ft of property fa Septic tank/pump chamber and restrictive strata: WJ Measurements to cuts;banks,and locations Laterals,trench bed,top and surface water and critical areas Observation port locatoot bottom Location and orientation of %W Clean-out location ,❑l Curtain drain collector curtain drain and all absorption .i Manifold placement sla Sand augmentation components Orifice placement Other�cross-section detail: 1Y' Location and dimension of l� Lateral placement with distance V"' Observation ports/clean-outs primary system and reserve area to edge of bed Other Information t� Buildings Audible/visual alarm referenced Yes No Direction of slope indicator Waterlines 121 Scale of drawing shown on scale O Design staked out 42 bar O O Recorded Notices attached t� Roads,casements,driveways, V(Elevation benchmark and relative O O Waiver(s)attached parking elevations of system components d ❑ Pump curve attached North arrow and scale drawing ❑ O Evaluation of failure shown on scale bar Non-residential justification O 0 Waste strength ❑ ❑Flow IL_DESIGN APPROVAL The undersigned designer must ben fi y installer at time of installation)21'S(es ❑ No S222vZC� Signatur o esigner 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 S ialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health 2(4 ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: U ✓ 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. 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