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HomeMy WebLinkAboutSWG2026-00274 - SWG Application / As-Built - 8/19/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,-967 ,WAE 98400 SHELTON:360-427-9670, XT 400 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: SWG2026-00274 APPLICANT Russell, Eric Phone: 3607893607 Address: 5015 NORTH 26TH STREET TACOMA, WA 98407 Email: ERIC@RUSSELLANDASSOCIATES.NET OWNER RUSSELL ERIC R Phone: 360-789-3607 Address: 5015 N 26TH ST TACOMA, WA 98407 Email: ERIC@RUSSELLANDASSOCIATES.NET SEPTIC DESIGNER Russell, Eric Phone: 360.536.7678 Address: 5015 N 26TH ST TACOMA, WA 98407 Email: erfc@russellandassociates.net Site Address: UNKNOWN Primary Parcel Number: 220247990041 Permit Description: New 4bd gravity trench with Class B waiver Permit Submitted Date: 08/19/2026 Permit Issued Date: 09/25/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $570.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/02/2029 (based on dale 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 ups/ape and downs/ape 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/health/environmental/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY DATERECEIVEO. r , c CA Public Health & Human Services AAtiOUt(TRtCEN 0 RECEIVE°�: ° r (7 o uc.lc Co 4 Environmental Health 360-427-9670,ext.400 or 360-275-4467, _4fi7,ezt,400 S WG O 415 N.6th Street-Shelton,WA 98584 O 0 U 1 z rn ON-SITE SE GE SYSTEM APPLICATION n APPLICANT MAILING ADDRESS-STREET.CITY,STATE,TIP GOOF l31 C F I m 5u 5 a 2� ✓ SITEADDRESS-STREET,CITY,ZIP CODE NAME OF DESIGNERS �+ I PHONE NAME OF INSTALLER PHONE C) PERFAI YPE(select one) DRINK YWATER SOURCE I I RESIDENTIAL OSS ❑ COMMUNITY OSS ❑COMMERCIAL OSS PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL 0 f }. TYPE QyIOFG<(select one) ❑ PUBLIC WATER SYSTEM NEW CONSTRUCTION!UPGRADES ❑ REPAIR!REPLACEMENT OTHER DETAILS(selecta'!fhalapply) ❑ TABLEXREPAIR I SVl3V ALS ❑ SURFACING SEWAGE ❑ EXISTING FAILURE O SHORELINE SIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEOR .VSI LOT SIZE J WASLOTCREATEDAFTE 10A0257 O WAIVERS}(IFAPPLICABLE) , 7-7 A(e_ YES NO I � DIRECTIONS TO SITE AND SITE CONDITIONS;(er.lockedgale) WP +.. L- Qr c-A fir~ Lea`` t p -vW -;) vza �c € o, - v p -1 1-0+- LSL W�tS� �1 V �ti I SITE MUST DE FLAGGED FROM MAIN ROAD AND TEST HOLES ES MUST DE FLAGGED W1TN TEST HOLE NUMBERS. OFFICIAL USE ONLY BELOWTHIS LINE UPGRADE I FAILURE SOURCE(for reporting purpases) VOLUNTARY ❑MAINTENANCE1PUMPING❑ BUILDING PERMIT❑HOME SALE❑COMPLAINT ❑OTHER; INSPECTOR SOIL LOGS COMMENTS!CONDITIONS J ' 3 L X13+ LCkA I . c\ OL1i- k4 SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT V=VERY GGRAVELLY S=SAND L=LOAM Si=SILT C=CLAY 6-EXTREMELY R=RO0TS REQUIRED FOR FINALAPPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE cJcI \ 1 24 __________ THIS FORM MAYBE SCJ.NNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised:01/09/2026 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 6 H 9 R © ii 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 Mason County Web site.Maximum pa per size: I1"X 17" � PARCEL IDENTIFICATION Permit Number: SWG !�7 �� 1 Zp .l Designer's Name: Applicant's Name: ____. 1 Designer's Phone Number: 3 c -7<6Q. 3&0) v4,, Designer's Address: �O i Q N 4 Si'' Mailing Address: ��,� � � '��o �V City Slate Zip City State - Zip Designers Email DESIGN PARAMETERS Treatment Device ❑Glendon ❑Sand Filter ❑Mound ❑Sand Lined Drainfield 0 Recirculating Filter 0 AN ❑Other Treatment Level(check all that apply): ❑A ❑g ❑BL1 ❑BL2 ❑ BL3 E ❑N rainfield Type Gravity 0 Pressure Trench ❑ Bed ❑Sub Surface Drip Septic Tank/Drainfield Specifications Laterals �J Number of Bedrooms / Schedule/Class ,.4I5 r Daily Flow:Operating Capacity ?j O gpd Length ft Daily Flow:Design Flow gpd Diameter in Septic Tank Capacity(working) gal Number 15 Receiving Soil Type(1-6) °t Separation ft Receiving Soil Appl.Rate Q, C� gpolft2 Orifices Required Primary Area "7�7 LF ft' Total Number of Orifices Designed Primary Area X-C.-' L ft2 Diameter in Dcsi ned Reserve Area ?_>�o l ',—L ft2 Spacing isY Trench/ d Width ft Manifold frcnc /Eicd Length fi Schedule/Class 0 Elevation Measurements Length Y�+N C, ft Original Drainfield Area Slope > % Diameter 4 in New Slope,If Altered %. Preferred manifold configuration used? ❑Yes, - o Depth of Excavation Up-slope in Transport Pipe from Original Grade Dorm-slo -A(f7 in Schedule/Class Designed Vertical Separation - itt Length —L_ ft Gravel-based Drainfield Required? ❑Yes�iid/o Diameter ! in Pump Required? O Yc:> -No Dosing and Pump Chamber Purnp/SiphonSpecifications � tt Number of doses/day Diff.in Elevation Between Pump&Uppermost Orifice 1� fl Dose quantity gal Drainfield Squirt Height/Selected Residual(head) fi Chamber Capacity(flood) gal Uppermost Orifice 0 Higher ❑Lower than Pump Shutoff Pump controls:Please check tl sc required. Capacity @ Total Pressure Head �J gpm ❑ Timer ❑ E apse Meter ❑ Event Counter Calculated Total Pressure Head ft If Timer: Pump on______________,Pump off Comments APPROV SEP 2 l 2026 Revised:6/11/2025 MASON COUNTY ENV1RONMENTA HEALTH RET i DESIGN FORM--PAGE TWO Assessor's Parcel Number: 2 2 U Z ` -? '`I r,, 4 / Permit Number: S WG j Q a(p— UD) I y DESIGN CHECKLISTS Sc, lcd Plot Plan Sc e I Layout Sketch Cross-Section Sketch O est hole locations raint�eld orientation and layout Refere depth from original grade: Soil logs Trcncl>/bcd dimensions and Septic tank IJ1Property lines 6 itical distances within layout Drainfield cover Existing and proposed wells -BoxNalve box locations Referee depth from original grade within 100 ft of property optic tank/pump chamber and re, (ictivc 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 l) C/ . an-out location ❑ Curtain drain collector curtain drain and all absorption Manifold placement til/�4❑ Satin augmentation components Orifice placement Other uss-section detail: Location and dimension of 0 Lateral placement with distance Observation ports/clean-outs /primary system and reserve area to edge of bed uildings Other Information O2/scale udible/visual alarm referenced Yes No irection of slope indicator of drawing shown on scale 0 f)esign staked out Waterlines bar ❑ -Recorded Notices attached ands,easements, driveways, O Elevation benchmark and relative —0 Waiver(s)attached parking elevations of system components 0 ' Pump curve attached North arrow and scale drawing 0 , Evaluation of failure shown on scale bar Non-residential justification 0 _Waste strength ❑ w DESIGN APPROVAL The undersigned designer n ust be no `tied y installeral ime of installation Yes 0 No ,. V , Signature of Designer 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 ecialist 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:6/11/2025 � � n CO) C) LT >~ o ';i . o - cZ U ILjF-uj.Y -r+� ti1 � � O °, v tal (A 4J ( \ VI d I._ o � J i.i z d 41 ? t,-tt_�`r�' t N ``\ • I h CI .-- \'1 .__ � 1.1 � �'..�� ,wY.••� L W y1s Q c"r ILI ro z n N 0 n: N z - N .t 1,l F-- Qr pp yj 'I li C k k: 1- til V7 t . 90'51 f`3,8'L,BQOdJ S C -rte - v °' I 0• j I n z 1: I. 1 I ti mU M t� - u tq : i! - 1 IiJ I.} 1- ? J 1•-lil ■ � z II, w • w --I Vj r•.l,l I I N i +,1 Q N � �,( M lV L9 ,... art 0l _�; I I�f In ziw h 1 �N r9'1'ff Al ,Ll,fi(LDO eV I N T ILI 4�coz fit) ' ro Vx'�I4--N(jb{ a a� :q (N1A1nk1 .a.7rrm':18 V o�:tivc!)i I M a z OO= N ty la- r� c9 j I , Its C)Il z WrOx/kcQn }„ 4. ;� � f/j (� (7 +,rri Z7Cj _) tl n_ • C5Ui,l O -- Q -- -- t _, to n• t,l 1Y tJ -- l,l - f 4. n O rY Cl lu O t`•1{ 7 Q F-• V1 _� Vj �n ._ 0 - - wO lt1 .f r. tlI U n. [t �E T o t i r C:t ail tt ? • I:1 I,1 IL . sul I- _I } n' �; � .y �r, InElRlt� 414. 11M�il �d!li3L�iEf1i Ili lUll S h # D2�(o . o o unity Development Atom ACT Lot "A"of Short Subdivisii�, No. 1882 , recorded July 18, 1989, Auditor's File No. 496206, a d ing a portioi of the Northeast quarter of the Northeast quay e-r of Section 24 , Township 20 North, Range 2 West, W.M. TOGETHER WITH and S�3B3ECT TO a perpetual non-exclusive easement, 60 feet in width, for xpad �fjd utility purposes, as shown on survey recorded May 5, i.Q89, ,tfolume 13 of Surveys, page 250. TOGETHER WITH an U�J 'I' TO a utility ea;3emon , 20 feet in width, as shown on S t at No. 1882, recorded July 18, 1987, Auditor' s File No. 49 ereby certify that the land descriptions of this Short ^Sbd vision are full correct descriptions of the land as they a ear on this Short Plat. urther certify that the parties signing as owner or owners, are fact owner or owners . i Regist.ered Land Surveyor L.S . 4 15653 ��W 313 t I. Short at #4 .z Da' , of niky IaevelpQment That portion of the Northa Omer o the Northeast one quarter of Section 24, Tow hip North, Itart 2 West, W.M. , in Mason County, Washington, r es crib d as follows: dBEGINNING at the Northeast crn 'r of said Section 24; Thence S 00 09 ' 39" E along it' s East line, 670. 62 feet; Thence S 89' 22 ' 57" W, 330.95 feet to the Northeast corner of Lot "A" of Short Plat # 1882 as recorded un1er Auditors File No. 496206, records of Mason County, Washington hd th TRUE POINT OF BEGINNING; Thence S 00' 09' 29" E along 4t ' s E'�a a,/line, 167. 53 feet; ' ,ence S 89° 24 ' 12" W, 330.95 feet t ' s-_*est line; Thence N 00 09' 77" W along Said West line, 167 .4 et'to It ' s Northwest corner; Thence N 89 22 ' 57" E along the.Nolh line of said Lot "A" , 330 . 95 feet to the TRUE POINT OF BEGI \G TOGETHER ITN d SUBJECT TO an easement 60 feet. in width for ingress less )drainage and utility purpos,e&: as shown on survey record recordId4Voijjme 13 of Surveys at page 250, records of Mason Count , a }lington . TOG WITH and SUBJECT }iUBJEC TO an easement 20 bet in width for gflftNpurposes as shown on Short Plat 4 3.882, A.F. t 495206, �Cq s 6f Mason County, Washington. N. /E HER WITH and SUBJECT TO easements c..r s,r_r 1 cE::lans, reservations a Gdvenants of record. wrrar.�anrr _r1 C' Shores fie ppp ed z 9 i f a inity Development L 2 That portion of the Northeast o e quarter of the Northeast one quarter of Section 24, Township 20 North, Range 2 West, W.M. , in Mason County, Washington, described as follows: I I BEGINNING at the Nor k st/rorner of said Section 24 ; Thence S 00° 09 ' 39" E along f: s Eaine, 670. 62 feet; Thence S 89° 22 ' 57" W, 330 .95 feet t \ No beast corner of Lot "Ps" of Short Plat # 1882, as recorded r Auditor ' s File No. 496206, records of Mason County, Washi - on Thence S 00"' 09 ' 29" E along it ' s East line, 167 . 53 feett- theRUE POINT OF BEGINNING; Thence continueing S 00 09 ' 2 (EaJhq1Said East line 167 . 53 feet to the Southeast corner of aid ft "A"; Thence S 89" 25 ' 30" W along it' s South line, 3 ��fe../ to it' s Southwest corner; Thence N 00' 09 ' 17" W along t' Wa ine, 167 . 40 feet; Thence 14 f39 24 ' 12" F,, 330.95 feet th tRUE POINT OF BEGINNING. To T E WITH and SUBJECT TO an easement 6(J feet in width for i res _ egress, drainage and utility pose ; OS shown on survey réc9fdedN n Volume 13 of Surveys at page 250, records of Mason y, Washington. �TOp ER WITH and SUBJECT TO an easement 2C feet in width for • Utz ity purposes as shown on Short Plat # 132, A.F. # 495206, r ords of Mason County, Washington. TOGETHER WITH and SUBJECT TO easements restrictions, reservations and covenants of record. K. • DECLARATION OF SHORT�iiVi5JQ ! n f �P ,�5�ro�` KNOW ALL.MEN BY THESE PRESENTS: that we the undersigned having a real interest In tl- tract of land described by this declaration do hereby declare the herein described\ivision of land approved as Short Subdivision Number SS• 7- on the day of ---, by the Planning Department, subject to the SO.IJjW to9ndItions: 1. That the land described by this declará, o.!i iSh y not lac further divided In any manner by anyone within Five (6) years Q1 a avo data of approval without $ final plat having been filed for record witI the it r of Pia"c'n County, pursuant to-the provisions of Chapter 58.19�RCW )i id the regu£allons of the i and Subdivision Ordinance and �C c -to-) naltios L�ttnndarit thereto. Platting yJ �• 2. That all maintenance of an ,, rivata r ad described by this declaration hall be by the owners of the parcels h - gi1 gaI ar ces, thereo their heirs, sslgns, or successors. 3. That the legal description o/f the land horer? sia. 'JivEl? ci i7 to not more than four (4) parcels in attached� rQ /9to and incorporated by roferonce as though fully set out herein. _ V nants restrictions If yin ftr the benefit of, solr3i y 4. That addit(l� f o� a Y Y the grantor, and his e1rs, u cessors, and assigns enforc�iabh3 only by such persons, are att �1hed hetó either as exhibits ..�._. .,_., ...�,__�_. ._�. a or as prevlausiy re' , rded der Auditor's File Number JV �_.�._, and Inc 'r orat©d r rb re co as though'fully set out herein. W the trhdarsi ned hereby waive all clairas fc.r clar against any 4t govepimonlal authority which may be occasioned to the a(l) mew land by the estal1shd constructiun, drainage, and maintenanco of said ro iii or driveway. 6 (We), ',1.Ufa .J , owne,(s) of the real estate described withl , freely consent and It Is my(our) desire to short subdlvklo this property. e)410 not own any adjoining land under the sa-no f4it-.on Cnririt;, Tax Identification Number which is not included In sal S shor 3i. v icjr7, l('Nt,) darstand that if this statement Is Found to be falso, at to tl ownership, the r 1iatter will lie referred to the Prosecuting Attorney for legal action, Oete Ap oved .., Director of Ity Development '! • Reviaed 1188 i ' Li DATE is d o � Grantor Grantor Grantor Grant r- Grantor _ t r STATE OF WASHINGTON) ) SS COUNTY OF MASON ) On this day personally appeared lea •a 79�)�a, fr J j 1!...�.± _�j_J.— ._ to me known to be the Individual described in an who executed the within and foregoing Instruniont, and acknowledged that — signed the same as JUL free antj.yclyntary act and dead;f r the iscs and purposas thinein mentioned. Q1 •QJVEI ttr�der my han n offff }a seal this —..L _ day of �t�,r�c._ .. I ;�. ► '• JOY DOESCI"E• Efi j u n c . Notary public In and for the State of ti ': washington, residing at JU t.iC+ t STATE OF WAS I1�olGT N) COON 0 'M ON ) 7Oihi Yp personally da ersonallappeared before me to me known to be the In Mdua desorlbed In an who executed the within and foregoirig instrurnent, and ac nwladged that — signed tho sameas ._- _ ._ iiiiifraiO.and voluntary act and deed, for the uses and purposes thF eon rrientionud. GIVEN under my hand and official'seal this _�. day of .�..� .. Date. p ved ' ......_...__�_� NOTAf.►' PUBLIC In and for the State of Wastiingtoit residing at Dirac r of ommunity Development 2 Revised 1/88 y SEPTIC SYSTEM DESIGN CLIENT NAME Eric Russell SITE ADDRESS Not Assigned PARCEL NUMBER 220247990041 NORTH / ', Sheet 1 I SCALE 1"= 30' Ft` RUSSELL AND ASSOCIATES •,, �' 4 Sr a 1 7 .Z� 5015 NORTH 26TH STREET - ° -S'3` b Ca \ S-A rVt (,, f,,i TACOMA, WASHINGTON 98407 h . ��.•, s� '� �'� I..��► Gv ti k { 1�' rf4 iy7s3 .kit 360.789.3607 !, v W �� o , , • SEPTIC SYSTEM DESIGNS fra.. Ci�1C I;. RJSS=LL l� C.d �'�t� �WN�J :` A ......1�;�.......iF �oG ( y"� �``�� L > • WETLAND STUDIES • FISH AND WILDLIFE EVALUATIONS ____ c L . ((AO - 3? 23b �fS �+ v }LNc7U�1� ►�}{ ,S SEP 242026 MASON COUNTY ENVIRONMENTAL HEALTH RET rrE i Cam. O } 1 V 23 fP • 1 f11 S"'fG CARSON INDUSTRIES BRAND ENCLOSURE SEPTIC SYSTEM GENERAL DESIGN NOTES: GRAVITY SYSTEM SPECIFICATIONS: MONITQRINGlCLEANQUT PORT 1. CONSTRUCTION AND MATERIALS SHALL CONFORM TO THE LATEST LATERALS SHALL BE COUNTY APPROV[D, VC PIPE. LEXAMPLEI REGULATIONS AND REQUIREMENTS OF THE COUNTY HEALTH DIAMETER 4.0 INCHES: LENGTH (>1 FEET 8" PVC DEPARTMENT AND W.S.D.O.H. THIS SYSTEM REQUIRES PERIODIC MAINTENANCE. THE CERTIFICATION OF THE DESIGN AND INSTALLATION 1. LATERAL SPACING 'S FEET ON CENTER. INSTALL MONITORING PORTS DOES NOT INSURE CONTINUOUS TROUBLE FREE OPERATION. ON EACH LATERAL PER TYPICAL,AND VENT USING CARSON ENCLOSURE. EACKPILL 2. THIS IS NOT A SURVEY. TOPOGRAPHY, BENCHMARKS AND ELEVATIONS 2. , {IF CHECKED)A DISTRIBUTION BOX WITH 17 OUTLETS REQUIRED. MATERIAL ARE BASED ON ASSUMED DATUM, FIELD OBSERVATIONS,OWNER INSERT SPEED LEVELS AT EACH OUTLET FOR ADJUSTMI_NT. A 24" STATEMENTS,AND PUBLIC RECORD. IF BOUNDARY CONTROL IS NOT DIAMETER RISER AND LOCKING LID AT GRADE ARE REQUIRED. AVAILABLE AND CLEAR,A SURVEY SHOULD BE OBTAINED PRIOR TO �/ COMMENCING INSTALLATION. PLEASE CONTACT A PROFESSIONAL LAND 3• ❑ (IF CHECKED)STEP-DOWNS MUST BE CONSTRUCTED PER COUNTY AND ,`,�j SURVEYOR TO HAVE THIS SERVICE PERFORMED. STATE CODE REQUIREMENTS. /-.'_.- �Il � � ivly 3. NO EXCAVATION OR ALTERATIONS AFFECTING DRAINFIELD AREAS ARE 4. AS-BUILT INSPECTION: ORA(N ROCK:B MfN. PERMITTED. ANY ENCROACHMENTS INTO DRAINFIELD AREAS MAY A FEE WILL BE CHARGED TO THE OWNER FOR THIS SERVICE. THE BELOW PIPE RENDER THE SITE UNUSABLE. RE-DESIGNS REQUIRED DUE TOT , INSTALLER MUST FAX THE AS-BUILT REQUEST FORM TC THE DESIGNER ENCROACHMENTS WILL BE AT OWNERS EXPENSE. (FAX 253.584.1517)TO REQUEST INSPECTION. 4. THE SEPTIC TANK IS TO BE A WATERTIGHT,TWO-COMPARTMENT WITH I'��� T PVC WITHSO DRAIN HOLES: MINIMUM1250 GAL CAPACITY. 24"DIAMETER RISERS WITH COMPATIBLE .rte !� EXTEND TO ITOROM N0OF GRAVEL ELEVATIONS; f UNDISTURBED SOIL TO MONITOR PONOING LOCKING LIDS ARE TO BE INSTALLED OVER MANHOLES. 8'RISERS WITH SCREW CAPS ARE REQUIRED OVER INLET AND OUTLET PORTS. ALL BENCHMARK IS + `` RISERS ARE TO BE AT FINISHED GRADE,WATERPROOF AND CHILD! '''I tiT _ INFILTRATIVE SURFACE BENCHMARK ELEV. '2 ?a1 U �,. TAMPER RESISTANT. INSTALL ZABEL TYPE BAFFLE EFFLUENT FILTER AT SEPTIC TANK OUTLET. ALL TANK PENETRATIONS SHALL BE MADE PLUMBING TANK INLET UT 55 s.us•o 0 WATERTIGHT. SEPTIC INLET 2 __ (159 rrm, SEPTIC TANK OUTLET f: DISTRIBUTION BOX '"L.--,' ., • �sr 0 5. SEPTIC TANKS AND SEWER LINES UNDER DRIVING SURFACES MUST BE DRAINFIELD INVERT 2- t Ca r' SW Fn`«,`I F" f,5s CRUSH-PROOF AND MEET D.O.T. LOADING SPECIFICATIONS. Typical Over flow Stepdown 6. THE DRAINFIELD TRENCHES SHALL BE A MINIMUM OF FIVE FEET FROM SECURED LID WITH GAS TIGHTSEAL , W � `+^�-._ -` r � ,.Era• PROPERTY AND EASEMENT LINES,TEN FEET FROM WATER LINES AND x4d DIAMETER 1 T xTi. I_z„m, BUILDING FOUNDATIONS, 100 FEET FROM WELLS. ACCESS RISER L FINISH GRADE Amy i I 9 vre i1am on/ J 7. WATER LINES MUST BE A MINIMUM OF TEN FEET FROM SEPTIC 1230 mm1 (116 mm! COMPONENTS. WATER LINES CROSSING SEWER TRANSPORT LINES MUST CROSS AT A MINIMUM OF 18 INCHES ABOVE SEWER LINES AND BOTH PIPES MUST BE SLEEVED TEN FEET EITHER SIDE OF CROSSING. 8. THE INSTALLER SHALL CONTACT THE DESIGNER UPON COMPLETION OFIr MONITORING PORT ENCLOSURE: CARSON INDUSTRIES L 708, OR EQUAL SYSTEM FOR FINAL AS-BUILT INSPECTION(SEE DETAILED INFORMATION FROM SEWAGE WITH 6"PVC TO BOTTOM OF ROCK REGARDING AS-BUILT REQUEST). A FEE WILL BE CHARGED TO THE SOURCE FLOATING MAT [j E OWNER FOR THIS SERVICE,CALL THE DESIGNER TO DETERMINE THE APPROVED ...j AMOUNT. EFFLUENT :Irz z,rz FILTER (G rrm.FA mm> 9. THIS SYSTEM IS NOT DESIGNED FOR USE OF A GARBAGE DISPOSAL. THE ti.afea,• , USE OF SUCH A DEVICE COULD RESULT IN SYSTEM FAILURE. SEDIMENTS ._� -va•lo —�z (19a n�m1 10. NO CHANGES OR ALTERATIONS ARE TO BE MADE TO THIS PLAN WITHOUT THE PERMISSION OF THE DESIGNER. ANY DISCREPANCIES FOUND ON THIS DESIGN MUST BE REPORTED TO THE DESIGNER PRIOR TO Erj . ` SEPTIC SYSTEM DESIGN COMMENCING ANY WORK. SEPTIC TANK [TYPICAL CLIENT NAME Eric Russell 11. THIS SYSTEM IS DESIGNED FOR A _ BEDROOM SINGLE FAMILY ••'}I r SITE ADDRESS Not Assigned RESIDENCE WITH NORMAL RESIDENTIAL WASTE STRENGTH PARCEL NUMBER 220247990041 CHARACTERISTICS. THE MAXIMUM WATER USE SHALL NOT EXCEED DRAINFIELD TRENCH DETAIL NORTH �� [-bO SOIL COVER R L QUIRED MINIMUM "MINERAL \ it 1!r` S,• GAU DAY. THE DESIGN CALCULATED SOIL LOAD RATE IS d� ' � ,(! +.I. TRENCHES EXCEEDING 36" DEPTH REQUIRE VENTS I i GAUFT2IDAY. REQUIRED ABSORPTION AREA i5 -ate SQ. FT.(MIN.). : Sheet 2 SCALE 1" - 30' � �\ QR1QfNALGICA➢E `!�"_I Iii - \�\~�` \\ rvcsEwt�e oIcArNIs '... cRl.l R. RUSSELL { 12. INSTALL �' LF 4.0 INCH PERFORATED PVC PIPE. r I r �� ��, \ \\. \, '�t(_�_,t;irE�. 5s=�.'[}t�i�ni�:;r"' ( RUSSELL AND ASSOCIATES LATERALS MUST BE LEVEL. SEE TRENCH DETAIL FOR TRENCH DEPTH. I �� ' ��� �i50TEXTILEFAaIUc r'����C_�` ` 5015 NORTH 26TH STREET 13. LOT SIZE IS ) t +!-SQUARE FEET. NL I �\ \~ F XI IF S r7f02Y27 �r f1.'5, z' Co o'•po�� 3/4 ro z uz- TACOMA, WASHINGTON 98407 II I+ �� dQ`3'$ rvnsHt�rnwracOf 360.789.3607 cgs 'g��c�{, OrZINAL LAW15TU7 B p APPROVED • SEPTIC SYSTEM DESIGNS SOIL • WETLAND STUDIES li ;I�II �ll�lll� I1 �� SEP 2 4 2026 • FISH AND WILDLIFE EVALUATIONS MASON COUNTY ENVIRONMENTAL HEALTH RET 415 N.6"'STREET,SHELTON WA 98584 MASON O U N TV 5EELFAIR:.36Q 275 4467,exit 400 400 Public Health & Human Services A plication for Waiver or Appeal Amount Paid: C) Receipt Number: '�OjQ ( S WAI 10 - DWI 7 Please note,all approved Onsite Waivers have the same expiration date as their OSS Permits. Instructions: 1. Complete Parts I and 2. No determination can be made until these parts are fully completed. 2. Fees maybe billed for waivers and appeals, based on the Environmental Health Fee Schedule. 3. Submit completed application with attachments to Mason County Public Health for review. PART 1. Applicant & Parcel Information Name of Applicants Telephone •�` '���� Mailing Address C'J .. Sit City _A �_►✓�q State WA Zip Parcel No. `Z' 4 -- 7 — q O Site Address i`.'1�7 -A I/cot Lt Subdivision Name and Lot __ _ > a 27 --r PART 2: Nature of Waiver/Appeal ❑ Onsite: Class A Waiver ❑ Food Sanitation Requirements CI Onsite: Class B Waiver ❑ Group B Water System Regulations ❑ Onsite: Class C Waiver ❑ Water Adequacy Requirements ❑ Onsite: Location,WAC246-272A-0210 ❑ Building Permit: EH Review Policies ❑ Onsite: Holding Tank,WAC246-272A- 0 Appeal:Enforcement Timciines 0240 0 Appeal:Departmental Determinations ❑ Onsite: Contractor Certification O Other Requirements Description of Waiver/Appeal(include justification, additional material may be attached.): Reduce Vertical Separation for Conventional Gravity or Pressure OSS Class B Waiver Checklist Recorded Declaration of Attenuation Zone Applicant Signature: Date: () , 2—L, Revised 03/03!2026 This form may be scanned and available for public view on the Mason County Web site. Page 1 of2 PART 3: Public Health Evaluation (Staff Use Only) 1. Type of Determination Required: Type of Onsite Waiver(if applicable) ❑Appeal El Waiver ❑ Class A E1 Class B ❑Class C ❑ Local State Waiver Criteria Number of Bedrooms: —t�TI, t'1_ `�, y(� Nitrogen Treatment: ❑Yes %' No_ Soil Type. 4 Minimum Lot Size: -t- ' Water Source:❑Public Private This Lot Size: J 2.1 sq t- amt Is This Lot Eligible for State Waivers: A]Yes ❑ No ❑ N/A Hearing Official: 0 Environmental Health Manager ❑ Public Health Director ❑ Other: 2. Identification of Specific Code/ Standard/ Determination (include date of determination or latest Code/Standard revision): WAG24fr272A-0230,Table V1 3. Nature of Appeal: Reduce Vertical Separation Requirements for Conventional Gravity or Pressure OSS 5. Mitigating Factors: Class B Waiver Checklist (Meets additional requirements outlined within) Recorded Declaration Covenant for OSS Attenuation Zone (AFN ) 6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and local policy has be n submitted. Staff Signature: Date: 13! 2(7 PAF�T 4: Determination of the Hearing Official 1T he hearing official has determined that approval of this request will not adversely affect public health and is hereby granted. This decision is based on the following findings and conditions: ❑The hearing official has determined that approval of this request could potentially adversely effect public health and is hereby denied. This decision is based on the following findings and conditions: Health Official Signature: G' �' `:��G� � :��a Co Date: ✓� Revised 03/03/2026 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2 MASON COUNTY RVICES MASON COUNTY PUBLIC HEALTH �f � COMMUNITY SE CLASS B WAIVER WORKSHEET 415 N.6TH STPFET,BtOG 8,SHELTON WA 08584 (State and Local waiver forms required) SHELTON:360-427.9670,EXT.400 B£LFAIR:360.2754467,EXT.400 APPLICANT NAME {— t"' ` 9 6� WAVERPER'ATnussBER WAI MAILINGAbORE55 ." '.__) hJ s `•-'- Y� CITY tkcrD N""✓Y''S� �1 � ...STATE �t2192 4 o') SITEAO0RESS i,�+'— F� /-� Ate.} 4(�yy` CITY P( �' TAX PARCEL NUY8ER L'��' 1 yl + CZ 'J • 070PO5EOD.SA6iFIELDTYPE CONVENTfONALGRAVrn' ❑ CO.NEY71OYAL PRESSURE 1.SOIL SERIES: 5.VERTICAL SEPARATION: The soil series must be Alder>,vood,Harstlne,Hoodsport, Up-slope vertical separation must be greater than 18" Shelton,or Sinclair Gravelly Sandy Loam. for gravity and greater than 12"for pressure. ly ndy Hoods port trlao Loam..........................._.. PJ � GDeterminedby: .,,.,..,..,.,..........,................,.,.,.. ......... ❑ Alderwood Gravelly Sandy Loam................................ Greater than 12........ .................,.........,......,reater than P Gravelly Sandy Shelton Gravelly Sandy Loam.......................................❑ ❑ Depth to hardpan...................,.....,.,........,........................ ❑ ❑ Sinclair Gravelly Sandy Loam.....................................❑ ❑ Depth to mottling..........................,........,...................... ❑/ ❑ Other :..........❑ ❑ Both................................... (Lk' 2.SOIL TYPE: 6.WATER TABLE LEVEL: Soil types must be Medium Sand,Loamy Sand,or Sandy If test holes show evidence of a seasonal water table Loam.Gravel percent must be less than or equal to 35%. above restrictive layer,a curtain drain may be requiredp / Medium Sand.................._........._ ........_..._..._............. ❑ .❑ -Evidence of seasonal water table: LoamySand.................................................................. ❑ ❑ �_ Yes...,..,..........,...,..,.,................,..........,...... ...................,,.. ro c, yNo................................................ ....................... ❑ ❑Sand Loam ....................... �- Percent Gravel: b -Curtain Drain q d YeLess than or equal to 35%...................................... LLd q Nos...,........." ..................,.,.,...,....................................,. ❑required:; Greater than 35,6................................._............._......❑ ❑ 3 ...... ................ UI lid' .,..,. 3.SOIL DRAINAGE: 7, HORIZONTAL SETBACKS: 5 Primary Drainfield must maintain 200'from down-gradi- rb Soils must be moderately well drained to well drained. OO eat marine shorelines,surface waters,and wells. 9 increased Well Drained...................................................................... ❑ ❑� .... . .. . ..... . Moderately Well Drained...............,.......,.. ................ �" -Are increased horizontal setbacks met: OtherYes........ ... .. .. ...... .............. .. .. .................. No...................................................................................... ❑ ❑ 4.DRAINFIELD SLOPE: 8.ATTENUATION ZONE Slopes must be between 3%to 309%. Gravity is only allowed on slopes from 3%to 15%. A 50 foot horizontal attenuation zone is required Pressure is allowed on 3%to 30%. down-gradient of the primarydrainfield. Less than 395...................................................................... ❑ ❑ -Is there 50 ft or greater between the down 3%to 15%..............................................._.. ..,.............. ( ' I ' gradient side of primary drainfield and 16%to 30%............................_.,.,..._............._.................. ❑ ❑ property boundary: Greaterthan 3096................................ ._. .................... ❑ ❑ Yes....,.............................................,,.............................,. .. No....................................................................................... ❑ ❑ The 50 foot horizontal attenuation zone is required to be recorded on the deed of the property as unbuiidable prior to design approval.The attenuation zone Is not to be used for the contructfon of roads,decks,patios, AFN: v(/� parking areas,vehicular traffic,or other similar such uses.The owner must agree to all these conditions. Proof of ewcmd''.9 18,5 FORM E'AY BE SCANSEO ANO AVAs1APLE FOR Pu 3L1e ViEWQY THE MASON COUNTY WEBSITE updated 312/1017 On-Site Sewage Systems (Chapter 246-272A WAC) w , st..o Request for Waiver from State Regulations $F H E A LT H Section 1. I (Completed by applicant) Name:(1) Local Health Jurisdiction Received (2) sseL+v (See instructions) Address:— Mason County l-AG0M-4 WA °064_D7 Telephone: Signature: ]i Property Identification:(3) � F' � � �9" ot:) 1 Section II. (Completed by applicant) WAC Number: (4) WAC Requirement: (5) Waiver Sought: (6) 246-272A- 0230 24"of V/S for Pressure (or) 12" of V/S for Pressure ass (or) Subsection: Table VI 36"of V/S for Gravity 18" of V/S for Gravity OSS Justification (Proposed mitigation measures):(7) ceC_�c . I G7 Completed Class B Waiver Checklist Attached,(Outlining Additional Requirements Met). Recorded Declaration of Covenant for ATTN. Zone (AFN: Section III. (Completed by local health officer) Review Criteria: (8) Additional Mitigation Measures:(9) Comments/Conditions: (10) See Class B-�/a1VEr WOiheef Type of Waiver: (11)LII Class A ✓fj Class B llJClass C— Request DOH review before granting? Yes❑ No ✓ Neighbor Notification: (12) Required?Yes jNo if needed, are agreements,easements, etc.filed? Yes NoEl Section IV. I (Completed by health officer) This Request for Waiver from State Regulations has been reviewed according to the provisions of Chapter 246-272A WAC On-Site Sewage Systems.The review criteria applied,and the mitigation measures proposed and/or required, have been evaluated for their ability to provide public health protection at least equal to that provided by this chapter WAC. Denied Approve�d/Gr ttedd—Subject to all lccornn ents,conditions and requirements noted in Sections II and III. Local Health Officer(13) l/�G.yGfi�+' G--���G_ ':v Date: /�•`___ DOH 337-175 February 2024 TAb A , 4Le1 _ k " ifl » » I4. a g » m » ^" 3 a 44 e , rw � rk 0 RA C 3 2246095 MASON CO WA ECL FtlU5SELL, ERIC #226377 Rec Fee $304 50 Pages 2 I4II11IIIIII III 11111111411IIIIII1111III III]III IIIIIII I114141111IIII Return To t2 x--- f,] �ASS iY - 4 v4 Grantor(s): (1) P-A C_ l`_ __ l L , (2) Grantee(s): (1) PUBLIC Legal Description (1) T -WJV iL O k' - 24 (t,, 7 (Abb ia�e fit :i.e. lot, block, plat or section, township, range) Assessor's Tax Parcel: 1; � "�- _ '? 9 O D 4 DECLARATION O V NANT FOR ON-SITE SEWAGE ATTENUATION ZONE I (We)the grant (s) her6i , am (are)the owners in fee simple of(an interest in) the described re o e sit ed in Mason County, State of Washington; hereby declare this covenant pl the-sae on record; to wit th ribed real estate on which the grantor(s) owns and operates 9 ( ) an on-site sewage dis aSaI s s e which has been granted a Class B State Waiver to reduce the Minimum V leaepar(ion requirements and grantor(s) is (are) required to maintain a 50-foot hors onntaI attenuation zone down gradient of the on-site sewage system to facilitate a eht of the sewage effluent. t is t purpose of these grants and covenants to prevent certain practices hereinafter e umerated in the use of the grantor(s) land which might encumber the land set aside for rther sewage treatment and disposal. i7 NOW, THEREFORE, the grantor(s) agree(s) and covenant(s)that said grantors), his (her) (their) heirs, successors and assigns will not construct or install any trench, channel, ditch, road cut, utility chase, or other structure of excavation what would intercept or serve as a conduit for migrating ground water. Dated on this j day of 202-c . Page 1 of 2 Sig re of Gran d�(s): (2) State of Washington ) County of Mason ) I, the undersigned, a Notary Public in and for th tZave med County and State, do hereby certify that on this 1'M day of ;~2p I RJ\rgIj p sonally ppeared before me, who is known to be signer of the above instrument, and ackno edge4hat he (she) (they) signed it, GIVEN under my hand and official seal the day and year last above written. Lft S1ANotaryPoblk • YR' bu Stateof Wabia1h■ Nota Public in and f r the ate of Washington, EK MARIA C CAMILON-PE ir72a7 �, N // residiIig at O1-`(?!A , VVA( r'4 t N Marc Sh O,20 My commission expires: 14RI41 It), 4Q '1 0 Page 2 of 2 2246095 Page 2 of 2 09/23/2026 10:53:54 AM Mason County, WA