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HomeMy WebLinkAboutSWG2026-00266/ASBUILT - SWG Application / Design - 9/2/2026 415 N 6TH BE STREET,SHELTON.WA 98584 SLFAIR:360-2154487,EXT 400 MASON COUNTY ELMA:360382-5269,EXT 400 Public Health &Human Services FAx5269, 27-7787 On-Site Sewage System Permit: SWG2026-00266 sS P.O. x Septic 9 en Phone: 3606988488 Address: P.O. Box 2954 Silverdale,WA 893 OWNER ELLIS MARTIN C&KIMBERLEY A Phone: 21 E DABOB PLACE SHELTON,WA 98584 Address: Phone: 366698-8488 SEPTIC DESIGNER ROD LEFT' Address: PO BOX 2954 SILVERDALE,WA 98383 21 E Dabob PI Site Address: 220075100043 Primary Parcel Number: Repair: Replace the SFR's existing Intermittent Sand Filter(SWG94- 00666)with a new 2-bedroom intermittent sand filter within the same Permit Description: footprint, replace the existing 300-gal pump tank with a new 1000-gal pump tank,and install a new control panel. 0811812026 Permit Submitted Date: 0910212026 Permit Issued Date: David Anderson Issued BY $845.00 (addmonal roes may be required upon inslaauoa of system). Current Permit Fees Paid: (based on sate m ^waalo^1 Permit Expiration Date. 09/0212027 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 from Mason County must vin installed by Mason s n County Certified Installer unless prior written er 4 Drain held installation not to exceed designed upslope and downslope depth specified on design form. 5 Installer is responsible for obtaining Mason County installation approval pdor to backfill o f system components. prior to 6 Installer is responsible for obtaining Septic Designer/En gineerinstallation approval P backfill of system components. and Installation fee must be submitted for 7 Mason County Asbuilt Form, Record Drawing, 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, or call: For Final Inspection visit: masoncountywa.govlhealthlenvironmentallonsiteloss-inspection-request.php 360-427-9670, extension 400. OFFICIAL USE ONLY FM�RMIVEM /�� MASON COUNTY RECMD.. REOUVFDIM. m Public Health & Human Services ${5 o till z mrmmental Health 360421-9610eR.400or 360215-461,e#400415N.6M5treel-Shelton,WA" G QOS84 cY'p l0 ' Z N ON-SITE SEWAGE SYSTEM APPLICATION 3 'z m n PHONE MPLICPNT Kimberley & Martin Ellis MAILING ADDRESS STREEL CIWY STATE,ZIP CODE 21 E Dabob PL Shelton WA 98584 m SITEA°DRESS-STREET,CRY,ZIP CODE R 0 Shelton WA 98584 ^' 21 E Dabob PL LJ NPME OF DESIGNER Lf Q PHONE 8-8488 I ro ROD LEFT o _ PHONE NPME OF INSTALLER � ] y O PERMIT TYPE(8 am) � DRINKING WATER SOURCE ®RESIDENTIAL OSS COMMUNITY ass COMMERCIAL DES ®PUBLIC INDIVIDUAL UAL WELLEM 1Pe PRIVATE CoMm TWO-PARTY WnI -PART WELL I I v Ab INC TYPEOFW°RN(NSTRUC DETAILS I Ul EE NEW CONSTRUCTIONIUPGRPDES ®REPAIR IREPLACEMENT °SURFACING SEWAGEN� EXISTIINNG FAILURE 0sHOREIINE SUSMI DESIGN 66 O I - [@DESIGNFORM(REOUIRED) 16SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE WAS LOT CREATEDAFTER 4tlltSR51 x IO 5)WAIVER(S)(IF APPLICABLE) 2 ().44 ❑ YES Q NO DIRECTIONS TO SITEAND SITE CONDITIONS:(en Axbdgl) I Q Io SITEMIASTBE FLAGGED FROM AWN ROAD AND LEST HOLES MUST SEFLAGGED WITH TEST HOLE NUMBERS I I W OFFICIAL USE ONLY BELOW THIS LINE VPGRFDE/FNLVRE SOURCE(tot npxllnp WTmb) E3 VOLUNTARY ❑MAINTENANCEIPUMPING ❑BUILDING PERMIT []HOME SALE OC0MPIAINT O0THER: COMMENTS CONDITIONS INSPECTOR SOIL LOGS 5w fy-f66 RECORD DEWING MID INSTALLATION REPORT SOIL CODES: REQUIRED FOR FINALAPPROVPL. V=VERY O=GRAVELLY S=SAND L=LOAM AT C=CUY E=E%TPFMELY R=ROOTS AP IONAPPROVEOI ISSUED BY DATE INSPECTOR SIGNATURE DATE APPLICATION UPIMTIOONN DATE Y(� o? � ZZL THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSRE Revised:4/14/2025 bl 04 C�y DESIGN FORM—PAGE ONE Assessor's Parcel Number: S OQ 7 -- 51 -- applicable items on checklist. A design will be reviewed when 3 conies of each of the following are submitte Scaled layout sketch,including all app th Completed design form that has been signed and dated. Cross-section sketch,including all app a Scaled plot plan,including all applicable items on rheckiist. J This form may be scanned and ava8abis for public view on the Mason County Web sMa.Marimam paper size: I/"XI _ - Designer's Name: Rod Lett PermSWG U 360-696-6488 Applicants Name: Designer's Phone Number: PG Box 2954 Kimberley&Martin Ellis Designer's Address: Appling Address: 21 E Dabob PI Silverdale wA 983e3 Mailing Address: Shelton WA 98584 City State Zip City State Zip Designers Email info@acmeseptic.com Treatment Device U Other ❑Glendon M Send Filler ❑Moans ❑Sand Lined C ❑ 1 eis OR� g L2 O BL3 g Filter A E 0 N Treatment Level(check an that apply): ❑A O B `It Drainlield Type Bed 0 Sub Surface Drip Pressure ❑Trench ❑Gravity Pressure Septic Tank/Drainfeld specifications specifications Schedule/Class 30 ft Number of Bedrooms d Length 0 Daily Flow:Operating Capacity t� gP 24 gPd Diameter Daily Flow:Design Flow 4 � ft Septic Tank Capacity(working) 1000 gal g al Number Summation Receiving Soil Type(1-6) �d1fta Orifices Receiving Soil Appl.Rate a Total Number of Orifices s Existing ft 1/8 in Required Primary Area ftr Diameter —_ n Designed Primary Area N/A Existing xi� ftz Spacing — Designed Reserve Area Manifold Trench/Bed Width 10 ft it Existing 30 SchedulelClass ft Trench/Bed Length Length �-- Elevation Measurements in o Diameter —�----' Existing_ /a Original Slope,If Altered Area Slope N/A `% Preferred manifold configuration used? ❑Yes No New If �— Transport Pipe Up-slape NI in Existing Depth of inal Grade radn N/A in Schedule/Class ft from Original pava-slope N/A in Length --- Designed Vertical Separation �-- Diameter _____ Gravel-based Dminfield Required? ❑Yes Id No Dosing and Pump Chamber in Pump Required? &l Yes O No 24 pump/Siphon Specifications Number of doses/day 4 gat &U ermost Orifice '!3 ft Dose quantity ______________________ gat Duff,in Elevation Between Pump PP 5 ft Chamber Capacity(flood) -�-- Grainfield Squirt Height/Selected Residual(head) Shutoff Pump controls:Please check those required. 16 Event Counter Timer 2 Elapse Meter C Uppermost Orifice Higher 0 Lower than3�P gpm f U+I Pump off '--hu-- Capacity Total Pressure Head If Timer: Pump on Calculated d Total Pressure Head I ft Comments Lateral information listed above is for the Sand Filter only. Existing drain field is to remain in use. Addln a new pump tank and panel. Revised:4/14/zos aoo7 00043 DESIGN FORM—PAGE TWO Assessor's Parcel Number: __ S� -- a _-- Permit Number: SWO DESIGN CfficKfd&TS Scaled Plot Plan Scaled Layout Sketch CrossSection Sketch ❑ Test hole locations Dminfield orientation and layout Reference depth from original grade: ❑ Soil logs Trench/bed dimensions and 9 Septic tank criticall distances ances within layout Dminfield cover O Property lines c D-Boz/Valve bo locations Reference depth from original grade � x Existing and proposed wells Septic tank/pump chamber and restrictive strata: within 100 n of property locations Laterals,trench/bed,top and ❑ Measurements to cuts,banks,and surface water and critical areas Observation port location C] bCurtain drain collector curtain drain and all absorption ottom Clean-out location CI Sand augmentation ❑ Location and orientation of g Manifold placement Other cross-section detail: components Eg orifice placement 0 Observation ports/clean-outs m Location and dimension of Ed Lateral placement with distance primary system and reserve area to edge of bed Other Information m Buildings 56 Audible/visual alarm referenced Yes No m Direction of slope indicator z Scale of drawing shown on scale O Design staked out 5d RecordedNotices attached P1 Waterlines bar ❑Roads,easements,driveways, p Elevation benchmark l�and relative g(Waiver(s)attached ts ❑ @f Evaluation of failure parking elevations of system components Cl pump curve attached m North arrow and scale drawing Non-residential justification shown on scale bar ❑ 5 Waste strength ❑ S Flow DESIGN APPROVAL R1 Yes The undersigned designer must be notified by instal err at tun ustallation �I No Date Signs 0 signer The undersigned has reviewed this d on behalf of Mason County Public Health and ed it to be in r gulations: compliance with state and local on n. Z Date nnrental Health S cialist CAUTION: DESIGN APPROVAL by Mason ounty UNDER Publ Health.E FOLLOWING CONDIT N' ✓ The design is stamped"App 1 ! �,�J (/ ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ✓ Dminfield 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. be scanned and available for public view on the Mason County Web site. 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