HomeMy WebLinkAboutSWG2024-00335 - SWG Application / Design - 8/6/2024 MASON COUNTY 415Nfi SHELTON: ,SHELT967 ,EXr 400
SH STREET,
,SHEL ON, EXT400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360482-520,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00335
APPLICANT CHUDECKE GREGORY T Phone:
Address: 4016 S CHICAGO ST SEATTLE,WA 98118
OWNER CHUDECKE GREGORY T Phone:
Address: 4016 S CHICAGO ST SEATTLE,WA 98118
SEPTIC DESIGNER BRAD SMITH.septic designer Phone: 253-851-2178
Address: PO BOX 1444 GIG HARBOR,WA 98335
Site Address: 480 E Treasure Island Dr
Primary Parcel Number: 121055200075
Permit Description: Replacement: 3-bedroom NuWater BNR500 system w/SSD drainfield
REVISED
Permit Submitted Date: 08/0612024
Permit Issued Date: 10/10/2024
Issued By: David Anderson
Current Permit Fees Paid: $540.00 ladmuonal lees may be reumred ucon installalmn of system).
Permit Expiration Date: 08/27/2027 (besed on dale of msreamn)
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 Drainfeld installation not to exceed designed upstope and downs/ope depth specked on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to bacitfill 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 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.
OFFCIAL USE ONLY
MASON COUNTY PUBLIC HEALTH
ONSITE SEWAGE SYSTEM APPLICATION .PEER B Ewe.
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DESIGN FORM-PAGE ONE Assessor's Parcel Number:-12,LaS - SZ-- 9t1112S
A dedgn will be reviewed when 3 copies of each of the following are submitted:
•Completed design lbrm that has been signed and dated. •Scaled layout sketch,including all applicable items on checklist
• Scaled plot plan,including all applicable items on checklist. •Crossaection sketch,including all applicable items on checklist.
This form may be scanned and aaailable for pjbk New on the Mom Cuun Web she,Marhnum paper site: 11"X/7"
PARCELIDENI'MCATWN ..::
Permit Number: SWG Designer's Name: �P
Applicant's Name: FG � > 4-Ck_ Designer's Phone Number: ' PJz �1
Mailing Address: 9ol.b Sir C11(YY{b Designer's Address: O
�— ls_ We 7115 GI of "
a side Citystem
---- Treatment Device
❑G1eo9onBiofiller ❑S�pdFilw ❑MomA O Sand Lived Duoundd O RwirmlmingFidur,Type:
Aerobic Unit MakeMIodd V 00 Q binitttion Unit Make/Model Other:
_ Drabrfleld Type
❑Gravity -QR ❑Trench ❑Bed �t SmSce Ikip
Septic Tank/Drainfield Specifications Lattsaia
Numbs of Bedrooms yy.� Schedulc/Class JAY �rsk'.
Daily Flow:Operating Capacity ZN� gpd Length $
Daily Flow:Design Flow In 2-z�qjQ gpd Diameter 2 in
Septic Tank Capacity B N A gal Number
Receiving Soil Type{Rate Separation
Receiving Soil Appl.Rate �� gpd/fa Orin 5tA rITE��
Required Primary Area fla Total Number of Orifices 4�
Designed Primary Area fir' Diameter , in
DesignedReswve Area C64eU R2 Spacing )2 in
Trench/Bed Width I Z` d M
TrenchBed Length _ZY53 I 8 Schedule/Class
Elevation Measurements Length 8
Original Drainfield Area Slope �L % Diameter in
New Slope,If Altered = % Preferred manifold configuration used Miles No
Depth ofExcava[ion Vpelma
3n Transport Pipe
from Original Grade m�blope ��'e�jeeec,,,', in Schedule/C7asa �
Designed Vertical Separation m Length )00 ft
Graveness Chambers Required? ����j�� , Q Optional Diameter v to
Punta Required' No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Z
Differma in Elevation Between Pump Shutoff,�and Uppermost Dose quandary �-�--
thifia Can 1'(ti" �1�-- R Chamber Cap—ty \ {� __
Uppermon Otifi �.Nigha Lower than Pump Shutoff Ptm(�•��q top Please rtquu J
Capacity®Total ead m �� p J Mato C
Calculated TOW Pteasmellaad If Timor.
Pump an
Comments
DESIGN FORM-PAGE TWO Assessor's Parcel Number.ILL Q S - S-L—-O C —Cn—s
Permit Number: SWG
DESIGNCtiECKLLSTS
Sc�led Plot Plan Se Layout Sketch Cross-Section Sketch
�t hole locations nfield orientation and layout Referency-depth from original grade:
1 logs �chibed dimensions and g� c tank
cal distances within layout �PI
Rroperty lines � Y f3 Drainfield cover
C( Existing and proposed wells BoxNalve box locations Reference depth from original grade
M/Methm 100 ft of property Septic taak/pump chamber and resstwtve strata:
0 Measurements m cuts,banks,and J7�calion, ZI Laterals,trench/bed,top and
,�irrface water and critical areas O Observation peat location bottom
d Location and orientation of Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Manifold placement ❑ Sand augmentation
�°1tl�onents fice placement Othe,,rf�-section detail:
H Location and dimension of �Latcral placement with distance l� Observation ports/clean-outs
�nwY system and reserve area to edge of bed
r mldings Other Information
on of slope indicator P/Scale of sual
alarm referenced Yea N—o/
Waterlines W Scale of drawing shown on scale ❑ El Racigr staked
Not out
/ bar ❑ Plljocorded Notices attached
Ld Roads,easements,driveways, ❑ :ilVaiver(s)attached
�baulking 0' ❑ Nmp curve attached
❑ North arrow and scale drawing ❑ ❑"Evaluation of failure
shown on scale bar Non-residentlal Justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL'
The undersigned designer must byaotified by iasiallerat date of WSW ca No
swurtime_of L)..' Date 49A4
The undersigned bas reviewed this design on behalf of Mason County Public Health and determined i170?��
compliance with state and local on-s gulations// 7 te41) / U/Zd L y MgS0N�06,*00
Envimnmantat Health Specialist I Date '%IA
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDI'Y'�N:FNTq<y��T
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is'
✓ Dminfreld 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.dated Dace: i znrzols
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