HomeMy WebLinkAboutSWG2024-00247 - SWG Application / Design - 6/4/2024 MASON COUNTY d15N8THELTON. ,SHELT670,EX8584
SHELTON:360d27-9670,EXT 400
4 BELFAIR:360-275d687,EXi 400
Public Health & Human Services ELMA:360J 269,EXT 400
FAX:360427-7/87
On-Site Sewage System Permit: SWG2024-00247
APPLICANT NOWOWIEJSKI CEZARY Phone: 1.509.868.5691
Address: 2746 NW RUDE RD POULSBO,WA 98370
OWNER NOWOWIEJSKI CEZARY Phone: 1.509.868.5691
Address: 2746 NW RUDE RD POULSBO,WA 98370
SEPTIC DESIGNER ADAM HUNTER' Phone: 360-753-1226
Address: PO Box 162 OLYMPIA,WA 98507
Site Address: 111 E Soundview Dr
Primary Parcel Number 320215801001
Permit Description: 3-bedroom OSCAR X02 system wl OS-100 coils
Permit Submitted Date: 06/04/2024
Permit Issued Date: 07/02/2024
Issued By: David Anderson
Current Permit Fees Paid: $805.00 (addmonal rags may ea muno uwn inswarn or assum).
Permit Expiration Dale: 06/1212027 Imaed oa dara ar mwewodl
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 Drainfield installation not to exceed designed upslope and downslope 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 forobtaining Septic DesigneNEngineer installation approval prior to
back ill of system components.
6 Mason CountyAsbuilt 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/heahh/environmental/onsiteloss-inspection-mquestphp or call:
360-427.9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH
ONSITE SEWAGE SYSTEM APPLICATION
415N6th5treet,MW98) Shelton WA98584 N
Shelton:3W427-960 at 400 BeBair.360-275JA7 at 400 SWG ;.11 1JLJ — Y� 2 fI
APPLICANT PHg1E .A
CEZAR NOWOWIEJSKI 509-868-5691 m m
m
r
MAILING ADDRESS.STREET CRY,STATE,➢P CODE
2746 NW RUDE RD POULSBO WA 98370
ic
SITE ADDRESS-STREET.CT'.ZIP CADS W
111 E SOUNDVIEW DR SHELTON WA 98584 A
NAME OF DESIGNER PHONE E Al
ADAM HUNTER' 3607531226
NAME OF INSTALLER PHONE
TBD TBD Ip
CHECK ALL APPLICABLE ITEMS IXUNMNGWPTERSOURCE
Of NEW CONSTRUCTION D RV HOLDING TANK ONLY PRNATE INDIVIWAL WELL 'Nr'
�] REPLACEMENT SYSTEM IN
PERMRONLY [] FRNATE TWO-PATTY WELL =
,�ltmi-E 9 REPAIR [] SINGLE FAMILY 9a COMMUNIttIPUBl1C WATER SYSTEM I r
[] TANK(S)ONLY Ea COMMERCIAL SYSTEM NAME BMIIECPEST 1
`Q.OftDRADETOE%ISTING O OTHER: BEDROOMS LOT SIZE PNC'
[] E%I6TING FAILURE �'w �^° 3 0.27 W IGo
0 11`
DIRECTIONS TO SITE.BE SPECIFIC WIDPDVISE OF ANY NEEDED INFORMATIONFORACLF55(m.bkeU BIN) 0
CRESTVIEW TO A LEFT ON HILLCREST TO A RIGHT ON KINGSTO <TOS NTHE
RIGHT AT CORNER OF SOUNDVIEW AND KINGSTON. 0
pSITE MUST BE FLAGGED FROM MAN BOMBARD TESTNOIES MUSTBE FLACEDWIIN-1 NOLO
OFFICIAL USE ONLY BELOW THIS UNE
UPGNPDE I FAILURE SOURCE(V R 9P -)
[]VOLUNTARY DMANTENA4CEIPUMPING QBUILOINGPERMIT DHOMESALE QCCMPLNNT BOTHER:
INSPECTORSOILLOGS /� COMMENTS I CONDITIONS
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THIS FORM MAY BE BCAMNFDAMO AVAIABLE FORPUBUC WEWON THE MASON CWNttBEBBRE REVISED IM1201
DESIGN FORM—PAGE ONE Assessor's Parcel Number.3-,A-Q a-L
A design will be reviewed when 3 copies of each of the following are submitted:
"Completed design form that has been signed and dated. O Scaled layout sketch,including all applicable items on checklist
v Scaled plot plan,including all applicable items on checklist. ♦Cross-section sketch,including all applicable items on checklist.
This form maybe scanned and available for public view on the Mason County Web sibs.Marimum PaPer size: 11"X IT'
PARCEL IDENTIFICATIOA.
((�� Designer's Name: ADAM HUNTER
Permit Number: SWG �v gn 360-753-1226
CEZAR NOWOWIEJSKI Designer's Phone Number:
Applicant's Name: gn PO BOX 162
Mailing Address: 2748 NW RUDE RD Designer's Address:
POULSBO WA 98370 OLYMPIA WA W507
Citv State Zi City State zip
aDESIGN PARAMETERS.
Treatment Device
❑�/Glendon Bioflwr ❑Sand Filter 0 Mound ❑Sand Lined Do infield [3 Recirculating Filter,Type:
err Acrnbic Unit Make/Model X02 ❑Disinfection Unit Make/Model Other:
Drainfield Type OSCAR X02
❑Gravity
❑Pressure O Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class PER OSCAR
Daily Flow:Operating Capacity 270 T gpd Length PER OSCAR ft
Daily Flow:Design Flow 360 gpd Diameter 1/2 in
Septic Tank Capacity 1200 r• gal Number 3
Receiving Soil Type(1-6) 5 Separation PER OSCAR R
Receiving Soil Appl.Rate 0.4 / gpd/ft
Orifices
Required Primary Area
900 — ft Total Number of Orifices PER OSCAR
Designed Primary Area 900 fit Diameter PER OSCAR in
Designed Reserve Area 900 fit Spacing PER OSCAR in
Trench/Bed Width 16 ft Manifold
TrenchBed Length 50 i� ft Schedule/Class 40
Elevation Measurements Length 40 ft
Original Drainfield Area Slope 4 % Diameter 1 in
New Slope,If Altered 4 % Preferred manifold configuration used? StYes ❑No
Depth of Excavation UP4I NIA PER OSCAR in Transport Pipe `
from Original Grade Dawn-slope N/A PER OSCAR in Schedule/Class 40
�T
Designed Vertical Separation "Lr,, j8 in Length 100SUPPLY AND 10ORETURN ft
Gravel[=Chambers Required? ❑Yes ❑No StOptionsl Diameter 1 to
Pump Required? R(Yes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 411 `
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity 0.8759 gal
Orifice it Chamber Capacity 1200 i gal
Uppermost Orifice G(Higher O Lower than Pump Shutoff Pump controls:Plcase check those required. �/
Capacity @ Total Pressure Head 12 gpm primer 9$lapse Meter a.Event Comte,
� Calculated Total Pressure Head
22.709 it if Timer: Pump on 30SEC Pump off 3MIN
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number:ajr)ate -- lt" odd
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
if Test hole locations lr Draintield orientation and layout Reference depth from original grade:
9 Soil logs Trench/bed dimensions and if Septic tank
E9 Property lines critical distances within layout El Drainfield cover
99 Existing and proposed wells It D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 6( Septic tank/pump chamber and restrictive strata:
U Measurements to cuts,banks,and locations ❑ Laterals,trench/bed,top and
surface water and critical areas 6d Observation port location bottom
• Location and orientation of 1Z Cleanout location ❑ Curtain drain collector
curtain drain and all absorption if Manifold placement ❑ Sand augmentation
components a Orifice placement Other cross-section detail:
• Location and dimension of E9 Lateral placement with distance R( Observation ports/cleanouts
primary system and reserve area to edge of bed Other Informadon
59 Buildings E9 Audible/visual alarm referenced Yes No
E9 Direction of slope indicator Scale of drawing shown on scale Ef ❑ Design staked out
19 Waterlines bar ❑ ❑Recorded Notices attached
E9 Roads,easements,driveways, ❑ ❑Waiver(s)attached
parking ❑ ❑Pump curve attached
E9 North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must be ti d asFdller at time of installation 9 Yes ❑ No
5129/24
S' to of Designer Date
The undersigned has review . esign on behalf of Mason County Public Health and determidEQ�a�e in
compliance with state and local on ite a[ions:/ , `(v�,VI
sow
Envirorwental Health Specialist Daze
p dNM
CAUTION: DESIGN APPROVAL IS VALID ONLY TINDER THE FOLLOWING CO1VHllTI 96
4
/z(
✓ The design is stamped"Approved"by Mason County Public Health.
✓ 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.
This form may be scanned and available for public view on the Mason County Web site.
'I Updated Date: 12/72015
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCELA 320215801001
DATE SUBMITTED:5I29I2024 LEGAULOT k SHORECREST
BEACH EST LOT
SUBMITTED BY: ADAM HUNTER
APPLICANT: CEZAR NOWOWIEJSKI
ADDRESS: 2743 NW RUDE ST
POULSBO.WA M70
I.CALCULATIONS
NUMBER OF BEDROOMS= 383
RESIDENTIAL GPD FLOW-
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= OA GPDIFT2
REDUCTION=LEAVEBfANHIF NOREOVCTION TAKEN
GRAINFIELD SIZING
ABSORPTION AREA= 9DO FT2
TRENCH LENGTH OR BED CONFIG.= 50X13'
PER OSCAR
II.WATERPROOF SEPTIC TANK
COMPOSP IN AND SIZE= 1200GA1--WU TANK
NEW OR EXISTING= NEW
III.GRAINFIELD CROSS SECTKIN
SAND DEPTH= 0-B"
IV.PRESSURE CALCULATIONS
USING PIPE CLASS 40
ORIFICE NETAFIM ORIPLINE
LENGTH DIAMETER FLOW FRICTION LOSS
SECTION (FT) (IN) (GPM) (FT)
SUPPLY 100.00 1.00 12.M 7.TM
RETURN 100.W 1.90 12.000 7.7543
TOTAL= 15.5086
TOTAL HEAD LOSS "
1)FRICTION LOSS THROUGH SYSTEM= 15.509
2)ELEVATION DIFFERENCE = 7.200
TOTAL= 22.709
5/29/24
APpRo t)
JUL 02 2024
MASO NCOU"ryENVIR ALH
Awia.xunx z
WA EALTH
A
V.CHECK THE PUMP CAPACITY.
PUMP: A.V.MC U[)3MPM-12HP PUMP(AIODEL#UNDIMU) (PEROSCAR)
EXCESS TON W.W (PEROSCAR)
TOTAL HEAD LOSS IN SYSTEM 22.71
STANDARD PUMP CONFIGURATION IS SUFFICIENT? YES
5/29/24
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