HomeMy WebLinkAboutSWG2024-00349 - SWG Application / Design - 8/19/2024 MASON COUNTY 415"6 H ELTON , 7-967 ,EXT 400
STREET
9H
.360-42TON, EXT SH
BELFAIR',3601 EXT 400
Public Health & Human Services ELMA.360482-5269,EXT 400
FAX 360427-7787
On-Site Sewage System Tank Only Permit: SWG2024-00349
APPLICANT PHILLIP TUCKER Phone:
Address: 10260 RAMBLE DR NW BREMERTON,WA 98311
SEPTIC DESIGNER RICHARD BAZZELL` Phone: 360-509-7900
Address: 165 NW TUPELO WAY POULSBO, WA 98370
OWNER PHILLIP TUCKER Phone:
Address: 10260 RAMBLE DR NW BREMERTON, WA 98311
Site Address: 101 N GADWALL PL NORTH
Primary Parcel Number: 422055101008
Permit Description: RV Holding Tank
Permit Submitted Date: 08/19/2024
Permit Issued Date: 09/09/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $265.00 (additional fees may be required upon Installation of system).
Permit Expiration Date: 08130/2027 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: RV Holding Tank
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 0 Drinking Water Source: Public Water System
Additional Details: Holding tank
Permit Conditions:
3 Mason County Asti Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17,
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/OR 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:
360427-9670,extension 400.
OFFICIAL USE ONLY
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MASON COUNTY DAAECND y OR
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ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT ONE m
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Phillip Tucker 360-265 4435 c
MAILING AOURE55,S- L P-CIT',STATE,ZIP CODE BE10260 Ramble Dr NW, Bremerton, WA 98311 IT
Pill ADORES.-S'REEL CITY.ZIP COTE fr�
101 N Gadwall PI North, Hoodsport, WA 98584 �r
NAME OF DFSICNeR PHONE
Caliber Septic Design - Richard Bazzell 360-509-7900
NAME OF INSTALLER PNDNF. o
To Be Determined N/A <_
11 OF WORK1K.R1-0 UILNNING WATERSOURCE
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® NEW CONSTRUCTION I UPGRADES ❑ REPAIR I REPLACEMENT ❑ PRIVATE INDIVIDUAL SUED. [IPRIVATE TWO-PARTY WELL Z ! F�
COMPOAENTI° TO RE REPLACED'INSTALLEU I PURI IC WATER SYSTEM Lk Cushman M01D1.Go,R 379AL) I Iv'
[] SEPTIC TANK OPURI TANK ARV HOLDING TANK tRUULW OI s2E h_
[]OTHER N/A 0.67 acres(29,1 AS sq/ft) E
OTHER ITTML.nMatl.1 N.I.D.IY1 A e IRSI saAON CHECKLIST r l
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[] SURFACING SEWAGE OEXISTING FAU JRE [I SHORELINE 0100FTIAELCICOMMUNITYAELLS x
EUBMIFTALS SOFT-PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS p
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N PLOT PLAN IREOUIREDI 0 TANK CROSS SECTION(REG JIRED) 10FT-DRINKING WATER SUPPLY LINES CI
Q PUMP DETAILS(IF APPLICABLE) I WAII tF APPLICABLE) � 5FT1PROPERTY;EASEMENT LINES,FOUNDATIONS FOOTINGS r
PLOT N CHECKLIST O lO�PLAN
LINES ADD EASEMENTS E EXISTING PROPOSED ST PICTURES 0EXIISTING1 PROPOSED DES COMPONENTS AND LINES
WELLS WCAN 1001 N WATER SUPPLY LINES N ORIVFWAYSt PARKING 0 SURFACE WATERS.STREAMS.RIVERS.ETC_.
DIRECTION OF S I OPH CONTOURS ❑PERIMETER CURTAIN TRAINS 0 NORTH ARROW ®SCALE BAR GOI_Y\/ 1
DIRECTIONS TO O LEAN.E.TE COXORIONC .1 UNA ..I
Get on US-101 from Olympic Hwy N; Merge onto US-101 N; Continue on WA-119
North/North Lake Cushman Rd; Drive to 101 N Gadwall PI North
OFFICIAL USE ONLY BELOW 1 HIS LINE
uPCAAVE I FAILURE SOURCI NP OFFFER 11W—)
QVOLUNEARY QMAIN'ENANCEROMPING Cl BUILDING PERN117 QHOMESALE OCCMPLAINT []OTHER:
GGMMENTs1 CONREON.
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SEWAGETANKSMUSTBEII STEFbNDERDOM'LI.TOFREGISTEREVSEWAGE'ANNS TANKS.MUST MEET CORRELL M1DMTM SIZE RECUIRENENTS,EQUIPPED WITH.RISERS
ANDUSEROSURFACE MIV INCLVOEAN EFFWENT FKTER yFAPPLIGnIE}RECORD DAMPING AND INSTALLATION REPORT TEOLHREO TIX RNALAPPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE PPOCATIO.V APPROVED;IS.VED SY RA
TE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSIIE NOISED07,09MR9
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