HomeMy WebLinkAboutSWG2003-00551 - SWG Application / Design - 11/10/2003 ON-SITE SEWAGE SYSTEM PERMIT
MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG Q
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98684 Date (7 N
N� PHONE (360) 427-9670 Receipt No. S
Amount$ Z
PROP Q NER: v,, DATE: W
\� A�SKQ CHECK APPLICABLE ITEMS �/ 3CP
MAILIN ADJURES :Q J`OUD L DAYq�3H n �j ' NEW SYSTEM o
VV REPAIR SYSTEM "~
CITY: \� STATE Z TABLE
INTENA CER m
MAINTENANCE REVIEW
PROP RTY ADDR SINGLE FAMILY
�Ov D OTHER: 3
ECIF� ` R S F LO G SITE: �V �� PRIVATE WELL m
COMMUNITY WELL/PUBLIC SYSTEM
JA9Woo 1N `o SYSTEM WFI q T SYSTEM NAME In_
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Y�i \ Old 1�-• N OW "4 G 1 o %\)D ' t� 1 t t NAME
Name Lot ft.x Z- — ft. MAILING DDR SS . Q
Installer )
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�x� Size: acres LEPHONE
Name of b � um er o GN o
n r W',�J Bedrooms X
OFFICIAL USE ONLY BELOW THIS LINE
q_DWARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDIT,IC NS
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SOIL TEXTURE CODES:
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INSPE OR( ri nam IN ION SIGNAT RE / DATE PERMIT EXPIRATION D TE
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•All systems require ongoing Operation and Maintenance(O&M)as speci ed in Mason County rin-Sille Standards.
•All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer,unless prior approval is granted otherwise
•All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted otherwise.In such ca es a preliminary on-site
meeting between health department staff and the homeowner is required.
•On-site sewage system design approval does not imply other building site requirements(i.e.RLC,Water Adequacy)have been met. ,
•Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.
•This permit expires 3 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial ate.
DESIGN R E A PROV DATE: INSTALLATION APPROVED BY: DATE:
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TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES LLII � IIII
November 20, 2003 PO BOX 1666 SHELTON, WA 98584
SHELTON (360) 42 -9670
FAX (360) 42 -7798
Robs Excavating ELMA (360) 48 -5269
1871 E John's Prairie Rd. BELFAIR (360) 27 -4467
Shelton WA 98584 SEATTLE (206)46 -6968
RE: Design for MANSKE
Case No: SW62003-00551
Parcel No: 320215804040
Your design for the above referenced parcel has been review and is APPROVE[).
Please refer to the comments section of this letter for any additional information.
Please call me at (360) 427-9670, ext. 353 if you have any questions.
Sincerely,
Cindy Waite
Environmental Health
Mason County Health Services
COMMENTS:
11/20/2003 1 of 1 SWG200 -00551
DESIGN FORM - PAGE ONE Reviscd February 19,1998
.•A assign will be reviewed when 9 copies of each of the following Items are submitted:
Completed design fortrrhr1 thathea been signed and dateQ_rn g/'Q �( sketch,lnoludMg all applicable Its on checklist,..,:
Scaled p?t,P .Inoludlrg ap applloabls horns an oleo Vow.° sketch,Including all applicable Item on checklist" '
£s y 3 i �rss.x•3s ;�£:.., 5 ;� "i ) u ''.:r+cc .ws x d.3
x s a a• SD. Q 3 'u 3y?:
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Permit Number. SW(i J .CEO SSI SZ Designer's Name: `a
Designer's Phone N:
AssApplicant's Name: ,, 1\ S essor's Parcel No.:
Mailing Address:
Subdivision:
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zcz ...;:,.,.. ....�; . .,.: ... •.........(NarsdDlvbl
city �
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koi ..`EiFnr.>Sd+°i�.;s:!�E>aa?a�' 'SxA �a`�.�S�xC:SE?:,.Er in.aw:, xv.. ,� n.,. y; � -��`a...n�'� e"�:3•fii.:t5.%+� �.::,e�`o-7o-kr4
Treatment Device -
O Glendon Biofilter O Sand Filter O Mound. O San Ovdfi5[ d
0 Aerobic Unit-Make/Model: — O Disinfection Unit - Make/Mode
ODWIN.'•,
Drainfield Type 'l:i' .N od"•Si•'R•a"''
Pressure ABad EXPIRESPR -
Gravity 13 Oravelles Chambers
Septic Tank/Dia I.lnfiaid Specifications Laterals ,:: +•:, ::: a
Number of Bedrooms Class
Dail Flow Length
Y Diameter
Septic Tank Capacity- Number
Receiving Soil Type(1 6) Separation
Receiving Soil,AppL Rate. . ;;.
Required Square Footage. Orifices
Designed Square Footage 00 Total Number of Orifices
Percent Reduction Taken OC °
Diameter in
Trench/Bed Width 973 4�
Spacing
Trench/Bed Length' ..
Elevation Measurements_
Scitedule/CIass AP P R t5VjED
Original Drainfield Area Slope I % , 'Length, , MC HEALTH DEPT'
New Slope if Altered ° Diameter
NOV 2 0 n03
Depth of Excavation fiom in
Original Grade (up-slope) ferred.Manifold Configuration Used? ❑ Yes C3 No
Designed Vertical Separation alom �tbfl Oft Pipe
. (Dowo- pe) Schedule/Class
in Length
Diameter in
Gravelless Chambers Required? ❑ Yes No ❑Optional
Pump Required? 0 Yes �No Dosing and Pump Cha ber
Number of Doses(Day
Pump/Siphon Specifications Dose Quantity Cal
pal
Difference in Elevation Between Pump Shutoff and Uppermost Chamber Capacity
Orifice: A Pump Controls:' `Timer(or) Elapse Time M ter(circle If required)
If Timer. Pump On ,Pum Off
Uppermost Orifice is C1 Higher, Q Lower lhitn.'Plimp.Shutoff;
"' Checkthe f lol g components y dra between doses.
Capacity�Total Pressuro Head:. .' of m if the n
Calculated,Total Pressure Head:' fi' ❑I'aterals '0 Manifold ,",.. 0 T port
(Attach'Piiinp Curve) .., . -. :'
` .. ... .. :t}R: ....o . .. i.t:'l,i Qila'+OIiC-0 .`�tj �p.;:1.:c1 •. .._... .. . .. . ',' .ii :.... . .
DESIGN FORK PAGETW0,1:.::<., �-.:.�:•:.,o. r. ,,.,�:•... .: .'.:.. :.:..:...: :.. R ,l"Fcbmxy18,1998
Scaled Plot'Plan '-` 'Scaled Layoflt`Sketch`"""" ' Cross'=Sebtlon' ketch "
Test hole locations -. -. - :"Dralnfteld orientation and layout Referenced depth f in original grade:
Property lines... _...... :Trench/W dimensions and critical Septic tank lid an drainfield cover .
Existing and proposed wells within distances within layout.... . . depth . .. ' • ""
100 ft of property lines..._ . . D-Boe,r/,'L"locations....-... _-
Critical distance measurements to cuts Septic uXWpump chamber location Reference depth fro original grade
barth,and'surfaca Witter' .. Oti3vivedoti'poll location ud reitrlettv'e'stt a
and bottom
Location and orientation_of curtain Clean out location 1atr tree top
drain and all absorption components Manifold placement O Curtain drain cull mtor
• au
Location and dimension of primary Orifico placement O Sand gmentati
system and reserve area'. Lateral placeinen4 with distances to
Buildings edge,of brd 1 ? Other cross-section etaU: .. :' .
Direction of slope indicator O 'AudibliMsual alarm roferenced 61 Observation ports and clean-outs -
0 Waterlines Scale of drawing shown on scale bar
Roads/easements/driveways/ s
parking '
- oa .o m
O Critical resource lands(if applicable) I 1 cap dap cent as
North arrow and scale'of drawing
shown on scale bar
Additional In matlon
-.... _..... . . Design staked ou
O Operation and M ' tmance Notice
Attached
,•, . ... -. . . O Waiver(s)Aaac6
PIN 1
The undersigned designer O does; d not,INet ' ant to be notified by the installer of the auta o d gives 48 '.
hours to perform a final 1pspectio'n prior to ova we
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Department of Health Services ate Jet be tiny
compliance with state and local on-site regulatio .' • ROBE T GOODVVIN '•.
ZU I •EXPIRES 08 08-
Environmental_Hgth,Specialist' D to
Cautions DESIGN APPROVAL IS VALID ONLY UNDER TH,Z FOLLOWING CONDITION:
The design is,stamped"Approved i • Mason County Deportment of Health S
.,.
' ltiti Oii-site Sewnge Peitnit note ''__JJ--the Permit Expiration Date Is: ' I'' j
' Yam :
'The=yateta i installed by'a'certifted' er;unlesi prior authorization la obtained m Meson County
Department of Health Services,
,/ - - Dminfleld site conditions have not ban altered to adversely affect conditions of des! approval
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