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HomeMy WebLinkAboutSWG2004-00650 - SWG Application / Design / As-Built - 12/17/2004 $ " PERMIT . PERMIT NO. SWG Q MASON COUNTY DEPARTMENT OF HEALTH SERVICES 4 N Date m' o 426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Receipt No. 5 PHONE (360) 427-9670 Amount$ w PROPERTY OW ER; DATE: CHECK APPLICABLE ITEM vm l'p r} D She��riv� ��' �'y' O� NEW SYSTEM MAILING ADDRESS DAYTIME PHONE: �. �j Rd REPAIR SYSTEM ySp W &Sint5S R-A yam°- S TABLE6REPAIR w CITY: STATE. 9BSbSZIP. MAINTENANCE REVIEW 2 S�e-'f� SINGLE FAMILY Z PROPERTY ADDRESS: 3 OTHER: 3 • D �'� �" PRIVATE WELL I SPECIFIC DIRECTIONS FOR LOCATING SITE: COMMUNITY WELL/PUBLIC SYSTEM I L SYSTEM WFI# Mf (t s'— M0On CaJ•�• FoJ,t.✓° �r4k'(S SYSTEM NAME h 1 APPLICANT P h G.t.C S;k- Va,+. t/Z7- 35vo NAME Name of Lot ft.x g MAILING ADDRESS Installe z • fie: acres TELEPHONE Name o ,+¢ah. vas um er o ��o eoy XIGNATURE o Designer � }j�,/ Bedrooms OFFICIAL USE ONLY BELOW THIS LINE DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITI NS O • x wJ I } P 0 ID H° SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely INS R(print nomg)� IN TON SIj URE n DATE PERMIT EXPIRATION DATE w Inlda I t�tnJ#,N I L I u 1 U •All systems re re ongoing Operation and Maintenance(O&M)as s ecified in Mason County O -Site 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 cases 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 aepeaIeJoje Health Officer within 10 days of deni I date. DES R E , W VAL S L BY: DATE: II LATI APPROV DAT J cwto Z 23 cb TOP: Health Dept. Copy MIDDLE: Designer's Copy B OM: Applicant's Copy \/ MASON COUNTY r≥,EfARTMENT OF HEALTH SERVICES PO BOX 1666 SHELTON, WA 8584 December 20, 2004 SHELTON (360)427 9670 FAX (360) 427 7798 Hatton Godat Pantier ELMA (360)482 5269 BELFAIR (360) 275 4467 SEATTLE (206) 464 6968 Rg E: Design for PORT OF SHELTON Case No: SWG2004-00650 Parcel No: 320081060000 Your design for the above referenced parcel has been reviewed and is NOT APPROVED. It does not meet the requirements or needs additional information. Please see the comments section of this letter for more 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: The sand lined beds/trenches require an orifice every six squa a feet. This may change your pump size. In the RSG for pressure, it shows orifices at 12:00 and 6:00. I have not seen the use the 8:00-5: 0 orintation in any pressure system. Your cross section of the septic tank shows 12" and 24" risers on the same tank. It needs to be clear on the tank cross section the depth to the top of the tank from original grade. According to the elevations the inlet of the tank will be li' below the finish grade. 12/20/2004 1 of 1 SWG2004-00650 MASON COUNTY DEPARTMENT OF HEALTH SERVICES January 28, 2005 PO BOX 1666 SHELTON, WA 8584 SHELTON (360) 427 9670 FAX (360)427 7798 Hatton Godat Pantier ELMA (360) 482 5269 BELFAIR (360) 2754467 SEATTLE (206) 464•6968 RE: Design for PORT OF SHELTON Case No: SWG2004-00650 Parcel No: 320081060000 Your design for the above referenced parcel has been reviewed and is NOT APPROVED. It does not meet the requirements or needs additional information. Please see the comments section of this letter for more 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: This design can be approved when we receive a copy of the ri corded operation and maintenance recording. The parcel number on he redesign was for a diferent parcel. The parcel number is 32008-10-6000 for your records. 1/28/2005 1 of I SWG2064-00650 it MASON COUNTY DEPARTMENT OF HEALTH SERVICES February 23, 2005 PO BOX 1666 SHELTON, WA 8584 SHELTON (360) 427 9670 FAX (360)427 7798 ELMA (360) 482 5269 Howard Godat Pantier BELFAIR (360) 275 4467 SEATTLE (206) 464•6968 RE: Design for PORT OF SHELTON Case No: SWG2004-00650 Parcel No: 320081060000 Your design for the above referenced parcel has been review and is APPROVED. 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, Ca� Cindy Waite Environmental Health Mason County Health Services COMMENTS: 2/2312005 1 of I SWG20�4-00650 II DESIGN FORM- PAGE ONE Revised Janua,y4 1999 A design will be reviewed when Locales of each of the following Items are submitted: Conwfeted design form that has been signed and dated % Scaled layout sketch,Including all app foaby Item Ion checklist plot plan,krokudIng as applicable Hems on checklist % Croaa-sebtlott sketch,Including all applicable Iteit ion checklist NSIUsSx � ¢�s may: y, ,, gYn`an`�:r `. :fiF.y. ; Permit Number: SWoU*k - P)UA Designer's Name:..,. GeotsA Designer's Phone#: 3�0 ° —/ 99 Applicant's Name: lPor� of Shel/ar— Assessor's Parcel No.: Mailing Address: W1.J /3Q)s as.' �� (Twelve-1>;g[Number) 9SSM Subdivision: .ti©Cor- /o— o City State Zip (Nane/vlvis Ioc J t) r:.� f3,•'v.:r.o?:iF,*sl;r<:<iT?S.!'x•..`.:.yg;:.s?xxis::2:g<:;:..k^x:.:...-a?::z....:<.x .::•..;<... :,A'.4; .:,<...T.<<.. . �d:.awo:&�5•<: .^a a.,,<::.:x..,.:4!a <.::.:x��.a ...:a•y ..:.cam.., <�.,».. sx'.&'..<.. st'.,,.a<x. ::s�:.z::ws, >':'.:e:,ae s m;v s :a �:A.�: .a , ..��,i...,.<:?.g:3; kY :o:::?s�: `3fM'd .::::.:.<.c;z.\.,.�y o:2y z2a.>2.x:'.k'"`.: cc*rgak.x...„ .<z:n`Js:ra.yy: .£'..: ....3,'a.,..:� 4!;:M k... . cv.. . �o:.��^eF�'c ..da. : '<xri<.>;...::.<4.,c .nom ?�:1: � � v z:':sa<..;,,<:,.,,<!Se:a;,a;,a:<x::oi''.'.'`>`;>.�Ka . ; �er ' a:.,.:''`�` s ;;Aa`���oR'8";�33'�`.o<'s`.r^`,.�;,Y.?::: .< ,. /12.qJ Treatment Device O Glendon Biofilter Sand Filter 0 Mound g Sand Lined I rainfleld O Aerobic Unit-Make/Model: O Disinfection Unit - Make/Model: Grainfield Type Pressure I Bed Drainrock Gravity 113 Trench 0 Gra tiles Chambers Septic TanWDrainfield Specifications Laterals Number of Bedrooms FMp{�./aas Schedule/Class yo Daily Flow 7� E _ Length � Septic Tank Capacity 12.E __ Diameter 1- 1/z in Receiving Soil Type(I-6) I R Number Receiving Soil Appl.Rate I,2a B Separation Required Square Footage t. 2 fie DesignedSquateFootage tip Orifices Q �' Percent Reduction Taken /� % Total Number of Orifices Trench/Bed Width Diameter Trench/Bed Length b g Spacing 24 in Elevation Measurements Manifold Original Drainfield Area Slope 2 % I.e�nged le/Class RI0 New Slope if Altered Diameter hi Depth of Excavation from in Preferred Manifold Configuration Used? ❑Yes ❑No Original Grade (Up-slope) in Transport Pipe (Down-slope) Schedule/Class Length ft Designed Vertical Separation i n Diameter 'L,o in Gravelless Chambers Required? ❑Yes No O Optional Dosing and Pump Chamb r Pump Required? )qYes ❑No Number of Doses/Day Pump/Siphon Specifications Dose Quantity /91 S gal Chamber Capacity o l eal Difference in Elevation Between Pump Shutoff and Uppermost Pump Controls: Timer(or) jmeMercircle If required) Orifice: 7 D ft If Timer. Pump On Uppermost Orifice is f JItgher, O Lower than Pump Shutoff Check the following components if they drain i4tween doses: Capacity @ Total Pressure Head °/" core aLatenis O Manifold ❑Thnspo Calculated Total Pressure Head: /(Lot ft (Attach Pump Curve) DESIGN FORM - PAGE TWO RevisedAjti24,199E g '.'P' ,.£.5 "^si"9fi3!�3:"`i!5�y!e.. �`.< .✓:'.>:3�6 h Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch O Test hole locations O Drainfield orientation and layout Referenced depth from original grade: O Property lines O Trench/bed dimensions and critical O Septic tank lid and drainfield cover O Existing and proposed wells within distances within layout depth 100 fi of property lines O D-Box/"T"PL"locations O Critical distance measurements to cuts, O Septic tank/pump chamber location Reference depth from original grade banks,and surface water O Observation port location and restrictive strata: O Location and orientation of curtain O Clean-out location O Laterals,trench/bed top and bottom drain and all absorption components O Manifold placement O Curtain drain collector O Location and dimension of primary O Orifice placement O Sand augmentation system and reserve area O Lateral placement,with distances to O Buildings edge of bed Other cross-section detail: O Direction of slope indicator O Audible/visual alarm referenced O Observation ports and clean-outs O Waterlines Cl Scale of drawing shown on scale bar O Roadsteasements/driveways/ ' :k}: :{y::u <.>:,.., Y. L�yi ,SIMS �.� u���.y�: (l My!y .:��.,. .Y:d ') r"'oE is"a�.,''�S' 'vx�'G YY.., � .I..GO Criticalresourcelands(if applicable) '. ,. z�.3.:.�>�:r;��kz .�. . O North arrow and scale of drawing ale b ..r: ._;'.. <...,>s : k::.:::::s :::s ::kx .., shownon sc ar _...,. ,:, ... iP.. Additional Information O Design staked out O Operation and Maintenance Notice Attached O Waiver(s)Attached al-Lu �.. 'k Y x y �4. > � c f.? <�i1 g ✓e [ .: @ 4'>y",'$,;.'�:c". x r g Ada'[.. u� The undersigned designer❑does, Ødoes not,waive the requirement to be notified by the installer of the installation and given 48 hours to perform a final inspection prior to co ignature of Desi er Date Gz7 The undersigned has reviewed this design on behalf of Mason County Department of Health Services and determined it to be in compliance with state and local on-site regulations: �tal �,�cwEo a�z3�or Environith Specialist Date DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Department of Health Services. ✓ The On-site Sewage Permit has nM expired,the Permit Expiration Date Is:_i z. 111107 ✓ The system is installed by a certified installer,unless prior authorization is obtained frdm Mason County Department of Health Services. ✓ Ihainfreld site conditions have not been altered to adversely affect conditions of design SEPTIC SYSTEM 01/11/2005 Leasee Mason County Forest Products HGP # 04-155 Parcel Number 3-)UUY--/0 -6 vcVU,) Applicant Port of Shelton 450 W Business Park Rd Shelton, WA 98584 Statistical Information Land Use Saw Mill No. Employees so Primary Flow Rate 15 Gal / employee / Day Reserve Flow Rate 15 Gal /Employee / Day Soil Type (Class #) 1A Application Rate 1.20 Gal / SF / Day Trench Width 3.00 Feet Orifice Spacing 24 inches Orifice Size 3/16 inches Orifice Flow Rate 0.59 gpm Number of Laterals 4 Number of Orifice / Lateral 26 Total Number of Orifice 104 Residual Head 1.00 ft Pipe Length (Transport) 32 ft Pipe Length (Manifold) 27 ft �` Pipe Length (Lateral) 53 ft ' H� Constant (Mannings) 10.46 Transport Flow 61.4 gpm Manifold Flow 30.7 gpm Lateral Flow 15.34 gpm Roughness Coefficient 130 Pipe Diameter (Transport) 2 in Pipe Diameter (Manifold) 2 in Pipe Diameter (Lateral) 1.5 in Static Lift 7.00 ft HATTON GODAT PANTIER c.\office\...\ossmas[erl Septic System--Page 1 Daily Flow Rate: 15 Gallon x 50 Employees = 750 gpd Employee!Day Primary Trench Length: 15 Gallon x 50 Employee = S.F. /Day x 1 = `209 If Employee/Day 1.20 Gal. 3.00 Ft. Reserve Area: 120 Gallon x 50 Employee x S.F. /Day x 1 = 209 If Employee!Day 1.20 Gal. 3.00 Ft. Flow Rate/Lateral: Number of Orifice x 0.59 gpm /orifice 26 x 0.59 = 15.34 gpm/lateral Total Flow Rate: #of Laterals x Flow Rate/lateral 4 x 15.34 = 61.36 gpm Friction Loss: hf= (10.46)(L)(Q) 1.85 Total Head: Gt.85 d4.87 Transport Pipe: Static Lift = 7.00 ft Friction Loss = 4.01 ft hf= (10.46) (32) (61) 1.85 = 2.85 feet Residual Head = 5.00 ft (130) 1.85 (2) 4.87 Design Point: Manifold Pipe: Total Head: = 16.01 ft Total Flow: 61.36 gpm hf= (10.46) (27) (30.7) 1.85 = 0.67 feet (130) 1.85 (2) 4.87 Use Hydromatie Model : SP$0 Lateral Pipe: 1/3 H.Y.or Equaivalent hf= (10.46) (53) (15) 1.85 = 0.49 feet 3 (130) 1.85 (1.50) 4.87 Drainfield Dosing: Daily Volume: 750 gals Dosing Frequency: 4 Time(s)/Day Dose Volume: 187.5 gals Pump Run Time: 750 Gallons/day = 3.06 Minutes to Dose Drainlield 61.36 GPM 4 Doses/day HATTON G0DAT PANTIER Septic System.. Page 2 y b1th1 I .« Performance Data 32 Pump Characteristics - -- Pump/Motor W 24 °a 1/2 HP W v z 16 F . . J Motor Type Split-Phase Three-Phase o 8 R.P.M. 1750 Phase 0 1 3 Voltage 115 200 230 200 230 460 575 0 0 32 64 96 128 160 192 Hertz 60 CAPACITY-U.S.G.P.M. Operation Intermittent Temperature 140°F Ambient Total Head (feet) 8 12 16 20 24 28 29 NEMA Design A GPM 1/2 HP 150 120 95 70 40 7 0 Insulation Class A Discharge Size 2"NPT std.(3"opt.) Dimensional Data Solids Handling 1-1/2" Unit Weight 70162.(SPSOABI 77 lbs.) 4-3/8--"l8-1/8 I.All ditensions in inches 5-78- Power Cord 16/3,S7Wq 111W,2001,230V=10' vary 1/8 inch std.(20'option/)16/4,STWA,3o 200V, 2 NPT 1.Coronent dimensions may 2301,460V,or 575V=20'end. 4-5/8 DISCHARGE 3.Not Fr construction pure es unless cedified 4.Mine sions and weights are appr image Materials of Construction 4 5.Wes ervetherigheto make revisions to our Handle Steel 7-6/16 modu,15 and their Lubricating Oil Dielectric Oil specif sions without notice Motor Housing Cast Iron{ 18"MINIMUM SUMP DIA. Pump Casing Cast Iron" Shaft Stainless Steel Mechanical Seal Faces:Carbon/Ceramic Shaft Seal Seal Body:Brass Pump Spring:Stainless Steel ON Bellows:Buna-N 12-7/16 6� DISCHARGE 12-13/16 Impeller Cast Iron' HEIGHT Upper Bearing Bronze Sleeve 5-7/8 55-3/4 Lower Bearing Single Row Boll Bearing PUMP OFF Fasteners Stainless Steel 'SPS DAB I=Bronze HYDROMATICTh Pumps, Inc. 1840 Baney Road, Ashland, Ohio 44805 (419) 289-3042 Daily Flo w Rate: 15 Gallon x 50 Employees = 750 gpd Employee I Day Primary Trench Length: 15 Gallon x 50 Employee = S.F. I Day x 1 = 09 If Employee/Day 1.20 Gal. 3.00 Ft. Reserve Area: 120 Gallon x 50 Employee x S.F. I Day x 1 = 209 If Employee/Day 1.20 Gal. 3.00 Ft. Flow Rate/Lateral: Number of Orifice x 0.41 gpm /orifice 24 x 0.41 = 9.84 gpm/lateral Total Flow Rate: #of Laterals x Flow Rate/lateral 3 x 9.84 = 29.52 gpm Friction Loss: hf= (10.46)(L)(Q) 1.85 Total Head. O1.85 Transport Pipe: Static Lift = 7.00 ft Friction Loss = 1.27 ft hf= (10.46) (20) (30) 1.85 = 0.46 feet Residual Head = 5.00 ft (130) 1.85 (2) 4.87 Design Point: Manifold Pipe: Total Head: = 13.27 ft Total Flow: 29.52 gpm hf (10.46) (18) (14.8) 1.85 = 0.12 feet (130) 1.85 (2) 4.87 Use Hydromatic Model: O$P33 Lateral Pipe: 1/3 H.Y.or Equaivalent hf= (10.46) (70) (10) 1.es = 0.69 feet 3 (130) 1.85 (1.25) 4.87 Drainfield Dosing: Daily Volume: 750 gals Dosing Frequency: 4 Time(s)/Day Dose Volume: 187.5 gals Pump Run Time: 750 Gallons/day = 6.63 Minutes to Dose Drainfield 28.30 GPM 4 Doses/day HATTON GODAT PANTIER Septic System.. Page 2 H A T T O N ,_ t E? €; T PANTIER 'i 1840 Barnes Blvd SW Tumwater, WA 98512 Phone: (360) 943-1599 — Fax (360) 357-6299 TRANSMITTAL LETTER To: Mason County Date: November 2111, 2004 Mason County Forest Business/Agency: RE: Products Septic Address Agency No. City, ST Zip HGP Project# 04-155 We are sending you: ® Prints ❑ Mylars ❑ Specifications ❑ Other 3 Copies of septic plan 1 Copy of calculations 1 Submittal form Items transmitted for: ® Approval/Submittal ❑ Your use ❑ Review and comment ❑ As requested ❑ Other Remarks: c Signed: David W Spiller Copy to: ❑ Regular Mail ❑ Overnight Fred Cool, Port of Shelton ❑ Courier Z HGP Delivery ❑ Client pickup E:\office\JOBS\2004\04-155 Port of Shelton-Mason County Forest Products\04-155 trans 11.23.04.doc Performance Data Pump Characteristics 32 Pump/Motor Unit Submersible Manual Models 0SP33MI 05P33M2 w24 = _ _.-- LL Automatic Models 05P33A1 05P33A2 w 1/3111' Horsepower 1/3 16 Full Load Amps 7.8 4.6 z - ._ Motor Type Split-Phase 2 -S - - R.P.M. 1750 o s-. Phase O • I ask Voltage 115 230 0 Hertz 60 a- 1 s,j/E P/r'C 10 20 30 40 50 60 Operation Intermittent Tb M C/73a 27 CAPACITY-U.S.G.P.M. Temperature 140°F Ambient Total Head (feet) 4 8 12 16 20 24 25 NEMADesign B GPM 1/3HP 60 55 48 39 28 7 0 Insulation Class F Discharge Size 1-1/2"NPT Solids Handling 5/8" Dimensional Data Unit Weight 50 lbs. 3-7/8 6-3/4 Power Cord 18/3,SJTW, 18/3,SJTW 1/e 10'std.(20'opt.( 20'std. I,All dime sions in inches 4.1/4 1-1/2 NPT 2.Comportnot dimensions moyva ±I/flinch Materials of Construction 3.Nat for nstruman purpo unlescerlified Handle Steel 3-3/4 4.0imensi ns and weights 5 me appr ximate Lubricating Oil Dielectric Oil � S.we rase a Iho dgM to Motor Housing Cast Iron make re isions to om products ad their Pump Casing Cast Iron spoof icn on:withom Shaft Steel notice Mechanical Seal Faces:Carbon/Ceramic Shaft Seal Seal Body:Brass '�'� '. Spring:Stainless Steel ` Bellows:Donna-N a>t 1z-1/8 Impeller Bronze / PUMP na/a � 11 oN Upper Bearing Single Row Ball Bearing TM Lower Bearing Single Row Ball Bearing Base Castlron Fasteners Stainless Steel PUMP OFF HYDROMATIC'" Pumps, Inc. 1840 Boney Road, Ashland, Ohio 44805 (419) 289-3042 SEPTIC SYSTEM 11/12/2004 Leasee Mason County Forest Products HGP # 04-155 Parcel Number 42002006200 Applicant Port of Shelton 450 W Business Park Rd Shelton, WA 98584 Statistical Information Land Use Saw Mill No. Employees 50 Primary Flow Rate 15 Gal / employee ! Day Reserve Flow Rate 15 Gal /Employee / Day Soil Type (Class #) 1A Application Rate 1.20 Gal / SF / Day Trench Width 3.00 Feet Orifice Spacing 36 inches Orifice Size 118 inches Orifice Flow Rate 0.41 gpm Number of Laterals 3 Number of Orifice / Lateral 24 Total Number of Orifice 72 Residual Head 5.00 ft Pipe Length (Transport) 20 ft Pipe Length (Manifold) 18 ft Pipe Length (Lateral) 70 ft n.tcr dI Constant (Mannings) 10.46 Transport Flow 29.5 gpm Manifold Flow 14.8 gpm Lateral Flow 9.84 gpm Roughness Coefficient 130 Pipe Diameter (Transport) 2 in .1 DS Pipe Diameter (Manifold) 2 in Pipe Diameter (Lateral) 1.25 in Static Lift 7.00 ft HATTON G DAT PANTIER e:\office\.,.\ossmasterl Septic S stem--Page 1 W H H in W LL' LL Z > F Q LL J ❑ ' z J cc .o J• W m ' w CO Q > C7 0 O in 0 to ' J O J .N J f0 N P' J O O O ;N O O J ^w O O N J � C C o Q U N wO. II a Q N o foe d Z C7� LL � N LLN Nom •.• • Q ? VQ' LL U) — dLL J o N LL J Z Z N < . 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J0HJ W W U) ¢ J ri 2 mU) ppZ SOU) WW Zo Oz _ fl : = =' - ate - J ¢ p F- (O N (O N 5 - ED ~ <~zO w U S W W m Q Z Z D0 ftm z ¢aOQO 30W O W 2 -XSo F- NQm -� CL O 0 �oaJF Z W0- Q 7 � J >' p> ¢ ¢ 2X ¢ �.— ¢ O co op =� fY2J JWy W ZUoO _ 00 Jm OH H "' a ZU mo- SOWW 0)) m0 U w � ¢ � Jw O2F- ¢ ft U) F= F- u) HM - ap ZDO 00 z 0- _j ) Opw X-�JiLs v Z V) � � W - H 0 U mwcaoOJ I- zz W ALL ELF- m � v W WU) W� �t- U woO > w o z z x00 < 0Y z22OW z ¢ J W > SU ? OWUv Jio OU zOO Q and cJWLp � 22 5o<JmO ZQFvD Oa 0 � m0w coO Z g ¢ COz z z 0- Z) (N ft U- - ' 2 00 LL O F H ® Y U ftJ U¢ m z �U p74// __ m q ZF— > 0 c¢n Q z o A -B S V iLT FOAM 111 ' ed February t8,1998 PARCEL L JO NT(FICATItiN' Pori- O4 S... *csr4 Applicant 'Y ci nl Cj ro- s+ 1 VC U tc Assessor's 10 Parcel# c4 ac&.. . c otaao Permit Number SWG �- (Twelve-DigitNumber) Installer O Subdivision (Name/DWlsionlBlooklLot) Designer hfnitN A4Y Ib I2Qm�-t e K INSTALLER CHECKIM NIA Yes Prior to Completion 1. SEPTIC TANK A) >5 ft.From foundation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B) >50 ft from wells and surface water? . . . . . . . . . . . . . . . . . . . . . . . . . . — ___ C) Bldg stub-out to septic tank: clean-out if not 1-2%? . . . . . . . . . . . . . . . . . — D) Baffles intact and clean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 E) Dividing wall intact?. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 14 F) Risers installed for access? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . .. . _L G) Tank Size: 12.00 gal.;Manufacture fl F\O. l /I enitt II. D-Box A) Leveled with water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x B) Speed leveler used? . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . III. DRAINFIELD A) >10 ft from foundation and>5 ft from property lines? . . . . . . . . . . . . . . . _ L B) >I00 ft from wells and surface water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . X C) >10 ft from potable water lines? . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . X D) Laterals level to±I inch&end caps present if not looped? . . .. . . . . . . . — X E) Gravelless chambers utilized? . . . . . .. . . . . . . . .. . . . . . .. . . .. . . . . . . . F) System dimensions the same as shown on the design? . . . . . .. . . . . . . . . . — X G) Gravel clean,properly sized,and proper depth? .. .. . . . . . . . . . . .. . . . . — X H) PRESSURE SYSTEMS 1) Sand quality ASTM C-33? . .. . .. . . . . . . . .. . .. . .. . . . . .. . . . . . . — 2) Head height uniform and z24 inches? Actual head height . . ____ 3) Clean-outs and observation ports present? . . . ... . . .. . . ... . . . . . . X 4) Mound: Side Slope 3:1? . . . . . . ... . . . . . . . . . . .. .. . . .. . . . . . . . —�- 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I? . . . . . . . . . . . . . — — IV. PUMP/PUMP CHAMBER ' A) Pump make v ; Pump model S P 50 — A B) Chamber size I ao() gal; Manufacture A}+�C1.S CC c _ — — C) Height of pump off bottom of pump chamber (1_________inches — 1G D) Pump chamber draw-down gallons per inch E) Pump capacity gallons per minute F) Pump controls:$ j)_(or)Elapsed Time Meter (circle if Installed) If timer is used:Pum On 3.L Pump Off$.ç,Ar — ___ G) Screen basket o (fluent filter ircle one)installed? k H) Riser installed for access9 . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . — -"C' — I) Alarm installed? . . . . .1SJO. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . . . As-wa.t DRAWING CHECKLIST ❑ Drainfield&manifold orientation &layout ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank placement.❑ Location of buildings. (I)❑ Observation port&clean- out location. ❑ Location of wells& roads. ❑ Undisturbed native soil between trenches. ❑ North arrow and CAUTION:Minor but adjustments septic compromise tn o viability of orientation te ..made hee the field resspos installer li are obtainrioly r writtene o approval fromfrom either the health department or the designer before making any deviations from the design that affect the system viability. Any deviations from the approved design must be shown above. CART{FICk110 4 OF 1t 1StA1 L A C1i33N Installer Check a box from Row"A"and"B",sign and date the certification A. I certify that I installed the system without any U I certify that all deviations from the design stamped deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above. MCDHS B. I certify that I contacted the designer and left the U I did not contact the designer prior to final over because the system open for inspection up to 48 his prior to designer waived the notification requireme t. cover. I further certify that all information contained on this form is accurate. I understand that if the info oration con ed herein is not accurate,there will be just cause for immediate suspension of my installer cc ' cation. ignam last a The undersigned approves this installation on behalf of Mason County ep m of H eb Services. 3 leSamtan a