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HomeMy WebLinkAboutSWG95-0469 - SWG Application / Design / As-Built - 7/7/1995 4026,221 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG 95- 01 y a m 426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date s N PHONE (360) 427-9670 Receipt No. Amount$ Z X OWNER DATE, w m W '� CHECK APPLICABLE ITEMS ✓ 3 MAILIN AD Irrn S AYTI PH NE: NEW SYSTEM l E� _ Gf REPAIR SYSTEM CITY: STATE: ZIP: MAINTENANCE REVIEW w Tb M G L{S SINGLE FAMILY m PROPERTY ADDRESS: OTHER — Z SPECIFY: 3 SP CIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL Cow -IrrP O r n B COMMUNITY WELUPUBLIC SYSTEM SYSTEM WFI# -rot, LG LK SYSTEM NAME rr Ln/, Lo A an C* jj � eS4 �/'� AME ANT Name of Lot �ft.x 1�ft. MAILING ADDRESS 1 Installer ' Size: acres T EP ONE c� Name of ��—�{ um er o 2 SIGNATURE o Designer 11 V Bedrooms �! X ' t PLOT PLAN Draw a dimensional plot plan, I including: m g16ft Precise location of test �1 > 0 holes,showing ix�: L-r y rt76 4 measured distances to property boundaries. �� LID �� � u�tt I��I owl �1 �{ F r �crEntry road;other roads, _r U'rfpT bd�o y VL 1 driveways. M� NOTE: DO NOT DRAW IN ■--r t SYSTEM DESIGN SA�1TiYd �(ARiA OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. SOIL LOGS 4 y !� 0--16 wl sor+.f ltQrc �6 Depth from Original Grade to Restrictive Layer or Water Table: In. DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS Finding Score esigner Two Soil Type Vertical Se aration in. Septic Tank Daily p �p Capacity: �� Gal. Flow: ��O GPD Slope [ i / Appl. Infilt. Parcel Size 6IJ Ac. � Rate 0. 6 GPD/FT2 Area FT' Distance to Shoreline _�IfA7 it. Total _ Inspector Date COMMENTS/CON fDITIONS FOR APPROVAL 1411 09I Q11 i� Dfl�ua� fi�Br �rrcoar. 21..E ySfil aWt,4�0,05 it •All septic systems must be designed and installed by contractors certified by Mason County Department of Health Servic ,unless prior approval is granted by the department,or the design is by a professional engineer. •Septic permit approv do not imply other building site requirements(i.e. RLC,Water Adequacy) have been met. •Any change from th ed use of the property or any site alteration affecting a system design may invalidate this pe mit. This Permit expi ears from date of site inspection.Denial of this ermi be appealed to the Healtp OfficerAvithin 0 days of denial date. SITE REVIEW: M ESIGN REVIEW Apt _j Not Approved NS L Ap roved ❑Not Appr vgd BY: DATE-7-/f4 BY: DATE: —� BY: DATE: TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTT M: App i is Copy MASON COUNTY DEPARTMENT OF HEALTH SERVICES MASON COUNTY BLDG. lll, 426 W. CEDAR P.O. BOX 1666, SHELTON, WA 98584 (360) 427-9670, FAX. (360) 427-8425 DATE: FROM: Guy Grayson - IV — FOR: 1wN PARCEL: x E, Tc Zjaun '_�„'7'. jai t!e aBaue aue��e�te�cced r"' "'_ (rad 6ee�c zealeu�ed a.�cd G�r��Z?Zd ��l�P', 0`l/�'D. " �� 7lce aca.aaoc<mJ ace; ' 1) TEST HOLE DEPTHS IN RESERVE AREA ARE: 49" & 56". 2) SLOPE IN RESERVE AREA IS 14%. 3) CALCULA,Ti[;AaS SHOW THAT A MINIMUM SOIL y5 DEPTH OF •• IS REQUIRED IN RESERVE AREA TO SUPPORT THE PROPOSED RESERVE BEDS. 4) DESIGNER TO ADDRESS ISSUE PRIOR TO DESIGN APPROVAL. s 5) DESIGN PACKAGES BEING HELD IN "ALpha" FILE AWAITING RESPONSE.--G.G. MASON COUNTY DEPARTMENT OF HEALTH SERVICES MASON COUNTY BLDG. 111, 426 W. CEDAR P.O. BOX 1666, SHELTON, WA 98584 (360) 427-9670, FAX (3cS0) 427-8425 ..:........ DATE.: 2 / Z,( / q L .._ . : :.:. TO: ���i �� FROM: ^' ^' ^' Guy Grayson N N FOR: r1f A�Q PARCEL: (2 3 3 u -1 - W 61D 1 ........... r .3 �OIUL d'ealq�c D^�� de, 4 4" ze�ce�cccd �1teCe �aa We WA40 a(d) a zer 1) LOT DIMENSIONS INACCURATE. 2) TEST HOLE LOCATIONS INACCURATE, 3) SLOPE FOR LONER LATERALS INCORRECT.-G.G. - - DESIGN FORM - PAGE ONE R.vis.d 07/28/95 A design will be reviewed when 3 copies of each of the followingftta submitted: Completed design form that has ,b,wa-signed and dated �/J/] N'j • Completed Resource Lands and Critical Areas Checklis ICv //�`J� • Scaled plot plan, including all applicable items on checklist L� • Scaled layout sketch, including all applicable items on ch9um s 1996 Cross-section sketch, including all applicable items on checkl R PARCEL ID ENTIFICAT_'- - Vlc I Fo Permit Number SId6� 7 v © / �R / Designer's Name_z,_i2m.,/C� 2_z q — II Applicant's Name �// 2!'1 �iOC(J4 prop. Owner's Name 41W• /'-f •, eoaCG,-� II II Mailing Addres _ /D- 5711 < �U Mailing Address 09/ . 67 II 4 9 S -1 U /4Ca l�l.A 96�1/f i y o a e Lip 6 --Zf p I II p ZY II II Assessor's Parcel No. � �30 � OOoo gubdivision ,.1.]�q/Kll'( -GOyC e e- _f u er `--CN_ e �ivision occ/'Lo'tT— II DESIGN PARAMETERS ROyun l ✓ It(ala_._, �, ✓ II nesigned II ,- Vertical Sep d7,3C jon 11 II Mound Subsurface Pressure Gravity Bed Trench 31.8$ in II II Septic Tank/Drainfield Specifications rII II No. Bedrooms 3 I Pressure Distribution? Yes No II II Daily Flow G ¢ andcvd I........................ (If yes, Proceed. . .) ......................::II Septic Tank Capacity —12 O al I Receiving Soil Type (1-6) I _ II Receiving Soil Appl. Rate Q g� cpd/ft° I Laterals 11 Trench/Bed Bottom Area ft2 I Schedule/Class, Z00 II 11 Trench/Bed Width ft I Length /tea- r/ ,�O Zc/ ft Trench/Bed Length 2 60 ft Diameter /Z• in II Elevation Measurements I Number — - 1 Original Drainfield Area Slope /7 2 I Separation ft 1 Drainfield Area Slope if Altered 17,Z I Orifices , Total Number of Orifices II 11 Depth of Bottom of Trench/Bed /Z•/z in I Diameter .7 Gin 11 11 from Original Grade upslippe I Spacing -3F in Fr ze II o P I Schedule/Class - �Z -k T,ength / FQ d1i 5- ft II Infiltrator Used? U Y s U No I L-ameter � - In 11 n I Transport Pipe II Pump Required? Yes u No I Schedule/Class Zee II 1 :::::::::::::::::::: (If yes, proceed. . . ) ::::....................:: i Length ft II IF* I .... .............. Diameter ' in II Pump/Siphon specifications I Dosing and Pump Chamber 11 Difference in Elevation Between Pump Shutoff I # Doses/Day 11 and Uppermost Orifice ft I Dose Quantity cal II Chamber Capacity 3Q0 cal Uppermost orifice is D kgher, U lower I II than Pump Shutoff I Check the following components if they drain II Capacity ® Tot. Pres. Head .39-.53 qpm between doses: /" fotdra L '3es II Calculated Tot. Pres . Head . �ri ft I .O SB K95_ y,936*i.Toto(-1 1 (Attach Pump Curve) I Laterals Manifold Transport II I !/oP-CA x . O_ Got ,vidd4-nH5 DESIGN FORM - PAGE TWO Rwi..d 07/21 II DESIGN CHECKLISTS II Scaled Plot Plan I Scaled Layout Sketch I Cross-Section Sketch Reference depth from orig- Test hole locations I �Drainf field orientation I final grade: I a d layout 11 Property lines I P I U Septic tank lid and Trench/bed dimensions and I drainfield cover depth IIl Existing and proposed I critical distances within 11 wells within 100 ft I ayout I Reference depth from orig- 11 of property lines I I inal grade and restrictive locations I strata: critical distancemeasurements to 'cuts, IV-Box/--T"/"L" eptic tank/pump chamber I LJ Laterals,', trench/bed banks, surface water I location I top-and bottom 11 U Location and orientation I : . Observation port location I : I Curtain drain collector 11 of cn and all I I 11 absorption area I U Cleanout location Sand augmentation 11 components I II i u Manifold placement i No external reference needed Location and dimension rR� II f rimary system and I u Orifice placement I u Observation ports and 11 r erve area I N I cleanouts II I `�' Lateral placement, with I 11 yxldings I distances to edge of bed I \Up/downsl mound information /Direction of slope I JAAudible/visual alarm I and downslope II i icator I referenced Idth II I I waterlines I Scale of drawing shown cap depth at / on scale bar Iand edge of bed Roads/easements/dr eways/parking Additional Mound Information: 1 slope jCritical resource lands I U En ope width I sl a bed elevat. 11 (if plicable) I u I II `�" Overall fil ons I Com leted Resource ds and North arrow and scale of I I Ar�ae Checklist 11 drawing shown on bar I I d �� /lip�l/VIOoi I - ;�v Yjau II DESIGN APPROVAL DdtB I II � 11 The undersigned designer does, u does not, waive the reqirement to be notified by the II installer of the installatio iven 48 }cuxs to perform a final inspection prior to 11 cover. a 1 1c li II STgnature orl II The undersigned has reviewed and app v d this design on be if of Mason County of Health �I Services. 71//G' 14 II a pec a e II CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIONS: ✓ THE DESIGN IS STAMPED -APPROVED- BY MASON COUNTY DEPTARTMENT OF HEALTH SE RVICSS 11 ✓ THE ON-SITE SEWAGE PERMIT RAS NOT EXPIRED; EXPIRATION OF SAID PERMIT IS BASED ON THE DATE OF INITIAL SITE INSPECTION, NOT ON THE DATE OF DESIGN APPROVAL II ✓ THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS 11 OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES L ai 17-2 s \ > 1nLiAM 1, LA 1 s 3 "v� &S on ion ,Paled s <o v-e Cyr �- Pt, SA / Z33a S3 - caco / Alit,Date a/ a� /Va7 td S2aCo � �� r� 19b� Elrv. / tO czr,LL �a l cc�l s� it L �Q15 �� / ri 4-1 eScv6 9..3- o y6 9 .Car I 123 3o n `i A/ �o � r 3° ` pc o Pa„ Dp('Cb ,�,sTa, , a off- i -,r- �� � ✓,Pn �o�ra p��7. i � Kati 4t B N h Ate4svxd �I �\ l t• l � e z � ti � o yak I. I N LN ands sae Zv / � z3 ,90 53 000B/ INSTALLATION_.1MAINTENANCE Pressure Distribution Systems 1 . Install laterals with contour of the ground. 2 . Install locator tape on top of all drainfield laterals . 3 . Install observation ports as indicated on Plot Plan , 1th bottom extending to the drainrock\native soil interface . 4 . Install drainfield during dry weather and soil conditions , any soil smearing must be eliminated by hand raking. 5 . Install threaded clean-outs at the ends of all lateral ( caps must extend to within 6" of finished grade ) . 6 . Install audio/visual high water alarm. 7 . Install 1/8" mesh non-corrosive screen (min. 12 sq. ft . surface area, preferrably in septic tank at outlet port . 8 . Install check valve in pump transfer line (and manifold when needed)to prevent system drain-back into the pump chamber . 9 . Provide a 3/8" NPT (National Pipe Thread) fitting between check valve and pump for pressure guage connection. Use pressure guage at time of pressure test to permanently record the 'Perfect System Pressure ' , so a comparison can oe made during inspections to determine 'Condition of System' . Pressure guage may be removed and replaced by pipe plug between inspections . 10 . Install all laterals with orifices placed at 12 o ' cloc . Leave at 12 o ' clock and place suitable shields over orifices ( except when using Infiltrators ) after pressure test and upon approval by Health Department . 11 . Filter fabric required over drain rock prior to back filling. If the drain rock extends above natural grade , run the filter fabric at least 2" down the trench wall . 12 . Have the septic tank and pump chamber pumped or inspected every 3 to 5 years . 13 . Inspect and clean pump screen every 6-12 months as n ected . Inspect floats and test high water alarm every 6-12 months as needed & use pressure guage to determine 'Condition of System ' . 14 . All materials and workmanship must meet County and State Regulations . 15 . Deviation from this design without pricL approval from the designer and Mason County Health Depart t,,, will make this design v 16 . IIfPre-Treatmentid is required, refer to : healphs•t�(�0 �Md INSTALLATION/MAINTENANCE /n/t/a/8 e of Pre-Treatment Systems Date '1 ` ON-SITE SEWAGE INSTALLATION FINAL INSPECTION ............... q r� ::::: DATE CALLED IN: C7IS TIME: vV INSTALLER: APPLICANT/OWNER: LA-) � IC)L0Y-) CALLER: PHONE # OF CALLER: PARCEL NUMBER: ����� 5 3 00 nc) SUBDIVISION: - � ( c)( DIVISION: l7 LOT: SYSTEM TYPE (CHECK ONE) : ^ .._. ." ... .__.. ._. PRES - - GRAVITY ..._ .� INSPECTION SCHEDULE (CHECK ONE) : APPOINTMENT PLUG IN AS-BUILT ON-SITE? (CHECK ONE) : It r—, j. j u "YYY "`iii 1 YES NO if ............................................................................................................................................................................................... STAFF INITIALS: h:caLhn.0 Revised 07/01/95 i ON-SITE SEWAGE INSTALLATION ........... ................................ STAFF INSPECTION REPORT .............................................................................................................................................................::.. ............................. I STAPP csSC IST I 1 CONPIRNP1l BY INSPECTOR? i IYes No Comments I I T. SEPTIC TANS I 1 A) >5 ft from foundation? E) Bldg stubout to septic tank: cleanout if not 1-2X? I c) Baffles intact and clean? D) Dividing wall intact? — IT. D-Box Leveled with water or speed leveler (circle one)? i � I III. DRAINPIBLD I _ I A) >10 ft from foundation and >5 ft from property lines? — I I E) Laterals level to z1 inch & end caps present if not looped? . — I c) System dimensions the same as shown on the design? — D) Gravel clean, properly sized, and proper depth? — E) PRESSURE SYSTEM I I) Sand quality ASTM C-33? AIA— I I) Head height uniform and >_24 inches? — I 3) Cleanouts and observation ports present? I 4) Mound: Side slope 3:1? I s) Owner informed electrical connections mist be made — by owner or licensed electrician and inspected by DL17 I I IV. A) >10a warms LINEs drain I A) >10ft from drainfield, transport line, and septic tank?s) Wells >100ft from drainfield? - I V. Poem TANG a) Screen basket or fluent fi er (circle one) installed? a) Riser installed f access? ' I C) Alarm installed? i _ I I vx. As Erma Rs4asR8Dz I I I vII. OTSER COMMENTS I I I I I I I � I I The undersigned has reviewed this ilea es hese indings;mbehak:fofty of Health Services. I I c or I I h:callin.w Revised 02/01/95 _ I ASBUILT FORM - PAGE ONE P. I..d 12/14/94 PAILCEI, - jlApplS,A,t I.am,. i `` Installer's Name �J '�"""'! Assc-ssor's Parcel No. Z J �S 3 O 0De Designer's Name 9 w r I — II INSTP.LLER CHECKLIST N/A Yes Prior to Il I I. SEPTIC TP.N3C Completion A) >5 ft from foundation? V B) Bldg stubout to septic tank: clearout if not 1-2t? !/ I! C) Ba£flas intact and cic-ar_? D) Dividing wall intact? V _ II. D-BOX Leveled with water and/or speed leveler (circle) ? II III. DRAINFIELD A) >10 ft from foundation and >5 ft from property lines? 1/ B) Laterals level to ±1 inch & end caps present if not looped? _V C) System dimensions the same as shown on the design? L _ D) Gravel clean, properly sized, and proper depth? J ✓ _ E) PRESSURE SYSTEM Il 1) Sand quality ASTM C-33? V — II 2) Head height uniform and i24 inches? v — II 3) Cleanouts and observation ports preserit? ✓ _ 4) Mound: Side slope 3:1? ✓ — I 5) owner informed electrical connections must be made by owner or licensed electrician and inspected by DLI? — 1/ IV. POTABLE WATER LINES A) >loft from drainfield? — V II B) Wells >looft from drainfield? V. POMP/PUMP CHAMBER A) Designed pump used, ors tacked for equivalent pump? I/ — II B) Screen basket or fluent filte (circle one) installed? — II C) Riser installed for access? II D) Alarm installed? — p CERTIFICATION OF INSTALLATION _ . H Installer: Check box from Row •A,` check box from Row •B,• sign and date a certification. II 11 A. I certify that I installed the system u I certify that all devia ions from without any deviation from the design the design stamped "APPRNED6 by MCDHS are II stamped -APPROVED* by MCDHS. shown on the *reverse sid i of this form. u h B. tJ Z certify that i contacted the � I did not contact the de ygner prior designer and left the system open for to final cover because t4ie designer II inspection up to 48 brs prior to cover. waived the notification Xe(ju rement. II I further certify that all information contained on this form is accurate.. . I understand u that if the information} obntained;hereinlis not accurate; there will-he 3ust_cauge:'fOr. = u immediate suspension of' m*ae ins lerrrcertification. II sa ae The undersigned approves half of Mason County Department of Health Services. _- .. I AS—BUILT DORM — PAGE TWO "��••' 1 2 /14/94 �--- PARCEL IDENTIFICATION _ Applicant' ., Na.Tr� Permit Number SwG9 - d Subd','.is ion Lod" l — ��a� ,se sir Par . l r,, ZrS 3� ero I Installer's Name we ve- igi - u �er7 Designer's Name O.I 4A drfcf I� II AS-BIIILT DRAWING II n II S S u II 3 _op II �• � oP' �.-- ii II II 'III u er an g—etally CAUM l: KSnot &djaetarnb Co septic tank lacattm and dralnfleld crteatatlm nude Sn the field by the Sna Cea IC to eept&ble to Loth fire department and the deatgner, but could In cartstn oaaee i�tae the viability o the M Eras eltber the health department or the dent before malting imfsller•a responsibility to obtain prior written li devi&ttma from the appEO.ed deatyn aar&t he &bole. devt&ttan& f:v the desutgn th&t affect system viability. ty Any II - AS-BUILT CHECKLIST u n U IIndisturbled native soil u Drainfield orientation U Observation port location between trenches II and layout U Cleanout location F-1 nn U North arrow tJ Trench/bed dimensions and r -1 critical distances within U Manifold placement ri shown U scale of drawing hlayout n on scale bar II U U Orifice placement II D-Box/"T"/"L" location U nformatio _ Lateral placement, with dditional M and II U Septic tank/pump chamber distances to edge of bed rJ Endslepe width location n II L-J Location Of wells, roads F_1 1--1 Overall fill dimension:' ill U Location o` buildings _ - _