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HomeMy WebLinkAboutSWG2001-00203 - SWG Application / Design / As-Built - 5/18/2001 PERMIT NO. SWG _ coMASON COUNTY DEPARTMENT OF HEALTH SERVICES, cC 0 �_ � g_o � a 426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date <. y ID 0 PHONE (360) 427-9670 Receipt No. Amount$ — Z F PR ERTY OWNER: DATE: CHECK APPLICABLE ITEMS �/ 3 PR GL.C:MC='VTS �/ 3c� p MAILING ADDRESS: DAYTIME HONE: NEW SYSTEM t7 JA,//-k 2.35- 6 3 /oS' REPAIR SYSTEM d ~' CITY: STATE: 20r6 1 ZI TABLE 6REPAIR Jz&-N70 ✓ WASH, 9$O MAINTENANCE REVIEW PROPERTY ADDRESS: SINGLE FAMILY .� c �Ilot l3veMr+ ✓� OTHER: � 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL I� ND �� WS- �p L/U t_�) Aw6F COMMUNITY WELL/PUBLIC SYSTEM SYSTEM WFI N I W L�MCNT ��vIJ S y97s Lc�w G72f{(fCs6. /ID SYSTEM NAME \. IN S M/AL pne) �L�/�7 1 .5' L7"/ //2? APPLICANT ME elC ?T �� 1 IN Name of Lot .5eE 4I`e5-(4P4v ESS ft. MAILING ADDR 76- Installer TOw �P i./ • g I �/�E� Size: acres TELEP ONE O Ar5 !cA 5S Name of um be,o SI E o !. Designer Af1�7 b0,y/L edrooms = OFFICIAL USE ONLY BELOW THIS LINE NT DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIC NS Io m o L� x �i0'�1n �ds�' Vlol¢5 vs� ID Slvvi1✓f IG p LS So,/w Cd'0b�5 5q � 1dAv— SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely INSPECTOR(print name) INSPECTION SIGNATURE DATE PERMIT EXPIRATION CATE P a .52( •All systems require ongoing Operation and Maintenance(O&M)as specified 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 uses 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. Ty Perm it a fires 3 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. DESIGN;;iEVIEW APPROVAL BY: DATE: INST LLATION APPROVED BY: DATE: / $ 1 \ 0 TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy • w June 5, 2001 Pam Denton Environmental Health Mason county Health Services PO Box 1666 Shelton, WA. 98584 Re: Design for JAMES E./ANNA M. CLEMENTS Case No. SWG2001-00203 Parcel No. 322075090904 Dear Pam, Per your request,please find the enclosed original NOTICE OF OPERATION AND MAINTENANCE OF ON-SITE SEWAGE SYSTEM. This form has been signed b Jim and myself and notarized per your directions. Also enclosed is check#13567 in the amount of$8.00. This is for our property in Tahuya. Please let me know if you have any questions or if you need anything else. Thank you. Anna M. Clements 12912 SE 185U' St. Renton, WA. 98058 206-295-9868 A 206-295-9868 Jim Mobil (5 D 206-755-1739 Anna Mobil JUN 06 2191 HEALTH SE ICES i DESIGN FORM-PAGE ONE D� E n O Ives clasign will be reviewed when 3 copies of each of the following Items are submitted: ! „ o� dadsrnramthatn..6eenaansa.ne� . seNwayoAsimi . were. a»wad p ot°vlr�.NwNdNw.M Nsaan.cn G'aw+eat on A ek M I�,, ,_ anakNtt •F CF►y_".. Permit her DesigncesNsme: aGJ'�1CJ`d Designer's Phone#: Applicant's Name: S6 nes + Onto, C(e. cn 4S• Assessor's Parcel No.: 3 07- Mailing Address: 1 all 1 CL SE 1$S St /0 Re44on Wo, 919'05Y Subdivision: City slaw zip Treatment Device ❑ Glendon Biofilter 8 Sand Filter ❑ Mound ❑Sand Lined D minfield ❑Aerobic Unit-MakdModei: (3 Disinfection Unit - Make/Model: °- Drainfield Type �T ❑ Gravity XTrench WGraDm all kChambers - SepticTank/DrainfieldSpecifications D.F, Laterals Number of Bedrooms a I a Schedule/ClassDaily 20G Length / s 7 rft SSq)c _Tank Capacity O 1600 Diameter o / Receiving Soil Type(1-6) Number Receiving Soil Appl.Rate /.A • udv Separation Required Square Footage 200 Doidped ga Square ZOO O6A•5 o Total Number of Orifices Orifices Percent Reduction 0 Trench/Bed w� [ ft Diameter / in Trendr/Bed Length y7l-g"C-p—ft Spacing U hi •• ElefaYM Me-ftbrbtneAhs-- '- _ _ .. . _ _ Manifold Original Drainfield Area Slope p , �gdulelClass o Z� New Slope ifAhered Y2 Diameter Depth of Excavation fiom in Preferred Manifold Configuration Used? Yes ❑No Original Grade �. aim) Transport Pipe (130"41W) Schedule/Chw O LO it rr Length O D Designed Vertical Separation in Diameter .s- /,s--r in Gravelless Chambers Required? ®Yes ❑No ❑Optional Dosing and Pump Pump Required? W Yes ❑No Number of DosesIDay Dose Quantity 911 Pump/SiphonSpecifications Chamber Capacity a Difference in Elevation Between Pump Shumffand Uppermost Pump Controls: Toner(or)Elapse Tune (okvk if required) Orifice: 4a 1 /0 if Timer. Pump On .Pump UWarmaa Orifice is N Wow, ❑Lowa it=Pump Shuouff . Clw&the following components if they drain 1 tw.doses: �y®TeW Pmanwa Hest, Q:966 t7. an !Lals ❑Mentfold ❑ Total Ptaaue Had 15, S' 1 1_3,A ft /� (Attach Pump Curve) A&Atr :OIV4�ds /2100 DESIGN FORM-PAGE TWO ttertred APB 44.19M BMW Scaled Plot Plan Scaled Layout Sketch Cross-Section ketch 10 Test hole locations 0 Drainf'eld orientation and layout Referenced depth t m original grade: D Property lines O Trench/bed dimensions and critical a Septic tank lid drainfield cover Existing arA proposed wells within distances within layout depth 100 ft of pl6perty lines 0 D-Box/"T7"L"IocatioAs O Critical distance pasurements to cuts, fF Septic bmWpump chamber location Reference depth froi m original grade banks,and surfacYe'water 0 Observation port location and restrictive stra : Al Location and orientation of curtain 10 Clean-out location IS Laterals,tren top and bottom drain and all absorption components 15 Manifold placement O Curtain dram coll r ID Location and dimension of primary 0 orifice placement O Sand augmentati system and reserve area 0 Lateral placement,with distances to 0 Buildings edge of bed Other cross-section etail: 0 Direction of slope indicator D Audible/visual alarm referenced M Observation and clean-outs al Watalines 0 Scale of drawing shown on scale bar 61 pRoads/eesanents/dnvoways/ y' , � ,x%�%{' A3tlIG cur zr zyeid. K bee tin.:. 0 Critical resource lands(if applicable) v` n fti North arrow and scale of drawing "� bCa shown on scale bar ` Af ➢ irf , 3 hr ��� `,<,A. ors '?h suer�`" Mr 10py z i Additional Information ® Design staked ou O Operation and Mi interiance Notice Attached O Weiver(s)Attach 'fk?if rn;:>,3 +r y .a. .. xxr,�fe`e Ar P t The undersigned designer does, ❑does not waive the jm�entto be nptilted by the installer of the instal 'on and given 48 hours to perform a final inspection prior to cover / -z.?--0o ) Signature of Designer Date The undersigned has reviewed this design on behalf of Mason County Department of Health Services and determ ned it to be in compliance with state and local on-site regulations: Environmental Health Specialist Date Caution:. DESIGN APPROVAL IS VAUD ONLY UNDERTHE FOLLOWING COMMON. d The design is stamped-Approved-by Mason County Department of Health Services. d The Ong Sewage Permit has not expired,the Peendt etpiration Date Is: ./ The system is installed by a catified installer,unless prior authorlrstion is obtaioed frc ni Madw County Department of Heap Services. ./ Dramfield she conditions have not been altered to adversely affect conditions of � gaao7-aa-9o9a4 �Jrm Rd Or�oiongj pe'�'^4 NO g3—C383 OM -OeS t;ov� RPlpyo)c� Os ara, pfgSurc ck 25+r 1) $yglc,t.k 13ast3ne-j �or.NJ J 05cs Son8 -P1, r ps-e-- � +L) gddr"S �c��ira I Scparo +;o�� Acccs►3 `i o? B8 R95, Rp I. Rat Moe- goi,w ll�Y :3 I L a 33% v"or-4fo✓, is it 46e- Sone 4'l kr- . Pr~--.►,Y«�xE�Ja . IOA�,Q Sur4+ t=llacr - �r �y `� �. � Tte. R3per*lJ was loot a 1oo71ji�j Per m,4- - -H•L 05FL +-j 5oa Pr, �t w;S l,e.l No.J rytpp t , e`DFo 0 I o 0 n St-ptt , u=3o� 1R,Jeu fny , Shope �/S�' sA y 1 G S'loPc �o Wajcn NOsd Cosa L Otter✓�Hoh LP*r'+ y.a p j6�t G-r�Qtaly �d Loa FI(�tr_ (p K20 '_zooz 01146C" Z4" spacipls wt Amp 'Rend a5 = 2 T✓kfi r- Ruhs , oRrrtu stj-on 36 @Pac+wJS nL H3.7S' wida krsf hsic a} I's- ('Lit) PSE) $LKill � 0 i 3• �s s°p Tr tr �� 1 ys.-fr' - y,� i ' = O ,noo. $eo O y"cn..ba6 DEc�S H Z Z CA ' A y r r`epT i tool o G S I f n � 1 v I I turves Pumps `� FEET 30 100� Os P1LVAM S _(� I iscr i I _ 20 so � t 90 e 0 GO Z< /0 60 a 100 _ t20 140 ,60U t ��3 1 Lllt,i p 10 20 30 no p � FLOW RATE �� �62OULDS P MPs ING . sleca =sw,oa°a°Ko.. U ERS F : SEAIES 7!!5 120 NZ35 sQL105 no ' •!— _ ---, stapes f�`_' _ _.} srr10 40 ao , S 2C t. --L— M 10EN_i- 0 00 to 20 20 40 .50 90 100 110 12D GPM 0 10 io 3011 m , CAPACrn Et=.y sJdn 102 -.... ►.--. ... e.entrarnusaassuusc-inev..•s...=.n==rreTeL p1tartllo04u -06 PRESSURE DISTRIBUTION DESIGN WORKSHEET AND/OR CHECKLIST Computed by, BELF,AIR SERVICES P.O. Box 175 Bel£air, WA 99528 (206) 275-6155 Designed for; SW3D F1'4r-r Street address: j SITE CONDITIONS: #,-Of Bedrooms - 2 $oil Type - 2 I . DESIGN THE DISTRIBUTION NETWORK 1. Make Preliminary Determination of Trench/Bed Configuration, A. Daily design flow 240.00 gals. Daily flow = (# bedrooms) X (flow/bedrooms) B. Application rate based on soil type = 1.20 gp /ft2 C, Required absorption area = 200.00 £t2 Required absorption area (ft2) _ [Daily design flow (qpd) ]/[Application rate (gpd/ft2)] D. Selected trench or bed width = 10.00 lin ft E. Total trench or bed length = 20,00 lin ft Trench or bed length (ft) = [Required area (ft2) ]/[Selected width (ft)] 2. Select a Primary Network Configuration A. Lateral length 19.50 ft Lat length ft = [Total trench/bed length (ft) - 0.5 ft]/[# of laterals] B. Lateral spacing = 2.00 ft C. Transport pipe length = 20.00 ft 1 D. Transport pipe diameter = 1.50 in E. Manifold length = 6.00 ft { F, Select an orifice spacing for this lateral 2100 ft 3 G. Calculate the number of orifices in this lateral 10.00 ' # of orifices in this lateral= (Length of lateral (ft) ]/[Selected orifice spacing (€t) ] (ROUND UP TO THE NEXT WHOLE NUMBER) I I . Calculate orifice discharge rate 0.59 gpm J". Lateral discharge rate for this lateral 5.86 gpm K. Select an appropriate lateral diameter 1.00 in L. Class of pipe for laterals is Class 200 3. Design the remainder of the laterals. Let Elev Dif Orifice Lateral # Orifices Orifice Lat Lat # + 2ft Hd Discharge Discharge Per Lateral Spacing Diam Length ---- -------- --------- --------- ------ ---- ------ 1 2.00 0.59 5.86 10 2.00 1.00 19.5 2 2.00 0.59 5.86 10 2.00 1.00 19.5 3 2.00 0.59 5.86 10 2.00 1.00 19.5 4 2.00 0.59 5.86 10 2.00 1.00 19.5 i 4. Select the Manifold Diameter. A. Calculate the total lateral discharge rate 23.45 gp B. Select adequate manifold diameter (from table) 1 .50 (End manifold using Class 200 pipe) 1wc IA `g , + - MAY 3 1 II. DESIGN OF THE PRESSURIZATION SYSTEM PS 1. Determine the Doss Volume A. Dose volume based on soil type 1. Recommended dosing frequency/day = 6.00 do ea/day 2. Recommended dose volume = 40.00 gallons Dose volume (gal)=Design flow (gpd) / Recommended dosing freq/day B. Dose volume based on dose volume/pipe void ratio 1. If entire network remains full between doses = 0 gal. 2. If just laterals drain between doses = 0.00 gal . I Required dose volume = (7) X (Interior volume of laterals) 3. If entire system drains between doses = 0.00 gal . Required dose = (7) X (Interior volume) + volume + volume ! volume of laterals manifold trans. line C. For desired dose volume, select larger of A or B above 40.00 gal . 2. Determine Required Pump/Siphon Discharge Capacity 23.45 gal . Required pump discharge = Sum of all discharge rates from capacity all laterals in the system 3. Calculate the Total Friction Losses in the Network 4 B. Manifold and laterals: 1.00 1. Calculate the Total Elevation lift 10.00 ft. Total elevation lift = [Elev. of uppermost lateral]-[Elev, of low water level in the pump chamber] i. Determine the Total Dynamic Head. Selected residual pressure: 2 .00 ft. Transport pipe friction losses: + 0.48 ft. Manifold and lateral friction losses: + 1.00 ft. Total elevation lift: + 10.00 €t. Total Dynamic Headz = 13.48 ft. 6. Required Pump Capacity is 23.45 gp Total Dynamic Head is 13• If r , AMC 1' Number of bedrooms 2 MAY 2u„i The required absorption area is: 200.00 sq ft The length of the bed is: 20.00 ft PSD The width of the bad is: 10.00 ft The length of the transport pipe is: 20.00 ft The diameter of the transport pipe is: 1.50 in The length of the manifold is: 6.00 ft The diameter of the manifold is: 1 .50 in The total Volume of the laterals is 4.52 gals The volume of the manifold pipe is 0.72 gale The volume of the transport pipe is 2 .40 gale Dose vol based on vol/pipe void ratios 0.00 gals Does volume based on soil type is. 40.00 gals The required dose volume is 40.00 gals The total discharge for the laterals is: 23.45 gals The friction less in the transport pipe is: 0.48 ft head Manifold and lateral friction losses: 1.00 The total elevation lift is: 10.00 ft head The total dynamic head is: 13.48 ft head i 1 1 1 1 { i i i i II i PRESSURE DISTRIBUTION DESIGN WORKSHEET AND/OR CHECKLIST Computed by: BELFAIR SERVICES P.O. Box 175 Belfair, WA 99528 (206) 275-6155 )esigned for* .° ;treat address: '� �- : a Epr ;ITE CONDITIONS: # of Bedrooms - 2 SAY 31 2001 t Soil Type - 4 P,9D C. DESIGN THE DISTRIBUTION NETWORK L. Make Preliminary Determination of Trench/Bed Configuration. A. Daily design flow 240.00 gal 3. Daily flow = (# bedrooms) X (flow/bedrooms) B. Application rate based on soil type 0.60 gpd ft2 C. Required absorption area = 400.00 ft2 Required absorption area (ft2) _ [Daily design flow (gpd) ]/[Application rate (gpd/ft2) ] D. Selected trench or bed width = 3.00 lirl ft E. Total trench or bed length = 87.50 lin ft Trench length is calculated by designer. Z. Select a Primary Network Configuration A. Lateral length 43.75 ft Lateral length is calculated by designer. B. Lateral spacing = 12.00 ft C. Transport pipe length = 20.00 ft D. Transport pipe diameter 1.50 in E. Manifold length = 2.00 ft i F. Select an orifice spacing for this lateral 3.00 ft i G. Calculate the number of orifices in this lateral 15.00 # of orifices in this lateral= t [Length of lateral (ft) ]/[Selected orifice spacing (ft) ] i 't (ROUND UP TO THE NEXT WHOLE NUMBER) j H. Select an orifice diameter (3/16- 3/8) 0.18750 n 1 i I. Calculate orifice discharge rate 0.59 gpml i K. Select an appropriate lateral diameter 1.00 in L. Class of pipe for laterals is Class 200 3. Design the remainder of the laterals. Let Elev Dif Orifice Lateral # Orifices Orifice Let L t # + 2ft Hd Discharge Discharge Per Lateral Spacing Diam Length ---- - ---- --------- --------- ----------- ------- ---- ------ 1 2.00 0.59 8.79 15 3.00 1.00 43.8 1 2 2.00 0.59 8.79 15 3.00 1 .00 43.8 i 4. Select the Manifold Diameter. A. Calculate the total lateral discharge rate 17.59 gp i B. Select adequate manifold diameter (from table) �,.50in r (End manifold using Class 200 pipe) a rWT 'MAY 31 2 ui II. DESIGN OF THE PRESSURIZATION SYSTEM PS 1. Determine the Dose Volume A. Dose volume based on soil type 1. Recommended dosing frequency/day = 6.00 doses/day 2. Recommended dose volume = 40.00 gallons Dose volume (gal)=Design flow (gpd) / Recommended dosing freq/day { B. Dose volume based on dose volume/pipe void ratio 1. If entire network remains full between doses = 0 gal. 2. If just laterals drain between doses = 0.00 gal . I Required dose volume = (7) X (Interior volume of laterals) i 3. If entire system drains between doses = 0.00 gal . i Required dose = (7) X (Interior volume) + volume + volume volume of laterals manifold trans. line C. For desired dose volume, select larger of A or B above 40.00 gal . 2. ueLoxminia 2equiied Pump/Siphon Discharge Capacity 17. 59 gal . Required pump discharge = Sum of all discharges iateb irow capacity all laterals in the system 3. Calculate the Total Friction Losses in the NetwaLk 9 A. Transport Pipe: 0.28 - Transport pipe is Class 200 B. Manifold and laterals: 1.00 1 I i [Elev. of uppermost laterall-[Elev. of low water level in the pimp chambe,:} 3. Determine the Total Dynamic Head. Selected residual pressure: 2 .00 ft. Transport pipe friction losses: + 0.28 ft. Manifold and lateral friction losses: + 1.00 ft. i Total elevation lift: + 10.00 ft. Total Dynamic Head: = 13.28 ft. S. Required Pump Capacity is 17.59 gpm Total Dynamic Head is 13.28 ft. i lumber of bedrooms 2 Phe required absorption area is: 400.00 sq ft rH n�® i Phe length of the trench is: 87.50 ft MAY ! 200, Phe width of the trench is: 3.00 €t Phe length of the transport pipe is: 20.00 ft Phe diameter of the transport pipe is: 1.50 in the length of the manifold is: 2.00 ft Phe diameter of the manifold is: 1.50 in Phe total volume of the laterals is 5.07 gals ' Phe volume of the manifold pipe is 0.24 gals Phe volume of the transport pipe is 2.40 gals lose vol based on vol/pipe void ratio: 0.00 gals lose volume based on soil type is: 40.00 gals Phe required dose volume is 40.00 gals Phe total discharge for the laterals is: 17. 59 gals t'he friction loss in the transport pipe is: 0.28 ft head unifold and lateral friction losses: 1.00 Phe total elevation lift is: 10.00 ft head Phe total dynamic head is: 13.28 ft head i t i i B l i 1 PRESSURE DISTR18UTION REQUIREMENTS I-Install trench bottoms level without any slope 2.Whan trenches are being used on different elevatlo),, , check valves are to be used between laterals Oil,.' qmnifold to keep manifold primed at all times. 3 . Inatall trenches with the contour of the ground. 4;.Install . locator tape to surface to locate laterals if ever • needed •S.Install observation ports within 24■ of ends of all trenches. 6.Install trenches during dry conditions. if smearing occurs, contact designer or the health dept. -official who signed . the,:design. This is a must or designer is not responsible fo; Yallurs caused by smearing of the trench walls. 7.Inatall a 'ohack valve in the transport line within the pump chamber. * S. Install either a pump chamber screen or an effluent filter . to protect the pump and the drainfield from contaminating solid matter. 9.•I11stall high level water alarm system to warn owners of pump failure. 10.1- nstall lateral cleanouts, screw fittings forty five up to finish 9rade: 1.Riser's_ara tc be installed at the pump tank to the finish grade level for ease in pump removal. if baffle type filter . b iseinq.;uded risers must also be brought to the surface. a .2.Install filter fabric. over trenches completely over irPT .3.Divert all• home and storm drains away from the. drainfield. �i1 ;1 4.Septic..spstem is to be iaspeeted, 'And or serviced every three to.-fcur years. tank should be pumped at a minimum Of evexty► five years. 5.Any deviation from this design without prior approval with Designer 'or Health Dept. official will make this design void, as well as the responsibility of the Designer. A. Install audio an'd visual alarm in pump chamber. -7. Z�420 aid 6j eo S14 � S -J-,"it a T..l%ow'iz Si w5 le Z?6a E Ca►i"if Fame -to ewe �ow �c fUwp 4exwr wig 44we4 !�dseltx7 zutaro dc6e -auk;,, %4,e- af, 14,*A 4 uoe_ ON-SITE SEWAGE INSTALLATION FINAL INSPECTION I ^ 11 DATE CALL$D IN: Tam: o INSTALLER: ttY.La f APPLICANT/OWNER: �� vn CALLER: MOM#OF CALLER: SWG#: PARCELNUMEER: SUBDIVISION: Div: Lot SYSTEM TYPE(CHECK ONE): PMSL GRAN INSPECTION SCHEDULE(CHECK ONE): APPOM 4ENT PUK IN AS-unLT ON-srm(CHECK ONE): YES II A n 1 N STAFF DMIAIS. !" V" l l./ �^? �Y�.��o.'"�"'S�"'?:err• s:«yam o-:..�...,:«: :< :air„w ; : w APPomwENT DATE: TIME: COMMBNTB: ON-SITE SEWAGE INSTALLATION STAFF INSPECTION REPORT Yes No Comments I. SEPTIC TANK A) >5&from foundation? x B) >50 ft from wells and surface water? C) Bldg stub-out to septic tank:clean-out if not 1-2"/,? D) Baines intact and clean? E) Dividing wall intact? — F) Risers installed for access? IL D-Box Leveled with water and/or speed leveler(circle)? M. DRAQtrmsrD A) >10 ft from foundation and>5 ft from perceived property lines? _ B) >100 ft from wells and surface water? y C) >10 ft from potable water lines? D) Laterals level to±1 inch&end caps present if not looped? E) Gravelless clambers utilized? u F) System dimensions the same as shown on the design? _fir G) Gravel clean,properly sized,and proper depth? X _ H) PRESSI=SYSTEMS 1) Sand quality ASTMC-33? 2) Head height uniform and 2:24 inches? a +, 3) Clem-outs and observation ports present? 4) Mound: Side Slope 3:17 5) Owner informed electrical connections must be made _ by owner or licensed electrician and inspected by L&d? IV. Pues MUMP Crrnam A) Screen basket or chk49 1pa(cirole one)installed? B) Riser installed for access? C) Alarm D) Pump demand(circle)? _ V. As-BmtTREQimm? _ VI. OTrtER COMMEtT[WOBSERYATIONQS The undersigned has reviewed this installation and verifies these findings on behalf of Masonn County Department of Beall It Services. 0' w Sanitarian Date . c:1MyFilaKuutd�edrvrpd Revise/9/XW FROM Helfair Services Inc. FRX NO. : 360-275-6155 Jun. 14 2001 11:20RM P1 AS-BUILT FORM lev'"Faenury ter.1993 u _ Applicant ;T[ses C-{edr aYLS Assessor's Parcel 3i ©7-5C1 - 8g0� Permit Number SWGZx1 - 002o 3 (TwaWe-0grcNumbeH Installer A ,"' !WKSQ Subdivision OWN 11 (NemertrM lonlBtocWLot) Designer SRL{� NIA Yes Prior to Completion 1. SEPTIC TANK A) >5&From foundation?........ .. ........ .. . . . . . ... . ... ...... . B) >50 R from wells and surface water? ........... .......... ..... . . C) Bldg stub-out to septic tank:clef-out if not 1-2%? . ......... ....... D) Baffies intact and clean? ........... ...... .... ........ .. . .... .. E) Dividing wall iotact?... ............. . ........ ........ F) Risen instsaled for access? ........ ...... _ G) Tank Size- 1200 gai.; lie(u j II. D-Box B) leveler used? ......with water? .... .... .... ..... .... . ... .._. . ... Speed 111: DRAINFIELD ' A) >10 ft from foundation and>5 It from property lines? ........ ....... B) >100 It from wells and surface water? ........ ... .. . ... .... ...... . C) >10 ft ft in potable water lines? .... ....... .... .. .... ... . ....... D) Laterals level to±I inch&end caps present if not looped? ........... Li) Graveliess chambers utilized? .. .... .... .... ..... ....... . ....... . F) System dimensions the same as shown on the design?......... . ...... G) Gravel dean,Properly sized,and proper depth? ..... ..... W PRWURE SYSTOW 1) Sand 4uelitY AMm C-33? ..:................ ..:. .... ...... k 2) Head height uniform and 2t24 inches? Actual head height,_.. . 3) Clean-outs and observation ports presents .............. . ...... 4) Mound: Side Slope 3:1? 5) Owner informed electrical connections must be made by 1 owner or licensed electrician and inspected by L&I? ... ... . .. ... . - — •— IV. PUMP/PUMP CHAMBER 'f A) .Pump make .. Pump model Ate C/0 p B) chamber sir 7�g 1 Manuf ict re Weodr c- - 'Po f�i__ C) Height of pump offborom of pump dumber 12 ' inches — D) Pmnp chamber draw-down A5 gallons per inch E) Pimp capacity 17.5 A gallons per minute F) Pump controls:Timer(or)Elapsed Time Meter (circle If installed) If timer is used:PumpOtt 2,3s4 Pump off YJ4 T G) Saeem basket a one)installed? ...... . ... ...... — —- H) Riser installed for access} .... . . .. . ... .. . . . . ... . ............ — I) Ale=installed? .... ..:......... .... .. .. . . . . . .. .. ... ......... }� FROM Belfair Services Inc. FAX NO. : 360-275-6155 Jun. 14 2001 11:21AM P2 Qmcmusr Drainflold&manifold �a orientation & layout /Q77S P firr--,�,, l0- 7'reneh/bed_dimensions and critical distances within layout SOPficIpump tank placement. Location.,of buildings, . �Obsdrvation port&clean_ out location. , XLocation of wells 8a roads. Undisturbed native soil - /between tranches. Gl Nadi arrow but and .. bbdgt:Qs:. eomptemiss9ovLbaiyofthesystemIth the ierhlkrs awn �amedroi�gbe&scyaloos+dpaevimoassnmme ffiu aresyaem`vmb °tmrsomdw '.de gpVAW bbo 5 Installer Ckeck a boz�Row A"and"B",sign and date the certid"cation A. ❑ I certify that I installed the systam without anydovixtion J� I certify that alldeviations from the de4 stamped MCDHS from the design stamped"ArPROVEp"by "APlntov6 r by MCDHS are shown B. I oatrfy that Y.contacted the designer and k8.the' ❑ Y did not eomtad the _ paint tu' cover because the system open for hM)Ocdm up to 48 hrs prior to tgn cover. designer waived the notific tign mWirean t I Rather txrtify that all information tamed on this form is accurate. I understand the herein is not accurate,there will be just calico for immedieU suspension ofmy installller tre o. erDIU The undersigned approves this installation on behalf of Mason County T . L of Healt}t Services. +tartan FROM Bel+'air Services Inc. FAX NO. : 360-275-6155 Jun. 14 2001 11:22AM P4 At) - (a L'Y os rnS CZ ►f� a /por+ 1,4) ✓C 14/' JeNSrd 1. syyro erg a G..beclly obLte/GI - Loa tb KRO '�ZOOZ oris4 fe3( 24" Spgcj,i�,s --I=1(1e.r•� . y Gn�esv�4 e.. Rif"C'en 3jI6 4D O rRc-ne�,es� q2 -1CnPil�*e�{csr K�ns, oa�reea Se�on3�, ap�aaiv.Js Id „ �•13.-ts' wt1.�. -4kvsf• Halt x� t.S ' '. 3116 s cr�tr �i�I6 Vo u� Spl cr i 0 - moo gi . �ar�cs- O y"uo,.Q,r. DF'CtS .