HomeMy WebLinkAboutSWG2003-00065 - SWG Application / Design / As-Built - 2/24/2003 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG — c y
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-. 426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date y: o
PHONE (360) 427-9670 Receipt No. m y
Amount$ Z -
PROPERTY OWNER: DATE: 2
OZ G 3 CHECK APPLICABLE ITE S
MAILING ADDR SS: h DAYTIME PHONE: S b NEW SYSTEM o
3530 Nt', of $I . Ne. csl, L�, Z7 - q REPAIR SYSTEM
CITY: ✓ STATE: 16519 ZIP: TABLE 6REPAIR m
T S S MAINTENANCE REVIEW
PROPERTY A DR ESS: ' II 1� SINGLE FAMILY o Z
O t I OTHER: 3 3
PRIVATE WELL
SPECIFIC DIRECTIONS FOR LOCATING S E: m
COMMUNITY WELLIPUBUC SYSTEM--
!21 / 43 �t� r SYSTEM WR q
pC rJ o "✓-e, en.n - YO —ITo SYSTEM NAME
�II APPLICANT
(o `?IG�y �jLv}ESMt t( ��. lvµ+tls Io Z NAME
Name of /Z�} I ("'O 1 Lot 3 7 7 ft.x ' ft. MAlll G ADDR S NNS
Installer &t✓�e't"s l�UA e- dw`
of Vze: acres
TELEPHONE O Z
DesiNamgner ((��-, ' (^�� � - � Number o SIG
g 1d� lu'-"^� Bedrooms 3 X
OFFICIAL USE ONLY BELOW THIS LINE
DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDI
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SOIL TEXTURE CODES:
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INSPECTOR(print name) INSPECTION SIGNATURE DA7;7m7XPIRATION TE
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•All systems require ongoing Operation and Maintenance(O&M)as specified in Mason County On-Site Standards.
•All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer,unless prior approval is ranted otherwise
•All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted otherwise. In such ca gas a preliminary on-site
meeting between heakh 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(date.
DESIGy,REVIEW OVAL BY: 1, DATE: INSTAL AQt� PPROVED BY: I �DATE:
�LNJ TOP: Health Dept. Copy MIDDLE: Designer's Copy 7h�LBOTTOM: Applicant's Copy
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
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March 07, 2003 PO BOX 1666 SHELTON, WA 98584
SHELTON (360)427-9670
FAX (360)427-7798
Butchs Bulldozing ELMA (360)482-5269
PO BOX 733 BELFAIR (360) 275-4467
Belfair WA 98528 SEATTLE (206) 464-6968
RE: Design for CROOKSHANK, JR
Case No: SWG2003-00065
Parcel No: 223047690201
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. 554 if you have any questions.
Sincerely,
Pam Denton
Environmental Health
Mason County Health Services
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COMMENTS:
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3/7/2003 1 of 1 SWG2003-00065
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DESIGN FORM - PAGE ONE `—��' ��- > renaary 4,199
A deign will be reviewed when 3 copies of each of the following Items are submitted.
% Completed design form that has been dgned and dated . SCealed I�yout aketoh,kroluding au applicable Items on cheokttat
Coaled plot plan,krotudlne aU applicable Mama on dtoeWist . tion sketch,4toWdlrtp all Ilppltoablo nemA on ottaokllst
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Permit Number. $ & M C�UC - D�signer's Name:
Designer's Phone#:
Applicant's Name: Qn 17 (14 D W C f oo k S�a4 Asses�or's Parcel No.: 223014 -
Mailing Address: 81 No., L a t sh brr_ Dr. N. 'twelve-DI it N mner)
Zj�y�JA IdA 48SBR Subdivision:
(NamdDivisi NBlorbut)
City state Zip
I 'w i DESIGN WARA' E�i MKS 't
vA Treatment De ice
i
(3 Glendon Biofilter 0 sand Filter CI Moimd O Sand Lined Drainfield
O Aerobic Unit-Makelmodel: O Disinfection Unit - Make/Model:
Drainfield Type MC HEALTH r_)',, @T
Pressure OBed , CgDrainrock
Gravity
®Trench O Gravelles Chambers MAR 0 '7 C[Jft
Septic Tank/Drainfield Specifications Laterals �+�►py,
Sche�d ile/Class --! }��
Number of Bedrooms Len KO ft
Daily Flow d Diameter i in
Septic Tank Capacity ) Z 00 gal Number `I
Receiving Soil Type(1-6) Separation
p ID ft
Receiving Soil Appl.Rate d/
Required Square Footage 100 W Orifices n
Designed Square Footage o ft' T
o ote'Number of Orifices
Percent Reduction Taken f Diart�eter 5' lwid t r"
Trench/Bed Width r9 O ft Spacing in
Trench/Bed Length
Elevation Measurements I, Manifold
Schebule/Class y#
Original Drainfield Area Slope % Length New
New Slope if Altered 0/0Diameter in
in Preferred Manifold Configuration Osed? ®Yes ❑No
Depth of Excavation from Original Grade (Up-slope)�' in ( Transport Pipe
(Dow -slope) Schemile/Class 0 ft
Length
Designed Vertical Separation yrf in Diameter 2 in
Gravelless Chambers Required? ❑Yes O�No ❑Optional Dosing and Pump Chamber
Pump Required? Oyes ❑No Number of Doses/Day
1 4-
Dose Quantity O gal
Pump/siphon Specifications berCapacity / DD eat
Difference in Elevation Between Pump Shutoff and UppetMost Purno Controls: Timer(or) Elapse Time Meter(circle M requ(red)
Orifice: Iq N-rl _ S N/-Poet./ — if l imer Pump On /V 4 .Pump Off
Uppermost Orifice is 0 Higher, 0 Lower than pum7 Shut utoff Chec die following eoytponents if they drain between doses:
Capacity @ Total Pressure Head: 1-1. ft4Sm Manifold ❑Transport
t',alculated Total Pressure Head: (�I`I lo.s $
(Attach Pump Curve)
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DESIGN FORM- PAGE TWO Revised Apra 24,Is
Scaled Plot Plan Scaled Layout Sk tch Cross-Section Sketch
O' T hole locators field orientation and layout Refe ced depth from original grade:
perty-lines Trench bed dimensions atl4 criiicel Septic tank.lid,}nid drainfield cover
IV Misting and proposed wells within Alstances within layout „depth '
� �ft o€property lines Box/"T'/"L"locations,
CY Critical distance measurements to cuts, 3ptic tank/pump chamber location Reference deptti from original grade
and surface water IV Observation port location and restrictive strata:
Location and orientation of curtain O 'Clean-out location O Laterals,trench/bed top and bottom
m and all absorption components GV1CTanifold placement ! O Curtain drain collector
Location and dimension of primary Ov6rifice placement O Sand augmentation
'stem and reserve area O�eral placement,with distances to
(5 Buildings edge of bed Other ss-section detail:
CV'btrection of slope indicator Pf dible/visual alarm ferenced bservation ports and clean-outs
aterlines Scale of drawing sho;on scale bar
O�ads/easements/driveways/ ILass�ecaaamnfnr tinnformnund
ping Layoutlnformatinnfor, nandsystem sys#em•
O Cfit[cal resource lands(if applicable) (yvara[[fill duension Q ttletlp depth t ccitteCflad ed o£'
0-'North arrow and scale of drawingpslope downsiope,and endslope bed
shown on scale bar fill width' 0 S[dgwall's[apo
AP ON
O LJp-slope antl do lope bed elevatietr
MC lit AY Additional Information
0 7 1 ,.;:,
MAR OP Design staked out
k�, O Operation and Maintenance Notice
D Attached
O Waiver(s)Attached
DESIGN,APP OVAL'
The undersigned designer Ll does, ❑does not,waive the requirement to be notified by the installer of the installation and given 48
hours to perform a final inspection prior to cover:
Signature of Designer i to
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:n c�
3 �03
Environmental Health Specialist Date
I
Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FO[.LO IfG'CONDITION:
✓ The design is stamped"Approved"by Mason unty,Department of Health Services.
✓ The On-site Sewage Permit has not expired,th Permit Expiration Date Is: 3 3 106
✓ The system is installed by a certified installer,tialess,prior authorization is obtained froth aeon County
Department of Health Services.
✓ Iha[afeld site conditions have not been altered) adversely affect conditions of design approval
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Construction Requirements
1. Determine location of underground utilities before digging. ,
2. Soil must be dry before proceeding with installation.
3. Do not remove any top soil and leave root system intact while preparing site.
4. Install laterals with the contour of the ground and install trench bottoms level.
5. Install observation ports within 36" of all trenches.
6. Once the trenches are excavated the side walls and bottoms are to be raked to
open the infiltration surfaces if there is any smearing or compaction.
7. The edge of the drainfield trenches must be a minimum of five feet from any
property or easement.
8. Install a check valve in the transport line.
9. Effluent screens must be used to prevent contamination of solid matter
10. Storm drains must be directed away from the drainfield. APPROVED
11. High level water alarms should be installed as they warn owners of �IEALTFI DEPT
failure. MAR 0 7 C003
12. A bio filter or tri filter must be installed in the outlet side of the septic tank
for proper filtration. �ys�
13. Risers are to be installed for easy access for pumping or removal.
14. All materials and construction must meet the requirements of the County
Health Department.
15. Deviation from the design without approval from the designer and County
Health Department will make the design invalid.
16. All orifices must be installed at a 6:00 position.
17. All manifolds must be preferred with riser and lid for easy access for
O&M purposes.
18. Filter fabric is required prior to backfilling.
19. All curtain drains must be 6" into restricted layer with an outfall of 30'
below drainfield.
20. Maintenance is essential. Clean the filters every 6-12 months and pump the
septic tank approximately every 4 years.
A_ 77`77
7 77,7
Date Called In: JAI OA Caller P _ l A l a
Pima: C1 U a SWG#: �o()7 - C) (-)rb CS 3(oo '113- 9i�-w�
Igstaller: D,\.a,nw Nnk\npr Parcel#: -I- l _ to- 020k
iksigner: VwN" Subdivision: tiff cl9Cv\ I k In gran
Applicant/Owner: (l AQ/ ,!()dk` Site Address: (o 9 p 1 • n � �
check all that F.IM'77777-7
Q Gravity ❑ Sandfilter
0 Pressure ❑ ATU/Proprietary Filter
❑ Mound ❑ Glendon Biofilter
❑ Sub-Surface Drip
Inspection Schedule: (check one): ❑ YES ❑ Nb
Bnik On-Site?(check one): ❑ YES ❑ N
Stafflnitials:
w`', � .
k:
Appointment Date. Time: UD
Comments:
1 n1�QI�A i a� n�
Is budding present? ❑. NO
Does necessary soil depth to have been altered since design approval? �'- ❑ NO
System appears to have been installed under suitable soil moisture conditions?System has been sited/constructed to prevent surgwag undwater infiltration? q NO
If gravel and/or spec sand has been used is it clean and of proper srze/gade? ❑ NO
Have all horizontal setbacks been maintained? ❑ NO
Disposal 100'from wells/surface water? ❑ NO
TW&VrranrporMlters SO'from wells/surface water?
Have waivers been applied for?
If so,have all waiver criteria been met? ❑ YE 9 NO
Has the system(layou0bomponeuts etc.)been installed as-per design? __❑ YE ❑ NO
If NOT,has designer concurred with changes? ❑ ❑ NO
❑ ❑ NO
Y Tank mid/outlet appear to be watertight? FN Risers to grade&appear watertight
N Lids�re ifeoatractornotpres nO Please secure
lids!
(YI
EN. Floats
N . Cleanout installed? on 1 or m vmtid ---
N Baffies intact with adequate clearance for inlet pipe? rge line as per design(check/ball valves,etc)?
N Outlet filter as per design and accessible? osition correct for dosing&t0preventhang-N Outlet piping sufficiently stabilizedtopreventscaling? separate not attached�o e7, ounter present if regmrcd?line correct&installed to nrevert se9tli ?
YIN Lateral&Offm p cut/shielding as per I ter has a P Well:
design? Y/N Lid of all vented?
Y/N Squint height unifora d adequate for orifice Y!N line as per design(checldball es,etc.)?
size? IY!N oat position correct for dosing&to prove t hang-ups?
Y/N Cleanouts present,acceasib and anchored Y Floats on separate tree,not attached to disc ?
properly? /N Float level prevents bottom of filter sand ft am flooding?
Y/N Observation ports to proper depths d
anchored? Location of Pump Float:
YIN Air coil present if specified on desi
y Pump float mounted to float tree Sin below]under drain pipes?
Y/N Treatme unit Y/N Disinfection unit present and as per design l ?
Y!N system appears to&insWled
Y!N D Box accessible from finishedY/N Trench/Bed width&length correct?
Y/N Speed levelers used? Y/N I ateraVlreabo separation r equa+e?
Y/N D-Beut water-leveled? N Trench/Bed bottoms appear level]and in contour
YIN Lateral pipe diameter/c root Y/ ranch depth Om
WV if rejuirad ear
Y/N Observation and anchored? Y!N Gra chambers
present N Preferred manifold configuration used? /N Cleanout ports as per design and
N Manifold length correct? N Trench/Bad width&length
!N Valve boa for manifold accessible from swfaca? /N LatetaVTronch separation
N Lateral pipediameter/class correct? /N Trenches/Bed bottoms appear 1 1 and in contour
AOrifice spacing/diameter correct? Y Trench depth coned?
Orifice shields if on ? / Gravelleas chambers if uired on ?
Jlort checklist: Y/N 2'minimum from edge of gravel bad to side slope .
Y/N Side slope 3:1 odge?
YIN Mound constructed perpendicular to slope&in Y/�Y Monitoring ports to gravel/sand/ interfaces present?
contour?
Y!N is control panel a`Glendon'authorized panel? X/N Stand pipes present and accessrb a from surface?
Y/N Shape and layout as per design? Y IN, if slope>5e/u is oa area on downsl
ope ow—
Y/N Square footage of sand areas correct? Do not on Glendonl
Comments: 1
O
.7te undersigned has reviewed this installation and verities these findings(xi behalf of Mason County Department of Helahh Services:
Sanitarian Signature: �'� �� �"` Date: i 0
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