HomeMy WebLinkAboutSWG96-0553 - SWG Application / Design - 8/5/1996 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG�- — y
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date N. o
PHONE (360) 427-9670 AmouPi$o. 5
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g_57 c76 CHECK APPLICABLE ITEMS 3
MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM
to (? REPAIR SYSTEM �»�
CITY: STATE: ZIP: ' MAINTENANCE REVIEW w
fic gy 5i�/ SINGLE FAMILY ti 'g
PROPERTY ADDRES : OTHER Z
lJE 11 1 1 K SPECIFY: 01 3
SPECIFIC DIREC/TJONS FOR LOCATING SITE: PRIVATE WELL
/ S U UA1,O I KE COMMUNITY WELUPUBLIC SYSTE
SYSTEM WFI# )` N
U _ &.<r SYSTEM NAME
/ APPLICANT IN
'C 6SS 7J/E /AV 14,/17-ol SIC'E• NAME r'
Name of Lot y��ft. xft. MAILING ADD ESS 07
Installer c / W
Size: Qf � O acres TELEPHONE tor;
Name of
Designer Numbero SIGNATUR o v
Bedrooms 3 XPn
PLOP �N i�itttj c
Dra nsional p�Gpl n,
inch LLrr z2 (o 00
������pppppp o I^
G F?lc of
h es sho tttltLL111LL B 79 ��E) ` I�
n e�n�led dj�ances�¢ � ,
p�boe laries�/•
❑ 10
drAad; er roil
O 4', C* 1 r
NOIF—DO NOT DR IN
�` �s —�LJ zL
TEM DE � r S
g
OFFICFAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. z
SOIL nL Gs7oax WO///a�/�j ev o�rV//
Cl V 5 ''
avtor U me)nsol,
Depth from''Original
Grade to R strictive
Layer or W ter TabIJ WS In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One ¢Two
Soil Type l
Vertical Separation �� in J� Septic Tank Daily ?
Capacity: 15 Gal. Flow: J�0 GPD
Slope �— Appl. Infilt.
Parcel Size O, Ac. Rate G GPD/FTC Area FT2
Distance to Shoreline / � ft. �j_ Total 0)! In ector Date
�YIlSoY1
OMMENTS/ NDITION FOR PROV
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•All se i systems must be designed and installed by contractors certified by Mason County Department of Health Service, unless prior approval is
grante by the department,or the design is by a professional engineer.
•Septic permit approval does not imply other building site requirements(i.e. RLC,Water Adequacy) have been met.
•Any thong om the specified use of the property or any site alteration affecting the system design may invalidate this permit.
This Per it xpires 2 years from date of site inspection. Denial of his permit may be a Baled to the Health Officer within 101da s of denial date.
SITE V DE I Approved -i Not Ap r ad INSTALLATION:O Approved ❑Not Approved
BY:` DATE: BY: DATE: BY: DATE:
TOP: Health Dept. Copy DLE: Designer's Copy BOTTOM: Applicant's Copy
�%ESIG M - PAGE ONE A.visad 07/26/95
A�leai ill be reviewed when 3 conies of each of the following items are ubmitted:
C= Completed design form that has been signed and dated
+n - Completed Resource Lands and Critical Areas Checklist attached
CnIV Scaled plot plan, including all applicable items on checklist
mcn Scaled layout sketch, including all applicable items on checkli t
M Cross-section sketch, including all applicable items on checklist
PARCEL IDENTIFICATION II
1t t- G9� - oss3
Permit Num Mber Sw Designer's Name < <'�'t z,' � I'
I� Applicant's Name Ll s Oe_ Prop. Owner's Name �� AS II
Mailing Address - O Mailing Address �/ I11
I
5 a eP
/i i y a ezip
II
Y
U Assessor's Parcel No. S OUo6 �.s Subdivision Q•�• /o l- �/3
II VINT
II
DESIGN PARAMETERS II
I
Designed II
�i �,-� f� Vertical II u •' U �--� Separat}•on II
II Mound Subsurface Pressure Gravity Bed Trench l in I�
N Septic Tank/Drainfield Specifications rf 11 II
U No. Bedrooms 3 Pressure Distribution? u Y s No
3vo cnd •" "" (If es, proceed. . .
Daily Flow ...........:. .. Y P ......................::II
.......... ... ........... ..........
II Septic Tank Capacity /too sal II
II Receiving Soil Type (1-6) 4 II
II Receiving Soil Appl. Rate •� and/ft Mason terals
Trench/Bed Bottom Area tuts ft'/� Schedule/cl °ant�7��aPt Hael(ry ob
Trench/Bed width 3 ft/� Length DDOI-`� C3
G Trench/Bed Length z/ ft l 1 R P.
I Diameter Initials _1�.� in�
q Elevation Measurements ,Number p` L�/_
b Original Drainfield Area Slope •� Separation Date -[ ZL � ftII
I' I
n Drainfield Area Slope if Altered 3 , Orif c II
I� Total Number of Orifices lR�
II Depth of Bottom of Trench/Bed //.S in Diameter - in
N from Original Grade ups lope Spacing
Q 8 in Manifold
h ljownsIope I Schedule/Class
11---
n I Length ft II
Infiltrator 'Used? El Yes � No I iameter /
II n n Transport Pipe II
II Pump Required? U Yes u No chedule/Class 906 II
................... (If yes, Proceed. . .) EiEE...................Bi I Length S' ft II:...................
II I Diameter in II
II Pump/Siphon Specifications I Dosing and Pump ChamDer II
Difference in Elevation Between Pum , ]}utoff I # Doses/Day II
N and uppermost Orifice ft I Dose Quantity b al II
II f—� n I Chamber Capacity 500 al II
II Uppermost Orifice"is 9 higher, U lower I II
II than Pump Shutoff 3�,� I Check the following components •f they drain II
II capacity @ Tot. Pres. Head NO m I between doses: II
II Calculated Tot. Pres. Head ft I r-,/ II
U (Attach Pump Curve) .v 3216 �`0 '--1 •Laterals u Manifold Transport I�
� � 3
DESIGN FORM — PAGE TWO Revieea 07/2$,
p DESIGN CHECKLISTS
I
p Sca d Plot Plan I Scaled Layout Sketch I Croon-Section ke ch
II I I Reference depth from orig-
II L__I Test hole locations IEI�Drainfield orientation j inal grade:
II r i I and layout j
II Property lines I D/ I �--� Septic to lid and
II rg/ j Trench/bed dimensions and I drainfiel cover depth
p u Existing and proposed I critical distances within
p wells within 100 ft j layout I Reference depth from orig-
p of property lines j rz;;� j inal grade and restrictive
p j U D-Box/"T"/-'L" locations I strata:
II Critical distance rN
II measurements to cuts, I Septic tank/pump chamber I ' Laterals, trench/bed
II /banks, surface water j location j top and bottom
II r-�r I I r-i
II u U/Location and orientation I Observation port location j u Curtain drain collector
II of curtain drain and all I n/ j n
II absorption area I Cleanout location j U sand augmentation
p omponents I j
II i u Manifold placement I No external reference needed:
p u Location and dimension I r -i / j E
II of primary system and j u Orifice placement j �+" Observation ports and
II reserve area j r� / I cleanouts
II j [!/Lateral placement, with
II L^J�uildings j distances to edge of bed I Additional mound information:
II Direction of slope j Audible/visual alarm I U Upslope and downslope
II indicator j referenced I fill width
II I I r�
II U S�faterlines I Scale of drawing shown j U Settled cap depth at
II j on scale bar I center and edge of bed
II u Roads/easements/ I I r-i
H driveways/parking I Additional Mound Information: j U Sidewall slope
II r i i r--i I r—i
II U Critical resource lands j U Endslope width ( u Up/downslcpe bed elevat.
G (if applicable) I u I
n I overall fill dimensions I Comolated Res urce Lands and
d North arrow and scale of j i Critical Area Checklist
q drawing shown on bar I j
DESIGN APPROVAL
I
0 r1
U The undersigned designer u do s, v doe not, waive the reqirement to be notified by the
installer of the installation d given 46 ours o perform a final inspection prior to
II cover.
II
II
The undersigned has reviewe and ved is design on beha f o# Mason County of Health
Services. A ��
II
CAUTION: DESIGN APPROVAL IS JPJD ONLY UNDER THE FOLLOWING CONDITIONS=
✓ THE DESIGN IS ST •APPROVED• BY MASON COUNTY DEPTARTMENT OF HEALTH SERVICES
U ✓ THE ON-SITE SEWAGE PERMIT HAS NOT EXPIRED; EXPIRATION OF SAID PERMIT IS BASED ON
II 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
u OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES
�b Collins lake Dr.
..................
proposed drainPield
i
i
thl i
i
i
north slope
P
i i
1"=30'
th2
�� h3
i
i i
.OP
i do
*trenches on 9' centers - '
reserve between trenches
driveway &
parking
pump tank
water and utilites
45'
septic tank Z16
229
proposed home
55'
i
i
i
50' �a
S�7
CGG
yo
PGr
O yPa'�h s
collins lake
Zs
reserve
34'
Q
reserve y"e 6'
34'
— - - - - - - - - - - - - 3,
f/
, YP _
reserve 6
34'
- - — 7 - - - - - - - - 3'
reserve 6'
check valves — — — — — 34� — —
reserve 6'
34'
- - rr — - - - - - - - - 3'
reserve 6'
34'
- - - - - - - - — - - 3'
f--f 1.5" pump line
MasoUnty Dept
.thitiai RO c�t>�*S�e;i,Cos
s LLJ
date
observation port
12-18" cover original grou d
ge filter fabr
9% slope
_► t7,
11"trench depth
trench depth
24" vertical separation
restrictive layer
finish gra,'- observation port clean out 6" from
A-� finish grade
12" cover ab'
Oz
''P*1 v vN ref
gate valve 33 ' lateral 6" washed rock
trench bottom /o
Notes: MasoI7 County Dept Heath
all orifices are 3/16," dia. ; facing the 12:00 position <�PbO Serv;Cas
and must have orifice shields tnlrats �'6
Date
6" riser w/ screw cap
lid
riser 6" min cover
i
500
gal pump
pump tank
lam- 1/4" per ft fall
filter
1200 gal
septic tank
audio and visual alarm
req'd
Masao
IleN/
COS
to
CONSTRUCTION NOTES
1.INSTALLER MUST ADHERE TO ALL MASON COUNTY HEALTH DEPT GUIDELINES AND REGULATIONS
2.INSTALLER MUST ADHERE TO WASHINGTON STATE ON-SITE SEWAGE REGULATIONS.
3. PREPARE AND CLEAR DRAINFIELD AREA DURING UNSATURATED CONDITIONS.
4.NO DRIVING OR PARKING ON THE DRAINFIELD AREA BEFORE DURING OR AFTER INSTALLATION O
DRAINFIELD.
5.SEPTIC TANK OUTLET FILTER IS REQUIRED FOR THIS DESIGN USE.
6.IF A PUMP TANK IS USED THEN A LOCKING LID RISER TO THE FINISHED GRADE IS REQUIRED.
7.PUMP TANKS REQUIRE AN AUDIBLE AND VISUAL HIGH WATER ALARM.
8.DIVERT ALL SURFACE WATER AWAY FROM DRAINFIELD AREA.
9.SEED FINAL COVER.
DISCLOSURES:
1. THIS MAP DOES NOT REPRESENT A SURVEY
2. THE LOCATION OF THIS DRAINFIELD IS BASED ON THE OWNER OR THE OWNER'S AGENT LOCATING
PROPERTY LINES AND PROPERTY CORNERS.
3. THE PARAMETERS OF THIS DESIGN ARE BASED ON THE MASON COUNTY qEALTH
DEPARTMENT'S FINDINGS OF CRITICAL DATA CONCERNING SOIL TYPES,
DEPTHS, STRUCTURE, AND WATER TABLES.
IFANY QUESTIONS PLEASE CALL JIM ZIMNYAT(360)630-4639.
Mason County Dept Health
;
Q,�E rv:ces
tnitials-
Date