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HomeMy WebLinkAboutSWG92-0717 - SWG Application / Design / As-Built - 9/24/1992 77 PERMIT NO. N MASON COUNTY DEPARTMENT OF H TH SERVICES + SITE E 1 UATION DESIGN AND IN AL TION Q Date Date o <, N ' ' DR/ OBOX /SHET ,WA98b844 � Receipt o. �- Receipt No. PHONE (206) 427-9670 Amount$ r�- Amount$ m CHECK APPLICABLE ITEM ✓ 3 M MAILIN ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM. a 3 �,►Q o f 3 3 '� REPAIRING OLD SYSTEM ZIP: EXPANDING SYSTEM CI ST E: w SINGLE FAMILY m PROPERTY ADDRESS: OTHER Z SPECIFY: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL ��5 PUBLIC SYSTEM SYSTEM ID NUMBER y SYSTEM NAME �DG S r APPLICANT NAME E v) Name o e Lot3365 _ft. x ft. MAILINGADDRESS Installers f�t Size: . S acres TE EPHONE 3 0 Name of um er o !y XIG TURE 0 I� Designer Le ryt Bedrooms 6• PLOT PLQF I LrrL,,I I Iti` Draw a di�onal plot plan Ixf + ��` �" 00 including:C�,^� F I� ❑Precise2plion cast holes,si1G0111ig U measurep�j'}tanc o IQ proper' clanvs. 230 �Y,�•wg f-- � 3D l I R ❑Entry roaer rQpds, drivewaM ` N NOTE: D FIAW IN 1 �� SDESIGN 33D OFFICIAL USE ONLY. D y SOIL LOGS q7-P0CrUIQ&rrD rH AV3-4- sr3,.ln� /o l�,3u� y .stoy 9 „ SrR�cYua�;,��o ot,OA7j -Roc5v—�-—�> 3a Depth from Original Grade to I lestrictive Layer or V later Table: In. DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS Soil Q YP Design:0 Level One �@ Level Two -7" � Y ��'JJJ/ 1� 7Y_ ,7 Septic Tank Daily ol GPD Vertical Separation Capacity: ,�QQGaI. Flow: s' Slope �_ Appl Infilt. /'� Depth rom ngma / JIG FT= Grad to Bottom of lg2 Parcel Size © Rate � (o GPD/FT7 Area `T` Abs lion area: In. Distance to Shoreline Total Inspector Date q COMMENTS/CONDITIONS FOR APPROVAL U Owner/Designer/Installer must meet on site to verify precise system layout 0 Owner must arrange pre-installation conferenos with health dept.staff O Winter observations required xtreme care needed during site preparation t preserve existing topsoil Any change from the specified use of the property or any site alteration affecting the system design may inval date this permit. This Permit ex as 3 years from date of Issue.Denial of this permlt may be appealed to the Health Officer with n 10 days of denial date. SITE: Approved Design Required O Nol ed DESIGN: Approved ❑Not Approved IN L T pproved O Not App ov d BY: r DATE:�Q BY: DATE:�a BY: DATE TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Ap nnt's Cop FEE.._ REEL 0FRA-ME_ AUDITOR MASON COON Y .y ALLAN T. BROTCHE 19% NOV -4 P 2: 10 6'78137 REQUEST OF: Return To: S'US.9n/ Sep v o, PoV 67`f Sz ,¢COY/,�` ` 9B `t I CERTIFICATE OF RESIDENTIAL USE LIMITATION ON NUMBER`.OFBEDROOMS I(We) the undersigned,hereby place this notice on record that the following described real estate Situated in Mason County,State of Washington; to Wit: (abbreviated legal description) 070SUAY, %roe- a PG ii� and having the Tax Parcel Number of: a'z3oa 'X6©©c-'o is subject to the following understandings and conditions: 1. The use of the residence on this parcel will be restricted to no more tha j2L_bedrooms. 2. The on-site sewage system was designed for and the building permit for the residence Was issued on the asis of no more than ,� bedrooms, and a•maximtmt residential Occupancy of not ore than persons. 3. The use of the other rooms in-the resiaence as bedrooms,in excess of the number identifle I herein, could result in hydraulic overload and premature fan=of the on-site sewage system,and Dould result in Mason County taking steps to cause vacation of the premises. 4. In the event of any future residential remodeling,expansion,or replacement that results in 3dditional bedrooms to the number specified herein,the property owner will obtain the appropriate pi amits for expansion of the on-site sew6ge system. WITNESS hand this---Lday of�, 199•�-•—. R�4UMf�. p e t67Al,y ^ Sagnature gl'gIlI tire Stateq on ) County of lvjason ) I,the undersigned,a'Notary public in and for the above named County and State,do hereby certify that on this day of_(S2SZ _ , 199tj personally appeared before me -A^A• tdAKJ'cAi=?1UffYZ (mown to be the individual described in and who exruted the within ins me tntand and acknowledge that he(she (they) signed and sealed the same as free and voluntary act and dced,for the us and p oses herein mentioned GIVEN under my hand and official seal the day and year 16and ove •tt 1 Notary Publiefor the to of Washington,residing at Uaf,� My Commission Expires: In- - • I &'ASON COUNTY DEPARTMENT OF H€UTH SERVICES ------------- POST O : CE BOX 186 SEMI N, WA 98584 (206) 427-9670 SAX 427-8425 M ■ : ,off 9/9-2 E M ' To: Designer R A ■ = C qs U M ■ Rs: Applicant (IliiUliHitlll!II IIIlliiili111IIil lllll i ll llllilllilff 1lflliill7illiill U11fIliillifiltitiittliilifiilllflilDfillfill!i1II111Iiiifllfitil(fIIIiIlIIIfIgIf Rilliiflilllll111U lil1l Masan County Departaent of Health Servicas inspected the above referencedparcel and approved the site for tte foolll/owLaq design enw: Lwt as aa.lgt '7�l:.wl now Owtga The design must address the following area($, of concern: waffle+! agaeaum m wafts. v�-'s+l sgarafir m 11aL" all .CMU. seta ara{tt" estaa.r slacset. QSecaaep to tA ' QSlowty aeuta ❑ Yr a" alit. Q77tvlots pLC"mz at ;..:.L. I MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OM E BOX 186 SEELTOII, WA 98584 (206) 427-9670 FAX 427-8425 M ■ nay: /a/1B/9a E M � ■ ro: R A 1V ■ rim: D LT M ■ its: Design fora- uuumuuuututtnuurnimuu a uuuuuuuuuutnutututttttttttgttD011tnO01t0°°°0°0auuuauuDDwwnauumuuun,uauunuuuunnu Tour design for the above referenced parcel has been reviewed and ! s hereby a rv�ed. © Tour design for the above referenced parcel has been; reviewed and is hereby 92 ticua-UT aoaeosad. The coaditioa(s) for approval, are..! a I ® Tour design for the above referenced parcel has been reviewed sad cannot be avcroved. The reasoa(s) for not appaovinq the design a 0 a adY .eau a1taCJ6'va ayatr 9dlaallaaa aa.e Y claaelY idaa='::ad 3 3a da.aaa atltl ld.a:l.d Mtn .. eau. Its mwqu.cy of :.easaeaa 7mu:teae:as Diu 5a aaa.a CL aarltft da"r=a •=a ctiwta:t a( cot=u+t aCaptad daa14tl X+cwxm. dapar=matal ?dllq., antl La l one and ',Ld 0aa19tl seaddarda. ALTERNATIVE SYSTEM DESIGN FORM — PAGE ONE P. i,.d osioLsz PARCEL IDENTIFICATION 7[FApplicam.tdsame S aS4 .C/ /1 W--rOttv( Prop. owner's Names Prop. Street Address 7'tC B.us-2 il1Ct' Sl'YirZ '. C1aY l6�a� iiv ciar I �/"-�� a6�a� alp Assessor's Parcel No.a,�,j(r,� ��n J�Sf� Subdivision (11+�1v�—D 1016 NUM�Y) (N�m�/Div1�i n/�leoJa/L06) Rnvn DEC 14 1992 o GENERAL SERVICES DESIGN PARAMETZRS No. Bedrooms Daily Flow pZ�cypd Soil Type S'2 Q. 14e Septic Tank Capacity 4929 19 allons Native Soil Application Rate'' o d/ft° Site Character: Level 21"Sloping Trench/Bed Bottom Area !/ ft' 3 - System Type J J J Hound Subsurface Pressure Gravity Bed '.. Trench Transport Pipe Manifold La s Schedule/Class J q D Schedule/Class at��_ Schedule/Class ��D Length ) ft Length J'7 ft Length 3' ft Diameter sin Diameter in Diameter �n Number separation ift Pump/Siphon and Chamber Capacity at Total Pressure Head elf 9LIM= or:Lf s Calculated Total Pressure Head ft Number of Doses per Day Number/Lateral Pais, Dose Quantity al Diameter is Chamber Capacity al Spaciaq (Attach Pump Curve) ALTERNATI"VE SYSTEM DESIGN FORM - PAGE TWO a..ia.a 09/01/92 PLOT PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . .. - - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - . . . . . . DESIGNER PLOT PLAN CBZ4=IST /Scaled plot plan if lot is under 3 acres Location and dimensions of reserve area (� '— Bxisting and proposed wells, including 13 Buildings, roadways, easements, parking yrells within 100 ft of property lines 'U,/ �roperty lines, building stub-out Topographical features, cuts, banks, percent and direction of slope Mound horizontal gradients endslope and upslope/downelope widths, overall Location and orientation of curtain fill length and width, depth of mound drain 6 all absorption area components cap at center and edges of bed i Us Z A N a � ti o � i -0�` z R i o A � es TERNATIVE SYSTEM DESIGN FORM - PAGE THREE F. i..d 09/01/92 DRAINFIELD LAYOUT DETAIL I . ., _ . .� _ . .) . _ . . . .. . . . . . :.,,,,:dam- . . . . . . . . ,as . . . . . . . . rid` r"�lrPa`• 6�1. . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRAINFISLD LAYOUT DETAIL CHECKLIST Manifold placement Lateral cleanout location 777 rifice placement (staggered) B Observation port location* i Lateral placement within bed Mound dimensions (if appl cable) ALTERNATIVE SYSTEM DESIGN FORM - PAGE FOUR a.a.ed 09/01/92 SYSTEM CROSS SECTION . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . co vz:V . . . . . . . . . . . - - - - - - - - . . . . . . . . . . . . . . ELEVATIONS All Systems • Depth from Finished Grade to Top of Septic Tank inches • Depth from Finished Grade to Top of Pump Chamber inches • Elevation Difference Between Building Sewer Stub-Out and Fixed Reference Po / inches • Building Sewer Stubout is MBigher '--'Lower than Fixed Reference Point • Reference Point Location: • Elevation Difference Between Shutoff Level of Effluent in Pump hamber and Uppermost Orifice --- // feet • Uppermost Orifice is Bigher Lower than Shutoff Level of Effluent in Pump Chamber Subsurface Systems • Depth from Original Grade to Bottom of Absorption Area at Downslope Edge - - inches e Depth from Original Grade to Bottom of Absorption Area at Upslope Edge --- //-/a inches • Depth of Cover Over Absorption Area at Completion ---------_�_�� /y/6 inches Hound Systems • Depth of Fill Beneath Upelope Edge of Bed inches ALTERNATIVE SYSTEM DESIGN FORM - PAGE FIVE a Iffi a 09/01192 DESIGNER COMMENTS AND CONDITIONS AG p to e-LL 4-Q Ue--y � k ! 0- /p w m � b V-1 tom,-k �' F� ��,• /' Re- s e- e-� IP-i4 CONDITIONiS AND UNDERSTANDINGS The undersigned designer agrees to hold Mason Counth Department of health harmless in the event the system installed in accordance with this design fails to operate as required by Mason County Health Code. In addition, the undersigned designer does, D does not, waive the reqirement to be notified by the installer of the installation and given 48 hours to perform final inspection prior to cover. ����� i1pn�Cur� e! D� Qner p��N The undersigned has reviewed and approved The undersigned certifies the system has this design on behalf of Mason County been installed in full accord3.nce with this of Heal ervices. design. N��lt Sa.�D�eier �p�{e Sn�6r1X—r D�6� MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 186 SHELTO , WA 98584 (2 6) 427-9670 F 427-9425 M O ■ To: )9/ vE12S07 j A DIV ■ Pt m: U M ■ RE: Design for ix> UEER Parcel No.j2':L �F>Qx ST1 I I t l t l l l l t 111111 U I I I I I U l l U I i l l i 1111I 11111 t l i l l l i t l l l l l l i l i I I I I i l t l l i l l l l t 11I I l i l l t l ll I A l l t l l t t t l l l t l l i 1111 f l l l l l l l l I I I I11IU1 U I tl1U1 Ult I11IUIl1 i i t l l tt I!1 i!I Il l I Il t 11111 i l t 111 Your design for the above referenced parcel has been reviewed andis hereby approved. ® Your design for the above referenced parcel has been reviewed and 'is hereby ecndiricna- iv ansroved. The condition(s) for approval are a a . a . rat= design for the above referenced pare" has bees reviewed and c m cw- be aooreved. She reasons) for Clot approvisq the design oln SO SOM Any • r..aelaa .'a aura alutaaC�n ayacr gdiaalaaa Clue �. clearly ldaai:::aa 3a daalga and I=rA-lad -IC3 raee...01 data. 'Mw of ,-� a�Y 7taeirte...,.. vtlZ 3a as OY Cae Orli3 dap.rMe.ne '"CLA e7a rnneai a[ =-=Ot aeapvae daalgm Pr= dap"--NkWyl POLICY, and LJ I one a" N" Oaalgd Standar". S w7 U O �i-O- ■ Y YRTIC % H.82 �. PUMPS 28 24 w 20 SV33; LL � 16 SV?$ = 12 J F 8 0 r 4 SUBMERSIBLE 0 5 10 16 20 25 30 p5 40 45 U.S.GALLONS PER MINUTE SUMP Head-Capacity: SV25 and SV33 Submersible Sump Pumps Max. Solids 3/4" Sphere; 4 Pole, 60 Hza PUMPS 26 24 r I $m 20 P33 LL z C8 r 4 0 10 20 30 40 60 60 U.S.GALLONS PER MINUTE _ Head-Capacity: SP33 and SP25 Submersible Sump Pumps Max.Solids SP33,3/4"&SP25, 1/4"Spheres;115Votts,60 Hz.,175O RPM 140 120 HIGH HEAD ='°° NJ o � EFFLUENT a o SP106 PUMPS 20 I SPSOH 1 0 20 40 60 so 100 120 140 U.S.GALLONS PER MINUTE Head-Capacity: SP50H, SP100H and SKH150 High Head Effluent Pumps Max.Solids SP50H,SP100H&SKH150, 3/4" Spheres; 115 Volts,60 Hz.,3450 RPM i chamber, or an orifice or two in each 1 terai cdn be drilled in the 6 o' clock position. :his mill still result in a system that Lan be easily pressure tested, and the pressurization Bill De faster than if all the orifices are at o o' clocK . �) In order to eliminate the potential for erosion into the gravel of backfill material overlying the trench or bed, a synthetic filter fabric (not untreated building paper, straw, or such) snould be used. \� b. If all orifices are placed at 6 o'clock, somelcrovision for air venting should be made. For example,) the final J orifice at the distal end of the lateral can be placed at 12 o'clock or a hole can be drilled in theiend cap of the lateral . 7. Transport Line - The transport line for .in indivicNd'+ system is usually 2 or 3 inches in diameter. The size otitne transport line may need to be larger if friction 1 sses become excessive ( see subsection C , Step L-3 for (1 tails) - 8. Larger Systems - For larger systems it is often aci isaule to construct the drainfield in units or modules and t us reduce the volume of individual doses. The oojective of his type l/ of design is to reduce the pump capacity required o pres- surize the drainfield. STEP A-3 - Choose an orifice spacing (Y) . The orifice spacing snoou d reflect the ability of the native soil to disber a effluent in a lateral direction. In all cases, localized conditions of saturated flow should be avoided. The designer in this step chooses the orifice spacing, r . :rat appears adequate. The designer is reminded that maximum allowable orifice spacing will minimize pump requirements. For mounds . fill systems and sand filters and any systems wnere treatmen is of primary concern (coarse soils or soils shallower than 3 feet) , maximum orifice spacing should not exceed 3 .0 feet. Ur Tice spacings to a maximum of 6.0 feet can be used if soils Are finer than medium sand. The design aids in tnis guideline are oased on orifice spacings of 1.5 feet, 2 .0 feet, 2 .5 feet, .0 feet, -1.0 feet, 5 .0 feet and 6.0 feet. STEP A-4 : Lalculate the number of orifices ( 11) . "he n moer of orifices ( N) per lateral length ( L) with an orifice spa ing ( f) is: "lumber of orifices ( N) : Lateral lendtn ( L) in feet / Jrt n ce spacing iY in fe t 11 ALTERNATIVE SYSTEM DESIGN FORM - PAGE ONE RWjMa 09/01/92 PARCEL IDENTIFICATION I' I Applicant's NameS//S� Prop. owner's Name �M G Mailing Address -:2 Ni9gZ/00-V �bG '/0 Prop. Street Address C ibY .ba• ilp CSCY i .b.6• iip I Assessor's Parcel No.,,2 Subdivisionp kSne,A yo (aw•i..•—nivic aa.,ma•r) (+a.u.•/aiv l.io /sleek/s.ee) DESIGN PARAMETERS No. BedroLCapaoi Dail ow,�c � Lape Qtidli29 -Septic Ta "� Soil Application Rate /ft' Site Character: El L l*Gg� ` �n111cchh/Bed Bottom Area ft' SERVICES System Type J J Mound Subsurface Pressu Gravity Bed Trench i I Transport Pipe ifold Late pals Schedule/Class oZ B O Scheduie 'Cla .2 Schedule/Class i,engcn � ft LengGn ft Length eft Diameter :, in Diameter �2 in Diameter / in Number 2 Separation ft Pump/Siphon and Chamber Capacity at Total Pressure Head Orifi s Calculated Total Pressure Head ft Number of Doses per Day 2 Number/Lateral Pai: Dose Quantity gal Diameter AJ in Chamber Capacity So gal Spacing (Attach Pump Curve) boy SYSTEM IDENTIFICATION AND DESIGN ASSUMPTIONS NAME: Server PARCEL NUMBER: 223027600050 LOCATION: Blacksmith Drive REVIEW DATE: 12-18-92 SYSTEM TYPE: 2 1-Mound 2=Subsurface pressure distribution system SYSTEM CONFIGURATION: 2 1=Bed 2=Trench PARCEL SIZE: ACRES 2 .50 DAILY FLOW: GPD 240 SLOPE: %_ g NATIVE SOIL APPL RT: GPD/FT2 0.60 FILL APPLICATION RATE: GPD/FT2 Not App - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - DIST SYSTEM DESIGN ELEMENT UNIT SPEC BED/TRENCH - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - WIDTH: FT 3 .00 LENGTH OF BED/EACH TRENCH: FT 44.44 NUMBER OF TRENCHES: # 3 DOWNSLOPE DEPTH: IN 9 . 00 UPSLOPE DEPTH: IN 10 . 08 TRANSPORT PIPE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TYPE: SCHEDULE 200 LENGTH: FT 30 . 00 DIAMETER: IN 2 .00 MANIFOLD - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TYPE: SCHEDULE 200 LENGTH: FT 18.00 DIAMETER: IN 2 . 00 LATERALS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TYPE: SCHEDULE 200 NUMBER: # 3 LENGTH: FT 43 .44 DIAMETER: IN 1.00 SEPARATION: FT 9 .00 DISTANCE TO EDGE OF BED: FT Not App ORIFICES - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL NUMBER: # 44 #/LATERAL PAIR (IF CENTER MANIFOLD) : # 29 DIAMETER: IN 0 .187 SPACING: IN 3 PUMP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - REQUIRED CAPACITY: GAL/MIN 25 .5 PUMP SELECTION HEAD: FT 6.4 (Transport pipe frict loss 0 .29 ) (Manifold friction loss 0.04 ) (Lateral frict loss 0 . 16 ) (Elevation difference 4.00 ) (Minimum residual head 2 . 00 ) PUMP CHAMBER - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DOSE: GAL 120 MIN USEABLE CHAMBER CAPACITY: GAL 360 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SYSTEM IDENTIFICATION AND DESIGN ASSUMPTIONS NAME: Server PARCEL NUMBER: 223027600050 LOCATION: Blacksmith Drive ' REVIEW DATE: 12-18-92 SYSTEM TYPE: 2 1=Mound 2=Subsurface pressure distribution system SYSTEM CONFIGURATION: 2 1=Bed 2=Trench PARCEL SIZE: ACRES 2 .50 DAILY FLOW: GPD 240 SLOPE: %. 3g NATIVE SOIL APPL RT: GPD/FT2 0.60 FILL APPLICATION RATE: GPD/FT2 Not App - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FILL DESIGN ELEMENT UNIT SPEC LABEL 31�ML MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTO , WA 98584 (3 0) 427-9670 X 42 7-7798 APPLICATION FOR VARIANCE/APPEAL . Directions 1. CoWtete Part A and submit to the Director of Health Services, PO Box 186, Shelton, WA 985841rr along with one of the following fees (as appropriate): $26 for appeal; $21 for staff review; $93 wen Health Officer review is necessary; or $113 when State Department of Health concurrence is necessa I 2. Staff and the director will make a recounendatiors to the Health Officer in Parts B and C. 3. The Health Officer will make an initial in-house determination in Part D. 4. The applicant, if unsatisfied with the initial Health Officer determination, can request a H atth Officer Hearing. Findings and determinations of the Health Officer may be appealed to the Mason County Board of Health. Part A: AppeaURequest for Waiver • Applicant's Name: - Address: Telephone; a� - ►- 13 �i ��n0(�5(7 5 VC_i ✓01 JL • Assessor's Parcel Number Subdivision Name and tbett Runber • Nature of variance or appeal: n Reduce separation between orimarv/reserve (circle one or both) drainfield area(s) and from feet to feet. r-t tJ Appeal findings or conclusions of environmental health staff (pl ase specify) : other (please specify) : 4% "I"AeNon S ( •or o - Applicant's signature Date H:IOn'-5ITE\t:44_NCE.N Rcvi ed: 01107196 Part B: Staff Findings n n LJ Applicant owns the affected well U Soil texture provides for tre tment of sewage n r' U Applicant does not own affected well, u Soil depth provides for treat nt of sewage but owner has been notified n U Enhanced sewage treatment wi(L be utilized. n u Parcel cannot be developed without variance Specify type: LJ Other: S - " C Nl2� y �(% Environmental Health Specialist Date Part C: Director's Recommendation M Director recommends approval of the variance or appeal, based on the fog irations: 8 m following conside �.. �i oJl a wel fo.�Sfyuc � fcs o� jr a+ p 6 uclt lk. !�a � r� tJ Director recommends denial of the variance or appeal, based on the following considerations: Dire for f alth Services Date Part D: Health Officer's Determination n u The Health Officer has determined that approval of the request for variance or appeal will not h ve an adverse effect on public health and the variance or appeal is hereby granted. This decision is based on the following findings- n LJ The Health Officer has determined that approval of the request for variance or appeal has a pote tial for an adverse effect on public health and the variance or appeal is hereby denied. This decision is sed on the following findings: _ Mason County Health officer Date i H:\O11-SITE\VARIANCE.W Revijed 01/07/96 i ON-SITE SEWAGE INSTALLATION INSPECTION ....................... ..................................................................................................................................... EEEj:: �rr��rr art rr�)�x;%f DATE CALLED IN: iJ V/ TIME: /,y ' I' INSTALLER: I!1 V U/ APPLICANT/OWNER: 9- ololor- Orver2 CALLER: PHONE # OF CALLER: SWG #: yl/ z2 ^ !/`�� / PARCEL NUMBER: (/ L-2IIO.7/) SUBDIVISION: f C !/ J Ii DIVISION: LOT: SYSTEM TYPE (CHECK ONE) : r 1 u PRESURE GRAVITY INSPECTION SCHEDULE (CHECK ONE) : u ✓✓✓ D� APPOINTMENT PLUG IN ,,/ �/s� J TS? ( ONE) : r� J 44 T V'(} � ,� YES NO ra .:::................................................................................. ............. . ........ ..................................................................................... : ::: :::::::: :::::::: . ........ .............. �9-lb u l l w STAFF INITIALS: �• ` d b eO f V h:callin.w Revised 04/09/96 ON-SITE SEWAGE INSTALLATION STAFF INSPECTION REPORT .......................................... .. .. .......................... STARK CBBMXST I COFIIRI® BY INSPECTOR? I I. SBPTIc TANK Yes No Comment ! A) >5 it from foundation? _ I a) Bldg stibout to septic tank: cleanout if not 1-2%? — C) Baffles intact and clean? I a) Dividing wall intact? xx. a-Box Leveled with water or speed Leveler (circle one)? /Y�J III. DRAI[DIII.D A) >10 ft from foundation and >5 it from property lines? 5) Laterals level to 11 inch & end caps present if not looped? — c) System dimensions the sane as shown on the design? D) Gravel clean, properly sized, and proper depth? I E) PRESENRB SYSTEM I I) Sand quality ASTH C-337 z) Head height uniform and L24 inches? 3) Cleanouts and observation ports present? a) Hound: Side slope 3:17 _ 5) Owner informed electrical connections must be made — by owner or Licensed electrician and inspected by DL17 I 1 I rv. POTABLB IUTER LIAR I A) >10ft from drainfield, transport line, and septic tank? _ B) Wells >100ft from drainfield? I Y. Pm@ A) SdreenrANx basket or uent ter (circle one) installed? B) Riser installed for eesa? y( I c) Alarm installed? L"'1�f��--� I vx. AS Bon.T Ragunm? I I vxx. ores cclamlxa I I 1 I I I I I I I The undersigned has reviewed this installation and ve ifi these findings on behalf of Meson County of Health Services. ,I I h:eallin.w Revie d 04/09/96 c� cI v >+ AS-BUILT FORM - PAGE ONE MN 1 8 19% Re i"ed 12/14/94 II PARCEL IDENTIFICATION ern II II Applicant's Name rn RTT !d Te toe _ II Permit Number SWG9a�, - , _ Subdivision II II l ame nivisio oc o II Installer's Namet;bffl A Assessor's Parcel No. J �I Designer's Name ✓ we v - igi u er II INSTALLER CHECKLIST II N/A s Prior to II I. SEPTIC TANK II �I A) >5 ft from foundation? Completion'�. II B) Bldg stubout to septic tank: cleanout if not 1-2%? + II II C) Baffles intact and clean? — T- II D) Dividing wall intact? II �I II. D-BOX Leveled with water and/or speed leveler (circle) ? II. DRAINFIELD A) >10 ft from foundation and >5 ft from property lines? II B) Laterals level to ±1 inch & end caps present if not looped? II C) System dimensions the same as shown on the design? I� D) Gravel clean, properly sized, and proper depth? II E) PRESSURE SYSTEM II 1) Sand quality ASTM C-33? T II II 2) Head height uniform and z24 inches? 3) Cleanouts and observation ports present? II II 4) Mound: Side slope 3:1? 5) Owner informed electrical connections must be made by t ii owner or licensed electrician and inspected by DLI? II IV. POTABLE WATER LINES II A) >10ft from drainfield? B) Wells >100ft from drainfield? II II V. PUMP/PUMP CHAMBER II A) Designed pump used, or specs attached for equivalent pump? B) Screen basket or effluent filter (circle one) installed? II C) Riser installed for. access? D) Alarm installed? I CERTIFICATION OF INSTALLATION II II Installer: Check box from Row "A," check box from Row "B," sign and date the rtification. II F--1 r-1 II II A. u I certify that I installed the system U I certify that all deviations from II without any deviation from the design the design stamped "APPROVED" by MCDHS are II II stamped -APPROVED- by MCDHS. shown on the reverse side of this form. II II B. u I certify that I contacted the U I did not contact the designer prior II designer and left the system open for to final cover because the designer II inspection up to 48 hrs prior to cover. waived the notification requi ement. II I further certify that all information contained on this form is accurate. I nderstand II II that if the information contained herein is not accurate, there will be just c use for II II immediate suspension of my installer certification. M2d r II li puc dose a C�cs� c1�Ij igna ure o ns a e a e � II II The undersigned approves is stall 'o f half of Mason County epartmenk of Health II I Services. � V II ea sp or e AS-BUILT FORM - PAGE TWO ,Revised 12/14/94 PARCEL IDENTIFICATION Applicant 's Name II Permit Number SWG9 Subdivision /lr ame .ivisio oc o _ II Installer's Name �L�L�/�-//yrJ/ / Assessor's Parcel No. Designer's Name u II AS-BUILT DRAWING —� I II II II II II II II �� II II � II II I II II II I II II II II II II II II II CAUTION: Minor adjustments to septic tank location and drainfield orientation made in the field by the insta ter are generally ac- ceptable to both the department wad the designer, but could in certain cases compromise the viability of he system. it is the installer's responsibility to obtain prior written approval from either the health department or the designer before making any deviations from the design that affect system viability. Any deviations from the approved design must be sho above. I AS-BUILT CHECKLISTFRI �f/ II II Drainfield orientation Observation port location L Undisturbe native soil II and layoutFTI�lbetween trenches Syr 7 Cleanout location f�'/ II u Trench/bed dimensions and F u North arro critical distances within u Manifold placement n II II layout Fy U Scale of d awing shown II orifice placement on scale b r II U D-Box/"T"/"L" location .—./ II Lateral placement, with Additional Mounl Information II u Septic tank/pump chamber distances to edge of bed �— i II II location " U Ends lope widthII F-ju Location of wells, roads ,� II II Location of buildings u Overall fill dimensions II I a W �y if ,9 TY L ` N • 0 ri Tzz cl ez r't " r; Q t/1 at vJ LA c 4.r tu U r 0 lu r 1t6- ALA .04_