HomeMy WebLinkAboutSWG96-0826 143 NE Sides Way - SWG Application / Design / As-Built - 12/16/1996 -Z ;
"tit
MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG — 2LP rn n
C N
O. N
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date u
N O
Receipt No. � N
PHONE (360) 427-9670 Amount$ z f
m m
�LI LA6<f14 ROsI - l -i - 9 6 CHECK APPLICABLE ITEM ✓ m
MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM ✓
N 41 tbES WAy REPAIR SYSTEM
CITY: STATE: ZIP: MAINTENANCE REVIEW 7 m
6Ur—A t2 wA 9 1$ SINGLE FAMILY _
PROPERTY ADDRES OPEC FY: 3
SAM E RS
SPECIFIC DIRECTIONS FOR LOCATING ITE: PRIVATE WELL m
CP wp1To RO ro z.,vtr oN Eliacm,0 asikD-4&or COMMUNITY WELUPUBLIC SYSTEM
SYSTEM WFI N IQ'
1,5 Hic€S FT otj S +Y- JJ8 R/OE wAV oO 1491 SYSTEM NAME
APPLICANT
tj Ft, 41 IDE WRY NAME 'r
Name of Lot 4`� ft.x ft. MAILING DRESS -6
Installer w
P.ANK aDeM1�Ro Size: S� acres TELEPHONE d
Name of um er o SIGNAT o
Designer To N y De M I€RD Bedrooms 3 X '
PLOT PLAN j p Acme rlefe5 U, F?6k oe
Draw a di a}•@�Qt n �7 r • .3
and s Qoeed no- r
in�cludin i I" ►IJ I n t j•eo o
+l L`J lRJ LL`h] l/ l� U o 0
Preci ation of test
holes,showing ntr + s Nl I O
measured distaAt�Ato 1
property boundaries.
Q� UWoAnxeiS Arrawp4n'
Entry T Rs{dene {o P Prlkj
drivew TRV0q7
r
10 6`
NOTE: DO NOT DRAW IN d
SYSTEM DESIGN
S;DeLorjg5 1Zd -
RWCIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
!,' ,' / SOIL LOGS
a rn b-/)-xV1JLJjxi,1V) ��aSc`rtuj�a`w� 0/392akib
id-bo �iYdtyva�l ►I !a-�65�u1dtyJavel la-�a5AI-;j ig rah
C/) �i rt
m � >=
< r �
n o-lasa,�i lcm
m /a 56tr)d Depth from Original
'7 rL,P2 1 A Grade to Restrictive
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTE REQUIREMENTS
Finding Score Designer Level: ❑One ❑Two
Soil Type
Septic Tank Daily
Vertical Separation � in. _/5 Capacity: J'S0 Gal. Flow: GPD
Slope -&- % Appl. Infilt.
Parcel Size 5 Ac 5 Rate GPD/FTC Area 0o ♦fT2
Distance to Shoreline ft, � otal_ T In ector Date
COMMENTS/CONDITIONS FOR APPROV L
it
•All septic systems must be designed and installed by contractors certified by Mason County Department of Health Servic s, unless prior approval is
granted 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 change from the specified use of the property or any site alteration affecting the system design may invalidate this PE rmit.
•This permit expires 2 years from the date of site review. Denial oft rmit may be appealed to the Health Officer within 1 days of denial date.
SITE REVIEW: DES N VI Approved -j Not Ap ov d INST TIO p ed ❑Not Approved
3Y: DATE:4a*1 BY: ATE: BY DATE:
TOP: Health Dept. Copy DLE: Designer's Copy BO OM: Kpplfllcanfs Copy
DES FORM EYAGE ONE s--i•b 04/24n4
7�ig� l reviewed when 3 copies of each of the following items are ubmittsdl
u�� �' leted design form that has been signed and dated
p, leted Resource Lands and Critical Areas Checklist attached
L�N a ed plot plan, including all applicable items on checklist
Z ed layout sketch, including all applicable items on checkli t
� pcs-section sketch, including all applicable items on checkli t
=�
n
Q q PARCEL IDENTIFICATION /�
1 Permit Number l b - 0�� Designer's Name .l,
Applicant's Name 41i42111,4� Prop. Owner's Name Q
d Mailing Address Nf• 21 Hailing Address
' f , Q
0 State
dAssessor's Parcel No. Subdivision T,Q /6 �� Q
Q r —�Nd,R�7T 6fAon/F 0CK'i'LbLT— Q
Q DESIGN PARAMETERS II
it ✓ ✓ ✓ ✓ u
Q , rL, Designed Vertical Q
Q U JdJ UU Separation z�I Q
p Hound Subsurface Pressure Gravity Bed Trench in II
i
N Septic Tank/Drainfield Specifications I Ip'1 r_1 Q
No. Bedrooms �5 i Pressure Distribution? + Yes U No Q
Q Daily Flow 43 0 gpd (If yes, proceed. . . ......................::
......................
Q Septic Tank Capacity / .00 gal f V`teg Q
Q Receiving Soil Type (1-6) / /` I $QC Q
Q Receiving Soil Appl. Rate /•Z gpd/ft= LaE
Q. Trench/Bed Bottom Area 300 ft'1 Schedule/Class <y OeQ ' 44 OD
N Trench/Bed Width /O ' ft Length DACOU� O fti
Trench/Bed Length 30 V May � 'Q1V •LSR
q - Diameter �y n
Elevation Measurements Number \N��a\5
A Orig. Drainfield Area Slope Z t Separation at 0 ft t
PE::
0 Final Drainfield Area Slope t �{' 8r1f1ces
II Depth of Bottom of Trench/Bed p� Total Number of Orifices
q from Original Grade O in Diameter in
Q —UPSTope A Spacing
Q _ pe I Manifold
Q ( Schedule/Class o0
n ��.y-,[; I Length ft
Infiltrator Used? U Yes �'+ No Diameter
N r"I Transport Pipe V
Pump Required? Yes 1 J N6 schedule/Class 7bO
(If yes, proceed. . .) E:: ..................::: I Length
Diameter O' n
Pump/siphon Specifications Dosing and Pump Chamber Q
Difference in Elevation Between Pump Shutoff N Doses/Day
N and Uppermost Orifice /o ft ' Dose Quantity sal
Nrvi r--1 I Chamber Capacity J6a gal
Uppermost Orifice is L4+higher, U lower (] I
than Pump Shutoff 1�1 / I Check the following components �f they drain I�
b Capacity i Tot. Pres. Head gom between doses:46A/6 CrJQ43' vp�j aj 5hrc/d5- - II
Q Calculated Tot. Pres. Head L Q -9� ft
Q (Attach Pump Curve) Laterals Manifold Transport Q
111�5IGN.FORM - PAGE TWO � "-d 01/24/94
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 8
Reference dept from orig- p
Test hole locations Drainfield orientation inal grade:
N and layout Q
Property lines i Septic t lid and
Trench/bed dimensions and drainfield cover depth p
f Existing and proposed critical distances within I A
wells within 100 ft layout Reference depth from orig-
of property lines I inal grade and restrictive
D-Box/•T•/•L• locations strata: p
critical distance - + 14
measurements to cuts, Septic tank/pump chamber I2 Laterals, rench/bed p
banks, surface water location top and bo=m B
ICE n h
� Location and orientation Observation port location U Curtain drain collector �
of curtain drain and all
absorption area = Cleanout location XV Sand augmentation p
I components I U
P Manifold placement No external rel'erence neededdj
Location and dimension I W R
0 of primary system and orifice placement Observation ports and 0
r reserve area I cleanouts Q
Lateral placement, with 1 R
Buildings distances to edge of bed I Additional mound information:u
r, u
Direction of slope � � Audible/visual alarm I tJ Upslope and downalope p
indicator referenced fill width Q
n
Waterlines I Scale of drawing shown I Settled eat depth at p
• I on scale bar center an edge of bed d
0 Roads/easements/
-. p driveways/parking Additional Mound Information: ' U Sidewall slope A
n I n d
d Critical resource lands u Endslope width u Dp/downslope bed elevat. Q
(if applicable) r 1
u Overall fill dimensions o leted Reso rce Lands and
North arrow and scale of Critical Areas Checklist
drawing shown on bar 0
1 DESIGN APPROVAL
n
A The undersigned designer does, does not, waive the reqirement to be notified by the
p installer of the installation and ven ho a to perform a final inspectionjprior to 0
cover. p
The undersigned has revi d d ap o d this design on be if f Mason Count+ of Health
Services. ^
d �
0 CAUTION: THIS DESIGN I6 OHL V ID IP STA?IpED -APPROVED- BY MASON CO. DEPT. .OP HEALTH Q
1 p
I
4
FM(4I 6i�S �
. 2 ' 3 " 3 'tI _!
Z�1" G-33
zq it
1. ¢FM TO IQ5MIGTISC LATER IM---- -
zxav t OvF IY.TYLL`e IWKT
3.L TOM`,.FrI TIM IS T rELT
LATEWL M COMALL6 IC TW rMT
1 . 25' �W
1 . FIRST ORIFACE 1 .5 -FROM MANIFOLD /
AND EVERY 3 ' THEREAFTER
FI I N I SHI GRADE
MANIFD S
2IN CL
TRENCH BOTTOM
SCALE 1 - - 10
10X30 ' PRESSURE 0 5 10
BED SYSTEM
I. IMTN1 mm wToe,alw+anm+
E. Iran Uo tm l8 rpcu1qm rAmic
3. FiIL'T%mcTSX S.i' LATCI1nL ecrNaTtEn O ,
3.9.
I
it
l
Mason County Dept. health e ices
APPROVE3D
Initials
Date
O .L
(f) 0
cn :3
W (D C®
U
U F- v
N \
J �
< I n > > a
W7-7 LLI�O < LS J (wJ1 2 n
�F-V << Y O�wp ^
F-^ <W Z
mW ED < —7
WIW r n _
�O .g I�L`1J V J
LOW JQS Z<
F W <U Z->
UWZ 1- OmY
F- J LrLJ
^ -� F-CU V� J
ZF-J » < w
Off- d >JS r� _
UO3 O WJU
Z� = WO'1.i l ` 41
—F-z :)F- 02
w(n< �z wz~ N
g�, z
mWS�HF-2 ;c=- OJF-O U
N F- F'^ U.{{LLB� .j
2W Z >-H <-m L`
XF
z� <J
��
O�SII�ili JF- W
��
W �< WOO LLI
>72 ��— m
TW3YUU� WO U)SU
~U)ZU) JWT U� T-
o \ IgC+
w^w (2O F-LLLU U
<=XS Z n m r
F—Z]F-- _< w
zo� Jef W¢
3 Y « 2
p Z N- F-:J
WwWO ZCC LL-= U >
HwF Oo `JC S
Mason County hot. team , e,4 43
APPROVED
Initials
i
Date -
EltLtb�.+�, �oSE
'Fti'iunect II 01
'' II
l• /O x5o pmoo l g� ��►rlt7Pd 0 S6 1100
N I
- P. ;3. 3609pd On 1.Z Ppl.i✓Pti'E.
vroo
_ -
r f�w6�
taker�.L ��CC PpnTp(, i _ 61mRED eacQl;or�. NN Ceyer✓a-
-- ex Co NX
e7 29; - o
t5 7O
NCCI'tJ . I NE� P.�ttortJ.
The fti
10
Y
PCCAXome
LLD .1 ExiSlYnq
- -
WDODk-D-
Mason County Dept. Hea!II1 ;ery ces
APPROVED
Initials —
Date ---tfl—
I
PRESSURE DISTRIBUTION
REQUIREMENTS
1.Install trench bottoms level without any slope
2.When trenches are being used on different elevation,- ,
• check valves are to be used between laterals e:l.tli:
manifold to keep manifold primed at all times.
3.Install 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
for failure caused by smearing of the trench walls.
7.Install a check valve in the transport line within the pump
chamber.
8. Ieither a
totprotect the pump all and tchahe drainfield from contaminating
r screen or an effluent r
solid matter.
9.Install high level water alarm system to warn owners of
pump failure.
10.Install lateral cleanouts, screw fittings forty five up to
finish grade. tank to the finish
ll.Risers are to be installed at the pump
grade level for ease in pump removal. if baffle type filter
is being used risers must also be brought to the surface.
12.Install filter fabric over trenches completely over
trenches.
13.Divert all home and storm drains away from the drainfield.
14.saptic system is to be inspected, and or serviced every
three to four years. tank should be pumped at a minimum
of every five years.
15.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.
16'." Install audio and visual alarm in pump chamber .
• 17• �v� dco3L ��ry�, ata� • 3$g� -
` Mason County 0 ���I.
�. • �pPR
• Initlals�� ',
pate —�
i
P.O. Box 175
Belfair, WA 99528
(206) 275-6155 Masoq County D
Designed for: ELIZABETH ROSE 4 i'' ep He"
Street address: N.E.141SIDEWAYS ROAD +l Sejvc ,s
BELFAIR, WA. 98528 /hide/s
SITE CONDITIONS: # of Bedrooms - 3 Oete
Soil Type - 1
I. DESIGN THE DISTRIBUTION NETWORK
1. Make Preliminary Determination of Trench/Bed Configuration.
A. Daily design flow 360.00 gal .
Daily flow = (# bedrooms) X (flow/bedrooms)
B. Application rate based on soil type = 1. 20 gpdj/ft2
C. Required absorption area = 300.00 ft21
Required absorption area (ft2) _
[Daily design flow (gpd) ]/[Application rate (gpd/ft2) ]
D. Selected trench or bed width = 10.00 liri ft
E. Total trench or bed length = 30.00 lin ft
Trench or bed length (ft) _
[Required area (ft2) ]/[Selected width (ft) ]
2. Select a Primary Network Configuration
A. Lateral length 29.50 ft
Lat length ft =
I
[Total trench/bed length (ft) - 0.5 ft]/[# of laterals]
B. Lateral spacing = 3 .00 ft
C. Transport pipe length = 75.00 ft
D. Transport pipe diameter = 2.00 in
E. Manifold length = 6.00 ft
F. Select an orifice spacing for this lateral 3 .00 ft
G. Calculate the number of orifices in this lateral 10 .00
# of orifices in this lateral=
[Length of lateral (ft) ]/[Selected orifice spacing (ft) ]
(ROUND UP TO THE NEXT WHOLE NUMBER)
H. Select an orifice diameter (3/16- 3/8) 0 .18750 Ln
I. Calculate orifice discharge rate 0.59 gpm
�3C
J. Lateral discharge rate for this lateral � i
Health Services
K. Select an appropriate lateral diameter 2tNc
initials
L. Class of pipe for laterals is Class 200 Date
3. Design the remainder of the laterals.
Lat 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 3 . 00 1.25 29.5
2 2 .00 0.59 5.86 10 3.00 1 .25 29.5
3 2.00 0.59 5.86 10 3 .00 1.25 29.5
4. Select the Manifold Diameter.
A. Calculate the total lateral discharge rate 17.59 gpm
B. Select adequate manifold diameter (from table) 2.00 in
(End manifold using Class 200 pipe)
II. DESIGN OF THE PRESSURIZATION SYSTEM
1. Determine the Dose Volume
e volume based on soil A. Dos type
1. Recommended dosing frequency/day = 6.00 dos s/day
2. Recommended dose volume = 60.00 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.
Required dose volume = (7) X (Interior volume of laterals)
3 . If entire system drains between doses = 0 .00 gall.
Required dose = (7) X (Interior volume) + volume + volume
volume of laterals manifold trans. line
i
C. For desired dose volume, select larger
of A or B above 60.00 gal .
2 . Determine Required Pump/Siphon Discharge Capacity 17.59 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
A. Transport Pipe: 0. 36
- Transport pipe is Class 200
B. Manifold and laterals: 1.00
4. Calculate the Total Elevation lift = 10.00 ft.
Total elevation lift =
[Elev. of uppermost lateral]-[Elev. of low water level in the pump chamber]
5. Determine the Total Dynamic Head.
Selected residual pressure: 2.00 ft.
Transport pipe friction losses: + 0.36 ft.
Manifold and lateral friction losses: + 1.00 ft.
Total elevation lift: + 10.00 ft.
Total Dynamic Head: = 13 .36 ft.
6. Required Pump Capacity is 17.59 gp
Total Dynamic Head is 13 .36 ft.
Number of bedrooms 3
The required absorption area is: 300.00 sq ft
The length of the bed is: 30.00 ft
The. width of the bed is: 10 .00 ft
The length of the transport pipe is: 75.00 ftY%17 C
The The lengtheofothehmanifoldort is•pipe is: 2.00 in OU171y 6.00 ft �pT pePt. Hea/t S
The diameter of the manifold is: 2 .00 in �[, o _h elvices
The total Volume of the laterals is 8.14 gals tntiais D
The volume of the manifold pipe is 1.13 gals pate
The volume of the transport pipe is 14.17 gals
Dose vol based on vol/pipe void ratio: 0.00 gals
Dose volume based on soil type is: 60.00 gals
The required dose volume is 60.00 gals
The total discharge for the laterals is: 17. 59 gals
The friction loss in the transport pipe is: 0. 36 ft head
Manifold and lateral friction losses: 1.00
The total elevation lift is: 10.00 ft head
I
I
i
Tfi
r�
Submersible
Qurves P u m PS
=� FEET _
100 I 1
30 ,SOLI05
15 I --RPAI•VARIES
Gum
20
O _60 I I I t
i 40
a t0 SH- I - I - •I I -
20 ---�- i
0 00 20 10 60 80 100 t20 140 160U�S.GPM
• 1 t5`i -
0 10 20 30 tR'm
I FLOW RATE
t �(� U`Z GaU UMPS-INC. -
R�I 6110{Ir
. K' Ikw1Qi O:.!
6CETPRS FEET
120 Im V4 SO GS
-L' '+ — RPM:3450
L;�S F:7,
I
90 }.
25
W _
15 500 40
I
r t
30
10
20
5 70
0 00 10 20 30 40 .50 60 70 80 90 100 110 12D �L&GPM
1
0 10 20 30 'Rt
CAPACITY Elte:.U:�J,iY. tDu
c�f5]Ga•nce avm:.+. Inc Sa<_C:r�U-CNS APE SU9.IEC'O Utu+CE wml4tt'NC—.CF- PFIn7E0 al U..S.s
CJs:.`.7•v
. l
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
.......................................... ....................................... ............... ,. . .
DATE CALLED IN-
TIME: l/A �f
INSTALLER: ✓�."/'C
APPLICANT/OWNER• lJ ,1 7 '•--`•"�
PHONE tk OF CALLER: '
�c� - a SWG O• o I
PARCEL NUMBER: L L—s
SUBDIVISION:
DIVISION• LOT:
.«...«..«.«........«..............«........................ ............. ««»..« .:» ....."'... �..«...�« .
SYSTEM TYPE (CHECK ONE) :
:-*-PRESSURE- - GRAVITY
]ISPECTION SCHEDULE (CHECK ONE) :
u U
APPOINTMENT PLUG IN
A—BUILT ON—SITE? (CHECK ONE) : Q Q
YES NO
...........9:: .......................... ....«�«:«��•»i9 'a ......... ..............................................
STAFF INITIALS: � --
I
h:callin.0
ON—SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
.................................... ..........
...................................................................................................................... eE�Si ................
STAFF CHECKLIST I
I
I CONPIAtffiD BY TNSPHCTOR7 I
i I
C®en
I. P Yea Ho
A) : TARP /� i I&4 I
I A) >5 It from foundation?
a) Bldg stubout to septic tank: cteanout if not 1-2%7 _ I
c) Baffles intact and clean? — I
a) Dividing wall intact?
YY. m-aoY Leveled with water or speed Leveler (circle one)? AVE
In. DRAXKF1 D i
A) >10 ft from foundation and >5 ft from property lines?
a) Laterals level to t1 inch t end caps present if not Looped? _
c) System dimensions the same as shown on the design?
n) Gravel clean, property sized, and proper depth? _ I
a) PRESSURE SYSTEM
I) Sand quality ASTH'C-337 I
a) Head height uniform and 224 inches? _ I
a) Cleanarts and observation ports present? ;spy
a) Hound: Side slope 3:1? —
s) 01 w informed electrical connections aunt be made
by owner or Licensed electrician and inspected by DL17 _
I
IV. POTABLE 101TER LIMBS I
I A) >tOft from draiMield, transport tine, and septic tank? _
a) Welts M00ft from drainfietd? _
I 1
V. Poem SJ.aE --
I al Screen basket orluent f (circle am) installed? = I
I a) Riser installed forf. s? I
c) Alan installed?
I vI. As sva.T RaODa=r -
I vrl. orasR «z>:,arrs I
I I
I
I I
1 I
I The undersigned has reviewed this installatf verifies these findings en behalf of Hason County of Heplth Services-
ns z a e
n
h:callin.w
Revised 02/01/95
�T
r;S-BUALT FORM - PAGE ONE Rl i..d 12/14/94
PARCEL IDENTIFICATION II
II Applicant's Name i / �-
I
II Permit Number SWG9 (5 - d82�. Subdivision 6 Lo CJ II
ame Jlvlslo oc o II
II Installer's Name i l L�"`�� Assessor's Parcel No. �23(I 7r -C'0/66
II Designer's Name w v g u e II
II INSTALLER CHECKLIST _ I'
•I
II N/A Yes Prior to II
II SEPTIC TANK Completion
A) >5 ft from foundation? II
p B) Bldg stubout to septic tank: cleanout if not 1-2t?
C) Baffles intact and clean? _
u D) Dividing wall intact? _ II
H II. D-BOX Leveled with water and/or speed leveler (circle) ?
II ' III. DFAINFIELD
H A) >10 ft from foundation and >5 ft from property lines? II
II B) Laterals level to t1 inch & end caps present if not looped. _
p C) System dimensions the same as shown on the design? _
M D) Gravel clean, properly sized, and proper depth? II
E) PRESSURE SYSTEM II
u 1) Sand quality ASTM C-33? �(
N 2) Head height uniform and z24 inches? II
U 3) Cleanouts and observation ports present? II
4) Mound: side slope 3:1? >T
5) Owner informed electrical connections must be made by
q owner or licensed electrician and inspected by DLI? II
u IV. POTABLE WATER LINES
A) >loft from drainfield?
B) Wells >100ft from drainfield? II
u V. PUMP/PUMP CHAMBER
u A) Designed pump usec ttached for equivalent pump? _
e) Screen basket or effluent filter (circle one) installed? I'
C) Riser installed for acc
II D) Alarm installed? (I
u CERTIFICATION OF INSTALLATION II
Inat ller: Check box from Row "A, " check box from Row "8, " sign and date the ertification. II
i r� II
A.14 I certify that I installed the system u I certify that all deviations from
without any deviation from the design the design stamped -APPROVED- by MCDHS are II
stamped "APPROVED" by MCDHS. shown on the reverse side of this form. II
B. 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 requirement. II
I further certify that all information contained on this form is accurate. I understand II
that if the information contained herein is of accurate, there will be just ause for II
immediate suspension of my i s ler rtif' at. II
q 7
lgna ure o ns a er a e II
The undersigned approves t is .installation of behalf of Mason County Departme t of Health II
Services.
/ Ln InSpeCCuL /� I)
.��J �J'i
AS-BUILT FORM - PAGE TWO Revised 11/14/94
II PARCEL IDENTIFICATION II
II Applicant's Name % Role,
I�
II Permit Number SWG9 b/ - 08;26 Subdivision
II T 1 Name/ lvisi n o II
II Installer's Name NL4L1-_rU Assessor's Parcel No. a'a3 I � �yb'�(� II
w e- i u
II Designer's Name II
II AS-BIIILT DRAWING
II "J"'� e AB�alll.� qs pea - II
14
II II
II �.
II n so tea n - � ,< CT t?T II
II Prffls P�• II
it II
II g _ II
fdvw; _ 51k) ,
II
II � -
�t`g� II
II II
u II
II II
it II
II II
CAUTION: Minor adjustments to septic tank location and drainfleld orientation made In the field by the Installer are generally ac-
ceptable to both the department and the designer, but could in certain cases ctwpromlae the viability oF the system. it is the
Installer's responsibility to obtain prior written approval from either the health department or the designer before making any
devlations froo the design that affect system viability. Any deviations from the approved design must be above.
N AS-BIIILT CHECKLIST II
I I
II r II
h Drainfield orientation u Observation port location Undisturbed native soil II
II and layout ] between trenches II
u .Cleanout location II
II � Trench/bed dimensions and North arr w II
I) critical distances within Manifold placement II
II layout Scale of irawing shown II
II u Orifice placement on scale ar II
II D-Box/"T"/"L" location ! II
II L-7 Lateral placement, with Additional Mognd Information (I
II Septic tank/pump chamber distances to edge of bed n
II location U Endslope idth II
II Location of wells, roads n
II Location of buildings u Overall fill dimensions