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HomeMy WebLinkAboutSWG2005-00341 - SWG Application / Design / As-Built - 6/1/2005 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Official use on iv 426 W. CEDAR ♦ PO BOX 1666 ♦ SHELTON, WA 98584 PERMIT NUMBER (360)427-9670, Ext. 352 SWG _ y 7(. APPLICANT I DA PWI a Jr'/�' 0�/' ISSUE DATE — � — J VJ MAILING ADDRES DAYTIME PHONE 3 RECEIPT NUMi2R I b I I Ql S('- 25.3 �32- 360 fi CITY / Icy f STAATE gZrI�P �3 y I ' " "' fY\ wp. `a'C)9�i NEW SYSTEM PROPERTY ADDRESS REPAIR SYSTEM C� TABLE 6 REPAIR SIG RE SINGLE FAMILY k. p OTHER Please describe j NAM OF D IGN PHONE NUMBER NUMBER OF BEDROOMS PRIVATE WELL v rs ff^^ LOT SIZE: ACRES FT % FT PUBLIC WATER SYSTEM W SYSTEM WFI# p � r �I �CreS fit— SYSTEM NAME rF SPECIFIC DIRECTIONS FOR LOCATING SITE Cc- c b I©� . 4 0+ wvo( 6�1 x ads 141 c 3 Official use only below this line IT DEPARTMENTAL SOILS LOGS/COMMENTS/CONDITIONS I 'z— T4 CFQy�.`fiI �f IW SOIL TEXTURE CODES }�' P V =very G=aravelIv S=sand L—Loam Si=silt C=clay E=extremely This application is for design PP g approval only. � An installation permit will be required to install the system • All systems require ongoing Operation and Maintenance as specified in Mason County Onsite Standards. I V • All onsite sewage systems must be designed by Licensed Onsite Wastewater Designer or Profe approval is granted. ssional Engineer,unless p+r • All onsite sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted. iii • Onste sewage system design approval does not imply other building site approvals. • Any change from the specked use of the property or any site alteration affecting the system design may invalidate this pern,it. I O • This permit expires 3 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 1 days of denial date. lO If TOR SIGNAyt1RE DATE D PPROVE,O BY DATE DESIGN EXPIRATION ATE I� White Copy—Health Department Yellow Copy—Designer Pink Copy-Applicant MASON COUNTY DEPARTMENT OF HEALTH SERVICES 426 W. CEDAR ♦ PO BOX 1666 1 SHELTON, WA 98584 (360)427-9670, Ext. 352 Cn SYSTEM INSTALLATION N ❑TANK REPLACEMENT ONLY(Attach Supplemental Tank Replace e t For CD N *CERTIFIED INSTALLER N ❑ HOMEOWNER Official use only2 _o APPLICANT NAME PERMIT NO SWG .��� C5 APPLICANT ADD SS ISSUE DATE CITY `A STATE /� ✓IP RECEIPT NUMBER V 1�.1,�ti -L INSTALLER NA FINAL INSPECTION AND BUSINESS NA E CALL-IN DATE cm MAILING ADDIkESS DAYTIME PHONE INSPECTION APPOINTMENT Z DATE/TIME / CITY STATE ZIP ASBUILT ON SITE? OYES ONO PROPERTY ADDRESS �• CD I hereby agree to comply with all requirements of the Mason County Department of Heath rl— finalServices Onsite Regulations and Standards. Upon completion of the work, the Health Department and the Designer shall be notified. All work shall be left open and uncovere until inspected. A completed asbuilt from the installer or designer must be provided at the ti a of inspection. The applicant has the right to appeal decisions of the Health Departme t. N,1 This permit is v li for one year from the issue date or th l IT, to expirati date f e septic design, which ever occurs fir t. F F— SIGNATURE OF CE I I INSTAL E R MEOWNER INSTALLER DATE IW Ala Official use only below this line Ql FINAL INSPECTION COMMENTS INSTAL I N APP R VED BY DATE 6-IL Revisio Date: 6/2/2005 White Copy—Health Department Yellow Copy—Installer Pink Copy—Applicant 6/2/2005 MASON COUNTY DEPARTMENT OF HEALTH SERVICES June 11, 2005 PO BOX 1666 5HELTON, WA 98584 5HELTON (360)42 -9670 FAX (360) 42 -7798 Jim Henry ELMA (360)48 -5269 PO Box 14531 BELFAIR (360) 27 -4467 Tumwater WA 98511 SEATTLE (206)46 -6968 RE: Design for HAYNES Case No: SWG2005-00341 Parcel No: 321361300030 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 informatio I. Please call me at (360) 427-9670, ext. 353 if you have any questions. Sincerely, L " Cindy Waite Environmental Health Mason County Health Services COMMENTS: 6/1 1/2005 1 of 1 SWG2005a00341 DESIGN FORM— PAGE ONE Revised February IS,I99S A design will be reviewed when a conies conles of each of the foil owit.�I��iitte(m�s'lare tts bmitted: Compfated design form that has been signed and dated a Scaled Tayb4t§kelcli}Maludingail applicable on cheoWist a Scaled plot plan,Including all applicable kemla on checklist a Cross sectIon sketch;Motuding all applicable ms on checklist u CEDAR ST.4 Permit Number: SWGe` �r 00 7'// Designer's Name: r PP PO rl( Designer's Phone Applicant's s Name: n p Assessor's Parcel No.: 2 310-13 Oo D3 Mailing Address: 310(o 0 1 SF_ Crwelvo- !Sit Number) 4:1� Ltaf- ff-0gz- . .Subdivision: X 4<__tyL' City State - Zip - (Name/Di ion/Block/Lot) c �°4 ^' 'm. ¢ `ga:'•?k6¢2,.M,..�.:.o...,�„b'iE.,t..te>rt:Y .r5.,...;.. .....::. L?, 1 �:�,. .i��.�..,vi ;\, u C k 4 4 afh;4 ,&¢��a£♦ x$FR k bo ... ..,\. ✓ a'.. ....:,k., f _,<."x'k .v::�Sv rS lYa..Y Treatment Device O Glendon Biofilter O Sand Filter O Mound ; O Sand Lin Drainfield O Aerobic Unit-Make/Model: O Disinfection Unit - Make/Model: Drainfield Type 0 Pressure Bed Rbrainrock Gravity Trench O Gravelles Chambers Septic Tank/Drainfield Specifics s Laterals Number of Bedrooms Schedule(Class c`" ()2� Daily Flow 3f� Length 7 it Septic Tank Capacity 1 z o o eal Diameter in Receiving Soil Type(1-6) 2 Number Receiving Soil Appl.Rate /. o god/ftt Separation , L4- it Required Square Footage - 3/ao f Designed Square Footage 3�0 ft Orifices Percent Reduction Taken - - o/a Total Number of Orifices Trench/Bed Width D Diameter Jt Trench/Bed Length 8 Spacing I _Elevation Measurements Manifold Origin d Drainfibld Area Slope (� ,/o Schedule/Class Depth of Excavation from /43 Z o/ Length . p SlopeNow m Diameter iin Original Grade (Up-slope) . Preferred M h i412, h" [Jsed? ❑Yes No Designed Vertical Separation �� in Tr�Mjport Pipe 364 gae (Dow"-slope) Schedule(ClassJUN S in Length O.f� �o Gravelless Chambers Required? ❑Yes �o ❑Optional Diameter CON in Pump Required? 0 Yes 'ENO Dosing and Pump Char tier Pump/Siphon Specifications Number ofDoses/Day Dose Quantity al Difference in Elevation Between Pump Shutoff and Upp st�J Chamber Capacity eat Orifice: ft Pump Controls: Timer(or) Elapse Time Mc ter(circle if required) If Timer. Pump On .Ptimj Off Uppermost Orifice is 0 Higher, 0 Lower than Pum utoff Capacity®Total Pressure Head: eom Check the following components if they drai i between doses: Calculated Total Pressure Head: it ❑ Laterals ❑ Manifold ❑Transort (Attach Pump Curve) 'I DESIGN FORM PAGE TWO RCYu�Febmart't t 99, Scaled Plot PlTare —/ Scaled Layout Sketch Cross-Sec 'on Sketch Vest hole locatiM D�infield orientation and layout Ref enced dep h from original grade: M Exoperty linesO/Trench/bed dimensions and critical Septic tank I d Existing and pro wells within p and drainfield cover ' lances within layout depth 100 ft of properts D-Boxf'T V'locations Critical distancerements to cuts, Q/Saptic tank/pump chamber location Reference depth from original grade O�banks,and surfaer observation port location anf restrictive s rate .ocation and orin of curtain �leaa out location (a Laterals,tren h/bed top and botton,and all abs components Or Manifold placement O Curtain drain collector Location and dimn of primary f0/Orifice placement 0 Sand augmentation system and reserva IKLateral placement,with distances to [["Y�uildingsedge of bedOther cross-secti n detail: [��"�ction of slopator O Au ' I yys�alaan referenced ftY Observation its and clean-outs IV Waterlinescafe of drawing shown on scale bar p Amids/easements/driveways/ dos sechan «a. tin C9 Crifical resource lands(if applicable) tq § North arrow and scale of drawin c h s' Wy(jansrgts ti q i1'O >a�c M YS yel S) l'3.Q.Mxi >o" •uM� ` shown on scale bar :sp6+' ila�I+fk :::• + Pr;, '. p uiicil. :.. �p-strpe'attd ;�nst . A50itional,in 'rmation Design stakedput', O Operation and &Intenancel4otice Attached O Waiver(s)Attached a + a� A. The undersigned designer 0 does, JRdoes nor,- aive the requirement to be notified by the installer of the ins lation and given 48 hours to perform a final inspection prior to v r: t 5 31 rgnatur of gner ate The undersigned has reviewed this design on behalf of Mas County Department of Health Services and deterr iined it to be in compliance with state and local on-site regulation Environmental Health Specialist Date Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Departrnent of Health Services ✓ The On-site Sewage Permit has not expired,the Permit Expiration Date is: ✓ The system is installed by a certified installer, unless prior authorization is obtained Dm Mason County Department of Health Services. ✓ Drainfreld site conditions have not been altered to adversely affect conditions of design approval PAGE 1 MASON COUNTY HEALTH DEPARTMENT ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN SITE#: PARCEL#: 32136-13-CO030 DATE SUBMITTED: 05/31/05 LEGAL/LOT#: PARCELI BLA 95-56 SUBMITTED BY: DICK YUNKER APPLICANT: PAUL HAYNES ADDRESS: 31066 117TH PL SE AUBURN,WA 98092 '.. I.CALCULATIONS ' NUMBER OF BEDROOMS= 3 RESIDENTIAL GPD FLOW= 360 '. IF NON-RE5IDENTIAL-GPD FLOW WILL BE AS FOLLOWS: GPD= APPLICATION RATE= 1.0 GPD/FT2 DRAINFIELD SIZING '. AB50RPTION AREA= 360 FT2 TRENCH LENGTH OR BED CONFIG.= 10 FT X 36 FT II.WATERPROOF SEPTIC TANK COMPOSITION AND SIZE= 1125 GAL-CONCRETE NEW OR EXISTING= NEW III.DRAINFIELD CROSS SECTION DEPTH TO DRAINROCK BOTTOM= 2' -0" ROCK DEPTH BELOW PIPE= 0' -9" , SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE MATERIAL/SEASONAL SATURATION= >3'-0" FILL DEPTH TRENCH WIDTH= N/A r JL pr I Mo F 4 Q� Cli m 0 � \ Q ago cn rn Z ON ill, ,r,P• r "' d ,ii 0 0 � } 9 W u u s. 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NgO�MZ 0=1 i� m� ,n ma 0 m rp m 0 Z I 1 m O x z�z2° mzm� 'OOZ Oz m zZ AO -4 A Z < A - m O cmi-(��0 OnzO x= c °O GZ)> �� 0 O m z D r- o rn �ct=nm� Dz�� �� v O i m0 O� ° � _ (� _ '� o Z �m��0 m�ZO m D cx D� PO W O m m _ �Os00 p�zon �- o z(n (nD o� < zv m m -i n m�vmZ mQcr Tn O 2m D� �_ 0 413_0 co Z Z O p °Z m� A In r vrl C ; m x ;u N�zo rpz D rZ icc ;m z m m < O 003�M °u P Da-i o 0 j) _� mm A fll = zi-�1D nWr-rDc (Am m vT D= �� m=�3ao mmAm O �n mm m0 ° V/ MT m N O Z L713 Om (n p n r- m — o 0 m0 I Z III= O I—IIII O r (n m CO p C- o p m :q O m m a r �t G) m ;a T O� o_ A Nr p D (n Z OC N O w n A m xz D z z W n = m N m lA N o ."' � K ° OX O z m CDo Z n r O 0 ow W m m m ;K �D o O Z Z D0 3 v m oD to (A cn T -I -4 w0 x � r (� o N N 01 m .Zm1 � 4 Z ^ T D 0 X W 'g . :U v 0 vm LL to 0 w Q W I W Q z � OA LLI W QQ g� Wc W z Zva o � � o m w w 0 ¢ wa F- � a = ow N 3 =rc O u ?= ai�> Fr Ed F WLL LL z NZn J¢ l� 0 N R 1�N R' Q ✓ 11 W Sn W J D H — 0 O Q' W co � gm � w ,OO �Q Q Y Z U F IL w o w m w ui ¢ Ix W V J Z N J co ¢ Z LL co W —' t Z >W LLIin DO w w J U . 1 AS-BUILT FORM RevisedJmuary4.1 Applicant Rol i"��5 Assessor's Parcel# b0O 3a Permit Number SWG20K-ppOd341 (( !� (Twetve-Digit umber) O�Installer A - C�1 t L Subdivision f G rreI B L \/ (NamelDivisionf Iock/tot) Designer ��f f✓I� 1 V Vl Lec . a. NIA Yes Pri 3r to Completion 1. SEPTICTANK A) >5&From foundation? .......................................... ❑ ❑ B) >50 ft from wells and surface water? ........... ..... .............. . ❑ ❑ C) Bldg stub-out to septic tank:clean-out if not 1-2%? .... .. ...... . ...... . ❑ ❑ D) Baffles intact and clean? .... .. ............... .. .. . .. . . .. ......... ❑ ❑ E) Dividing wall intact?.... ..... .. ... ..... . . ... . ... . . .... . .. .. . ..... ❑ g( ❑ F) Risers installed for access? .. .. .. . ..... ... ..... ... ❑ l5r ❑ G) Tank Size: 119 gal.;Manufacture�0� K57 I ASC�L I1. D-Box A) Leveled with water? . . . . .... . . . ..... .. . . ........ . . .. . . .. . . . .... . . ❑ ❑ B) Speed leveler used? . . . . . . .. . . . .. .. .... .. . ... ... . . .. . . . .. .. . . ... . ❑ ❑ 111. DRAINFIELD A) >10 ft from foundation and>5 R from property lines? .. ... ......... ... . ❑ ❑ B) >100 ft from wells and surface water? .. .... .. . .... . .. ... ..... ...... . ❑ ❑ C) >10 ft from potable water lines? . ............................ ...... ❑ ❑ D) Laterals level to±1 inch&end caps present if not looped? .............. ❑ ❑ E) Gravelless chambers utilized? ...................... ............... ❑ ❑ F) System dimensions the same as shown on the design?................... ❑ ❑ G) Gravel clean,properly sized,and proper depth? ❑ ❑ H) PRESSURE SYSTEMS 1) Sand quality ASTM C-33? ................................... . ❑ ❑ 2) Head height uniform and z24 inches? Actual head height ..... Pir ❑ ❑ 3) Clean-outs and observation ports present? ...... . ......... ........ ❑ t ❑ 4) Mound: Side Slope 3:1? ❑ ❑ 5 Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I? .. .. .. ..... . .. ❑ IV. PUMP/PUMP CHAMWER A) Screen basket or uent fill (circle one)installed? ... ........ ........ ❑ B) Riser installed for access? ..................................:...... ❑ C) Alarm installed? ................................ ................ ❑ ❑ D) Pump make Pump model / - E) Chamber size gal; gal/mch; Chamber Manufachue F) Pump chamber draw-down inches per minute; Height of pump off bottom of pump chanal ec inches G) Pump controls:Timer(or)Elapsed Time Meter (circle If installed); If tinier is used:Pump On Pump Off RECEIVED JI!?'< 2 9 2006', EALTH SERVICE, `', �P: 3. e "Y v: ...ch% :.. . CEWA3aJS 1 ❑ Drainfield&manifold orientation &layout ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank placement. ❑ Location of buildings. } ❑ Observation port&clean- 1. out location. n L ❑ Location of wells& 1 } roads. ❑ Undisturbed native soil C between trenches. ❑ North arrow CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer m genaally acceptable to both the department and the designer,but could in certain cases compromisew the viability of ayam• It is the installers responsibility to obtain poor emnen approval from either the health department or the designer before making any deviations from the design that affect the system viability. Any deviations from the approved design must be shown above. ` A� `rFRTIEIAII©N(I7 IN$T TidN r W a Installer Check a box from Row"A"and"B",sign and date the ce cation A. ❑ I certify that I installed the system without any I certify that all deviations from the design stamped deviation from the design stamped"APPRovED"by "APPRovED"b CDHS are shown above. 1 MCDHS B. .91`I certify that I contacted the designer and left the ❑ I did not ct the desi rior to final cover because the system open for inspection up to 48 hrs prior to designer ived the no ' on irement. cover. I further certify that all information contained on this form is accurate. I unde i ation contained herein is not accurate,there will be just cause for immediate suspension of my installer ce i 3 - t o sta r ��Date the undersigned approves this installation on behalf of Mason County D nt f H Services. 4"1 2 Ub Sanitarian Datd n � z CHECKLIST ❑ Drainfield&manifold orientation &layout ❑ Trench/bed dimensions and critical distances within layout cl Septic/pump tank placement. Q Location of buildings. ❑ Observation port&clean- out location. , ❑ Location of wells& � roads. 7 ❑ Undisturbed native soil between trenches. ❑ North arrow CAUTION:Minor adjustments to septic tank location and dminfidd oriemation made in the field by the installer are generally a to both from ethe pa�the - ent and the designer,but could in certain taus compromise the viability of the system. It is the installer s risibility to obtain nor approval health dcp t=t or the designer before making any deviations from the design that affect the system viability. Any deviations 6om the proved design most be shown above. j �- �'iEr{T#FCC'ATIL?NCjF1NST GAT16N Installer"Check a box from Row A and`B",sign and date the re ' canon A. ❑ I certify that I installed the system without any I certify that all deviations from the desi stamped deviation from the design stamped"APPROVED"by "APPROVED"b CDHS are shown abo e. MCDHS B. I certify that I contacted the designer and left the ❑ I did not ct the desi riot to final cover because the system open for inspection up to 48 hrs prior to designer ived the noti on re uiren�ent. cover. I further certify that all information contained on this form is accurate. I unde i ation contained herein is not accurate,there will be just cause for immediate suspension of my installer ce 'fI �� Sr e o sta r ate The undersigned approves this installation on behalf of Mason County t f Hea Services. J(w� Z Ux, anttanan \� I i� �� `I �- i 1 L _ i l I l I, G( }VFa LESS P�trJ 'DR�41h�FIE PaT�o DQ �i 4`' PVC Ti µTLIrOiE- sePTl L -rWIL- U�FI L-TF P-- VsE oK 2�ss'�E g2G� n�►�Y MI-riGFFT-F— RF-DVc- 5�-TBrj-cam 51A o >14 r l O R!CHP b1 1"2 I JIM HUNTER ASSOC,. CONTRACT OF P.O.BOX 162 OLY,WA 98501 A-prc o um- , -153-12:26 INSTALL D TE (r� Olp AS—BUILT FOR SITE-ADDRESS/LEGAL OWNER - `04JL RAIYN6S IFI A `6' '' FINAL DA E 64 D TPA 321'36-13-0003o SITE� ZOD -D03',<�