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HomeMy WebLinkAboutSWG93-00572 252 W CLARK RD - SWG Application / Design / As-Built - 5/11/1993 - TE SE1Ni�GE YSTEM SITaE EUTALUATION AND.Fill— PERMIT NO. — . co n ON COUNTY DEPARTMENT OF HEALTH SERVICES y SITE EW_L TIO I SIGN AND IN A LATION a m 1426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date �/ I Date y Receipt Receipt No. S y PHONE (206)427-9670 f Amount$ Amount$ Z PROPERTY OWNER, DAIL: 3 w m I Ctk RRU E. �OkFt l- ( r 1 9 3 CHECK APPLICABLE ITE S e/ MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM V P.O, [30 (�Pkb (so b 1+2b' 2267 REPAIRINGOCDSYSTEM CITY: ' STATE: ZIP: EXPANDINGSYSTEM w S r= L'ION (y)Pt SINGLE FAMILY ✓ m' PROPERTY ADDRESS: OTHER c W 25p Cf-RRK RD. 5tk8C,ToA iJ+k ga584 SPECIFY: . 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL ✓ m 1, 15 Ati ()VT PUBLIC SYSTEM 16.1 SYSTEM ID NUMBERI C 1 SYSTEM NAME N Lp� RD1l `fMiLEto OIkN Pr3tv�CJAY. PlIcCEED;Do+�tf D2�vEwA . APPLICANT 600 P-r To OFEft AAEA. ON RI *T. FOLLOW A RRaGaS,C 7�E eD NAME RICVFR RD oUN Q Name of Lot ft. x ft. MAILING ADDRESS. P O 113oy-t"L '.. Installer 5 kFELToK W ati Q&55 I - o (•N. Size: /a •s acres TELEPHONE 2oG �t2b- 26 Name of um er o SIGN RE' No Designer Bedrooms X PLOT PLAN I{v }I �25 Draw a dimensional plot plan, d, I�3 including: o ❑Precise location of test f 3 C LRQK RD Q holes, showing �{ measured distances to �o propertytioundaries. ff, o iL ❑Entry road other roads Y NOTE: ADO NO.T DtRAWJAI e r 4SYSTEM DESIGN 7-56 f Mr�V 1 1; 1 93 f Z , OFFICL__ _E_ON Y. DO NOT WRITE BELOW DOUBLE LINE. U I— }L I F u s ®a! SOIL LOG'Sf +r �' ( ZJf5 . �Ze t�'A-' ` 4 CMIX ID-Z� �'�v'` 2II1-31 Vr.�otr n. �► � �"�'� �� -3y � �„ rig 31-3�' �ff;�, , T u vas � '2a Depth frorn Original - v9 Grade to Fkestrictive Layer or Water Table: In. DESIGNER DESIGNATI N SCORES MINIMUM SYS EGIUIREMENTS Fin�d�ing Score Designer Level: Xwo Soil Type Vertical SeparationqA Septic Tank Daily p "� Capacity: 70D Gal. Flow: GPD Slope- .f - -�1 . Appl / Infilt. I Parcel Size � �- - Rate' �`f7 GPD/FT' - Area �� T' Distance to Shoreline Total Inspector Date COMMENTS/CONDITIONS FOR APPROVAL I ► i SYq J 7 G A L�lG&�1 25 1 d r-9'4 °42 Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit. This e • xpires 3 years from date of site Inspection.D i of this permit maybe appealed to the Health Officer within�10 days of.denial date.. SITE: r esign Required ❑Not Approved DESIG : Approved'' O Not Approved- INSTALLATION:D Ap roved ❑Not Approved BY: D BY: DATE4-Zf-,V.I BY: DATE:, TOP:,Health Dept. Copy__,MIDDLE. Designer's Copy BOTTOM:Applicant's MASON COUNTY DEPARTMENT OF HEALTH SERVICES POSTI OFFICE BOX 1666 SHELTON, WA 98584 (206) 427-9670 ' FAX 427-8425 APPLICATION FOR VARIANCE/APPEAL Revised 10/25/92 . .........,•c .iiiiiiiiii .... Directions .............................................................................................................................. ........... .................................................................. 1. Complete Part A and submit to the Director of Be lth Services, PO Box 186, Shelton, MA 98584. 2. Staff and the director will make a recommendations to the Health Officer in Parts B C. 1. The Bealth Officar'will make an initial in-house determination in Part D. 4. The,applicant, if unestisfied with the initial Health Officer determination, Can regat a Bealth Offi- car Bearing. The determination of the Health Officer at the formal Bearing will be made in Put H. Findings and determinations of the Bealth Officer nay be appealed te the Mason County Board ofl Health. ............................................................ Part As Request for Variance ............................... ....................................................................................... :::�::..�......... ............................................. ............. :::::::::::::::::............................ ..... \ • Applicant's Name: Q1Uf/9RD yOT Mn1 �t�)�u� w317c�J�t Rls1 .�. • Address: - 1Ta (201:. 14 L/(..) Z'St+ Gw'�+�xl F�-0) � }}E1,TON ,W Rig}. 98SS�4 I • Telephone: ( Zo:. ) WIG I SZ031- ZL-Od01 O • Assessor's Parcel Number • Subdivision Name and Lot Number • Nature of Variance or appeal: 4 Reduce separation between rimar /reserve (circle one or both) drain- field area(s) and from 100 feet to 9 S feet. 0 Appeal findings or conclusions of environmental health staff (please specify): Other (please specify): I I • Applicant's 3 gnatura • Date ............... .............................. .................. ............ .................... ............ ............ .......... ...............................::::::::...................... ............................... ................................................. .......... : Part B: Staff Findings ............................... ........ iiii?iiiiiiiEiiii .......... .......... :::::::::.......................:;::::::............. ............ ........................... ...I.......................... ...................... .............. ................................. ........... ................................. ...........:;;.................................................. Applicant owns the affected "I, Soil texture provides for t I townt of sewage rm, Applicant does not owr� affected well, Soil depth providesf treationt of wage but owner has been notified Enh&bCod mWG90 treatment L be utilized. p,,,,j C&O,ot be developed without variance Specify type: 0 other: Enviroranental Health Specialist Date ................... ............... ......................................................................... ............I........ ii ........... Part C: Director's ROcOUSUNIndatiOn iiE ................................ .......................... ........................................................... Director recommends approval Of the V&Xi&uCG OV &PP"l, bseed an the following considerations: Director recommends denial of the variance OX &PP"l, bemd on the following considerations Director of Health Services Date ................ ........... ................ ............................................................................................. Part D: Initial Detexu1nation Of the RsSIth Officer ............................................................................................:HHHH: The Smith Officer has determined that approval Of the request for veZieVoel Or Appeal will have an adverse, effect on public bm&ltb and the vszi�e or appeol is hereby g ranted. This decisionU based On the following findings: The R".1th Officer has determined that approval Of the request for variance Or appeal hIs a poltial for an ad- verse effect ch public health and the varianceOr appeal is hereby denied. This decision is based OR the follow- ing findings: Mason County Health Officer Date Pmvised 10/26/92 ........................I...... ............ ............................... ............ ............................... ...................................................................................................... Part z: Health Officer searing (Completed if Applicable) ............................... ................ ............................ ............... ......................................................................................................................... Evidence Presented Final Determination The Health officer has determined that approval of the request for vari- ance or appeal will not have an adverse effect on public healtbed and the variance or appeal is hereby granted. This decision is bason the following findings: The Health officer has determined that approval of the request or vari- ance or appeal has a potential for an adverse effect on public health and the variance or appeal is hereby denied. This decision is based on the following findings: Mason County Health Officer Date RwisW 10/26/92 + 4ASOc�F COUNTY DEPARTMENT OF-HEALTH SERVICES POST"OFFICE BOX 186 SHEr*TON, WA 98584 (206) 427-9670 q FAX 427-9425 E p O � TO: R N •rnan: U[/1 D n / �j 7 �? M RR: Design for �(��1 Parcel t(o.✓)e-, �—Z2—(]©D 10 - ❑IIIOItllll111111111111IIItI1tI111III111111111IIi IIIIllII1tII1111IIIIIIIIlIiI11I111111111111III1111111111II11111111Ii111111111(Iil❑It1I111I111111111I1I11I11111!lIII(lilltlltlliN! Your design for the above referenced parcel has .been reviewed l is - hereby approved_ FOYour design for the above referenced parcel has been revi Wes aIn 1rtC/ hereby coaditJjmna. y approved. The condition(s) for approval are: / a � Your design for the above referenced parcel has been reviewed and cannot be approved., The reason(s) far not approving the desigajare: - a a !Cite Aey varLtian L' atata altataatl" syatan galdalln. nut Oe elaatly LdaatL � �m dnlge And )natl:lad vltII tntanlul data. :]s adequacy of tm2uml"I jmtl= tlm vLu b lanward by taA Real= dpatty rit vt-1,, toa comet of taradt aeeaptad daaiga prattler. pateie[tal POLICY. and Ln L one "d r o Oaaiga_Staadatoa. DEStGN. FORM,-PAGE ONE A desiga.. wi11 be reviewed whan;'4 copies of each of ,the following it :are ubmitted: ' completed design, form that has been signed and, dated ( ' Scaled plot 'plan, including.all applicable 'items ,oa-checklist • Scaled layout sketch;. including all applicable items on checklist • Cross-section sketch; including all .applicable items on checklist WARNING: A review fee will be ch azged for all incomplete designs. I �. z FI cAT ION PARCEL. . ..-IDENT I ' Permit Number Sl.)G-93- �5'7a Designer's Name APPlicant's Name • MAD E YOHrJ Prop. Owner's Name R14kYkRA -._Do. _. 14VAG Prop Street Address Ala..-, A RK n t i Mailing Address bdivision i Assessor s Parcel No 3 ao'31-12- 1'X30J d� � Su ---so^is�o^kizot> ea th Services ryA ,PARAMETERS `.-(�I . DsszcN , gtlals J J J Date 61f1 Designed Vertical Separation ,a, Trench in Mound rn Subsurface . Pressure GravitY Bed , . tiona ainfield ;8 cifica ' ❑ Septic_Tank/Dr pe .c - No.•=Bedrcoma Pressure� Distribution? Yes No„ Daily, Flow ; $GO 'oPd - (If yes, :proceed. . . ) ' Septic Tank Capacity - 12ao gal ' Receiving Soil Type (1-6) � x Laterals .Receiving Soil ,App1 Rate. .(a 9Pd/ft L/Q Z ft� Schedule/Class ft Trench/Bed,}Bottom Area _ (, 3aE Trench/Bed Width - :._ ft . Length ' Jr� y £t. -Diameter 1° • Lineal Footage Number i r— Separation Elevation Measurementa' � � Z,A - , Orifices Arig Drain field` Area Slope O �Z X 3 yp Final Drai.'nf' ld Area,.Slope 'Number/Lateral Pair �2�6 Depth of.Downslope. Edge of 'Diameter J in Trench/Bed ;from-Orig- Grade in Spacing �— ,� - Manifold Pump Required° Yesy' No Schedule/Class ��— ----ft y'es; proceed ) _, Length - J S--r------ I- yes, Diameter' < .� :.z' -----in .e '. Transport .Pipe Pump/Siphon specifications Dif-ference' in Elevation`Between 'Pump Shutoff., _ Schedule/Class y�--- ft l. and Uppermost Orifice ' "7.S- eft ' Length '3--�- - 1 Diameter . .� lower Dosing and, Pump Cham�e Z Uppermost Ozifice is ®higher, - ; ;'> than Pump%Shutoff -, # ;Doses/Day y2, y6 �gpm Dose Quantity '� J_._ —.— gal ' Capacity @;Tot. Pres.-Head + gal e.d' "'ot. Pres. Head ft Chamber Capacity '�asoo�®a . �� smra.aeaewws�ws ia. ee. �ws YW 3} n �iY TA )xd, , k ,,ES Tt�Sy£��`",�+5,. a4 k, s t +x 6 a {AY cG 4'ti ✓' 1 :f t IW Bed 0{/21/93 , DESIG4N FORM PAGE TWO _ rr „i,: y` F !c ) t 1 Y"' fi �Ary$ ` �{., sx [� y 'h 2` i .. 1 Y ., T xn,.�wT �� '" + a '. k5x B< sd, re o a b t ' , �-e s 3 �, �. DESI6Yi,CNECKLI3�161 + r .; i nt �i i I ' s yP3 Croee Section Sketch scaled Plot, Plan, ry Scaled Layout ske, ., ,,� i a, '.x , N [I ' n w, 1 r s e >., Y' ,�� , f,�Fs , sa' �; s,o 4, Depth from oraq al grade of Teat hole locations Drainfield orientation _ following iystem� compone : { Im ` , and layoutw ? 4 1 t. r � ,, 4 t u y f sFr, a i} ` i�4A "{ Sw 1� Building atllpOIIt 5 Property lanes p, rs , s 1 b ,Ii _, Trench/bed dimensions and (( " '' + Septic' tank id , Existing and proposed __ critical distances within ,, 5 F `Well O,'' including +� �5 t 4t '�l ayOUtyc { u ;t , . r z'i ,, + It F' +`�z� w rl Lateral a adjacent'­properties v rf ,' + ,A4, 4 r t 1 ,L f._ i 1 11 , 1 1, f v C G i e 'I 1 k�h 5 ,x , + P D BOX/ T / L lOCat i.-" - i �j',—yJI Critidal distance *°"s " ' "''s�'` '"� st ��, ;',l.e '! Tre ch%Bed bottom ineasurementa to cute,` ` Septic tank/pimp chamber , 'p%,4 Trench/Bed top " �' t banks, surface waters location 3 'fit , , t ' e n "` v `a Ai w"r-F j ,S w-"�` y+ r s+ ' W ar't .s { e ° ,'+F za , z, , „ `� Drainrock de th I obsarvataon ort*location P Location and orientations P } Of CUrtaln drain and all �� ,+ 9 pia- , , a� , y e + , � `+ `�" + ,:Cleanout 'Potation t Cover depth ; < absorption areair , I s . vF ° F -� d g C. ` b 5 i 1 '" I r r r s tjn "' �i4 pn` 5 .h�, ' +`-vu "` + a �": COmponenta a n r �5 ip-' ' r '"Ff + Aeatrl�tiVe layer (! , i, sr t , , ti� i + r Manifold+placement , x. �' �� N ayy T > as �,_ 5. Location and dimension <. ",Ntf, A `,;* � " `` 1 m .* 9 4 -, k�t� _ , ,® CurtaiA drain ` .„ Orifice; placement n >"1 of primary system and , r P , f, ,t i i '{, reserve ,.area f ,Y R } 4 P f r " k° Observation orta and ° Lateral placement, with P i4r i1'"1' '� X,LI 1 ry r- w v '� s ` cleanouta �5 }}} Buildings a k,", F r {R t ' With diatanoee ,to edge of ,, - " ¢ y �_�n �- 7 J ' a x ,° �, i"_bed x,�4 gy r`+' i v' +,g " h <p z y� ,.FJi4 s'j "-, r 4x a 1 1 < t x, Ir, P r h, a , 'i Sand augment tion , ' ,� , ROdda/easements; . ," �'' % r, S � r '>� F 4r g9 t ' ' ` - ' "Audible%visual alarm`s r * + i t��, +,, ,, s,: .� �.N! b+q f6` . , "Additional: Mound Information Driveways/parkin 7 1 ✓lkx i? , ,, ^ ,t nF Y{Su i 4.NOrth 48rrOw g 's�s�{+`Y 5} i .:5 .rr`° , b ?r Y+ t, ° Upslop and ownslope;. j " Powerjgae/waterlines ",yy kWf's , f " y�� c + ; > a ` S`cale of drawing ushown�* p ,fill width t, 4 »iR 4 >,L��" : 9 <} t! , 4 x. "' h �.m,y IP yq Yta rv, e .� ty v t-i s ,1 Refefence point location on;`si,.,I, ar4 ,r" t 4 i' " 3 x �" Settled cap epth at­`( .� SF: M ir'dr-01s:,°' -+ E a g ^ �'� a f<. t r S�Xi1>a �f� s s''f ,`I`c+; .,x'' + t „�. z + s center' and e e Hof bed , North arrow +eP Addit`aonal Mound Information 4 x r lti+ �5} :i ' 1' , Y1.pr SR"''kiy.Y �i., iT ✓ h u�. a + ` , P ti vi'""x �, � 1 s d3 e5`5` 1 5�"'f F'# rvF i",` $idewall al0 e Seal°e of-b drawing s town x Endalopek oYidtih* '; g a r .l �r ,` r S" I v i"v ??�F "+i n a 5 f r^h w �.,t 5 ` S pgl.es f p,4ke J v P, P 5 " ♦ :5 ,5 : �x r on scale bar s . s r +� a , ; r ar ' 'bed elevat Overall fill dimensions aSbjpEwnslope �,• , `,r _ m f' 'r*r„�,ru x + 4, x ev' i5* r, '' F r° 7 ,cy fia, �BIVIC@$ -r, L a a x,a s A"'u" g a , t a . }}"ry S, "L . rk a y +. I , „,� + tY'h 9 is A,+ y S'' � 4 y_ ' , yy ,4 1 ri - .. ) ., ` s t 'r o- F ,- ti , D$SIGN APPROVAL`'# ao,`� ' ,i L 'r. - lS W.`1 . « It a f, rc i y. c r ,,>E x '* a e S : sw 1 1p r i I 4. } T _ n 3 `" y�C c'u' A�-0` 1 4a4 t$`rvk e 1 ti� 5 ."j ' " '.. n e }p S iYv +4 i <ky ,2 4 tF f L l 2Fky! �, d'�i Pn4 ✓ . .� r��� -, The undersigned d+eaignez Y floee, 8oea +not, waive the ,regirement to be notified by,the £ installer oI .r ,,," " 'L"allation andtgiven''a4 'hours*to perform a final inspection prior to I �,:s i . s 5 ; 3 ng t4,-, 5 ` c < +. . COVer 4 7 u, ,e �, r , r _ .y �`s k 5 xev �,x 4}K ) �, �.� // i, :. ,i s i 5 X ­5�1 ) a e,° J r "k , rP k rf " ' } " s3 _ `' ,.. eT 1 ai4 t _ • u4. . i ' *, t s n c kp ag i YF:'i t " "" - i a.. iy` � 1 L' p4C T,,A' - 'sky , ' } f ; stt.. s `� g �• t 4 +i r 1Y ,s , g y+ £+`;x ' 1 v t 'r b ) k G r ` 1 ca4 ? x f�' ha r 1 i , ^n I� 1 + I 1 t Y y The undersigned has reviewed`=an app ve thaa design on behalf of//Mason County of Health u+, = Y,i tc `Se lOe9 ,i r� } r y s i r e`X'6 >� �i ' < - t , � & '��" 7 �} �j He 1bK WA}FBA60.Y D/•�b ek E` , y y y si xi " - 5 ' ,, Y F i(' 1 j ' a! t u 1 �n�"Ynx THIS'DFSSYGN,'T5 OPiIiY VALI'b;IP X'P X9 sTAMPTID "111�'1�3201 �" �Y 3%�130N C6 YTB` OF AT.Tg a ,'l,'I._ ma emI .. �mmsw h m� �•� mommomommi MENEM ' ■ ON ENE in- ME ■NI ■® o ME ■ ® i' ' MOEN ®®®®®®®® _ ® IMan F® ® ®® ®®am MI SUN 019, 1111111111m, Mimommom Emig Off � ®� MMM Bl Ml �® ■ ■■ MAIN- MINIONS �■ ■ ■ ■ ENE ■� mom ME �... ON■ ■■ ■ ON BE ON MINES 1111111111101 mmms ME SEE IN ■■ MOEN mom ®®®MEIN won HI No MEN SU- ENE ■ ./� �DM■ ■ ■ ■■MEI MOEN IN MIN ME IBM Bl 1111111111101110111 mom ■ ■■N ■MENN Memo ®■■®■■■■■■ M�■■■■■ ���■■■■■■■■■ N ■■■■■ ■ ME �iiN � �:■■■■ ■■■■ ■■ ■■■■■ IN■ i ■■■ ■■®M■N MM■■■■ ■ . ■®®■ ■■ ■■■■ ■■IN ommmommimmmmommmom■ ■■■■■ r i. i i y Y 4 ` f ..: i �•. r y tr V _ 1 t a �f k` .k �1,,vy �'' I! f � r .N M r vti' a�S4 r,y,S'5�,.'�x � , v �J v 3e - ♦ ' p1� 4I� f r Per4r�rrriancwlcriPay '°`t i f 4 . 5 a t 'Purim Characterrstics , =ti , ;`r Pum /Motor Unit Sabmerslble r, t'Y. `',�� r i, dr, f Manual Models I SPM1OMI b= SP40M2 S Y Y 4110141` , r r, Automatic Models fP4UAl SP4UA2,` �Er " +w x r Horsepower i full Load Amps 9.4 4J, . Motor Type' Split-Phase M rt R.P.M. 1 75 A off@ Phase 0 - I' Voltage I15 230 ds as ti Hertz: 6U s R,-'f td U r� ev r. 2U a 40 t 60 .. 80 a 100 p 11u1' j, rr pr ti. . v L 4 � r fTV US GPM: n y y�..l. t ! x Intermittent y , w at f, SowPAC 5 1rv: t Qpef011an eroture 1f Ambient �s r 2 Tem J40 P T4fyl Haad (4e,or) r A B NEMA Design A;' IQ BP ' 120 z108 ; 98 68 4 2Q` 0 GPp1 4/ : ' Insulation ,2n.NPT Discharge Sine 5otidrHoadlmg ", T 1/A Drrnensrons�lYData Unit Weight ` 60:lbs y , 316/18 B-1S/ib , 1'An dhSalWMtW '�'1 . Power Cord 18/3 Si 115Y 10 rsid4, Ya a / To-tM 1(anpu„wrdimauinmlmcA 5 12D apt) 4 , 2NP7:`I ory*I/B aKT `.' 2304='20'std F �# DISCHARGE 3,hatawmvuawliWPM t j 16116am t unWst neiwd r a n �" a � +P��1+¢ +`s l Mwemiaa wdrropids ao I K , i v i°i�Cc r ay l -' apgocsooa -- . .; s 5 Wvrcwrerktq�hNc 'X I material$ of COnstructionr Sh r'Ja 03/4t 4 } nwka r nefr Huudle - 5teel �„ °`�jfiyt �� r: spallKalm�s ntinW noun _ , Dielectric Od Lubricating Otl .. , t r . r Motor Housing ' Cnsto ron i r 5,_ ti J'�/y "ru .I CPt ft8affi " Y'' rG�fVlC s, s w Ytt� e Pump Casing nsYTron Shaft Stainless Steel Me(tunic(d Scud Faces:Caiban/ceramit } r u rifiY r"r� `S Y' t tt Short Seal Su a(Bo{y Erass SpnmJSfuin less Steo► �L L 2i114 '{ Bellows.Bono N �yi�� y Y p It DISCHARGE PUMP i R fv ( F� &+ �hfH4iGHl' 1 UN 2 $p* Impeller Thermoplastic ' r Upper Bearing -Single Row Bail Baoring Sin Ie Rnw Ball Beans PUMP GFF i Lower Bearing g 9 r Fasteners - ` ` .3 Stainless Steel " /�tYGt�I�A/!'$YDRO6U4�PC Inc k x i$40 Baney.Barz0j A5n16nd, Qhiv),44ES85' 2 (4T9) 289 304 ,1 I WWI L I I +S E AsRGi t _. 77, r IT FTI Al IA, , I , r _. ,� I, s i I i ' i • I —' ! �w l rr�—I i f�—! is 1 1I � •"tx �/n F•' 3 1 I ! , r Y (77- � t k Rxi r11 C- IAROR I r 1 L 1 � 1 1f => I J I ! , I 11' F1bM Elul.W5° I I I -+ I I + of n_L�L LeAw � - -_ - 7 1 1 5 t n7 w e - °`� _ �_ { i I I -- { � � S 9� NJ}L (y 9'11U F. J, ,�, 12 Lash FU, IL I I _ LH - - - - -- 1 — .i.. '- ra - -- --_ y t ----- i I + I I { 1 t YICQ 10 - i r ,„�n,MggSV'^15'F^+L`s,(y':°F" s Ir`trY FeG �tfi `qypy' . x ly r ✓i (' tr + r�F('b }N1'e� r( a. w f(v YK rM y I,i .G.it.,o af, 0W�.?kh9 El:::ai.�i y f'I eY✓ii-Y.':):IG�i;S 5r'I �ii4"dl is J'>.,�i16° r : F x ftt j Ir, �rna , (d .;Pump Characteristics sz Pon or Unit 21 � SuLn+ersibin -- i—f — I 7, _ MnnuallNnuals SI'40MP40M2 AUlanlntl(Masiels SP401P+10A2 _ 3: n ilmspower FuIILoadAmps q•4 4.7 A,,"Type SpliLPhose - R.P.M. Phase 0 Vuhaye 115 Hartz - 60 . . eo zo 4e. hltanniuout cnrncnr-U.S.c.P.na. Operation.. _ `• I' Twuparature 140'r Amhieol - Total Htud..(faot) ' +.'4 . 0 12 16 20 24 28 HEMA Nsign A ClussA GPOte 0/10 P 1R0 10A 90 68 42 20, 0 Insulation Discharge Sue 2" SolidsIleniling 1.1/A"' �tllilwTIS142T1Cl� �CTto Unit Weigle 6016s. 3 ( -nth/t( : I All dimwrim Mi M:hn Power(Ord IP/3,S1TW. 115V= 10'sid. � . alRl _�.7 (onfui.Mlfmm�mmlmry (A'opt l r«`R fi ,b" a z NPr 230V 20 sld. oiscHtnncE mytl/AunA ' C E 7ztt 3 "m lm mrn nema Imp." = ,( J F ok r t / -^-- '1 �' i'otiF /NirJl br 'r �,rc ' s D,rnMimwn!euphn we OVGn[xHgM ' (! d rlkr / 5 H Imnv.IM liYl no Materials oA[ S3TiS$rUC91C4f1 3 I/4 l��rti^li}+,n Ilmulla 51ec1 1_..--. 7-. LuhHiadinq Oil Dielndrir ail_ ` y�.�'• . , ---_---_-----S �(ISt.rUlI". (I I � t. He alth ervrcaCaslrun' mPGuinl I ----- ,0VE� SlIeff Sto!uiess Sl.=elnill h4erhuniull S 'i Fntrt..Car'uml/t:xnnni(� � i;'� ���vislr"."�'• 5w'dt Seal S+UI randy: Cis ' w.e.! Spent Slmnless i4 Steal 12 t/y J) Ifulows:Pm(u•1! IA ' T % td/ DISCHARGE POW' r`+ J" ` { H I 1 III aGHr nw Impeller Upper Rowing Single Pow Bull I i mmg ,r{ � t :1/e b6/16 T i(1; i"ar.r i Lower Polling 1 Single Raw Roll Peanng ! {,.. r 1," vuMr OFF Fasteners Slainloss Steel I840 nausry Vr_.ml,Ashland, Ohio 44805 • (rTT?) 2ti9 tnrlx MASON COUNTY21 DEPARTMENT of HEALTH SERVICES m. Mcson County Bldg.Ill 426 W Cedar �� - P.O.Box 186 Shelton.Wcsrwigton 98584 ro C206)427-9670 • Belfr4r.278-4467 Secure:464-6968 •Other. 1-800 5625628 environmental health ,-- persona!health 1, water quality- , , nallns ecn6 _ peptic System Date __ . : � _ ' .ff IL°7 � �' c�✓r� 111 ,9,Uex MI 5b6EOi 1 Qi7 t© Installer. j-_-Q,�j-,��, L Applicant/Owner. /?lcyA �Q/�ir/ 2 111.vSsa E urtiz �, Date of Periiut j 7-�3 c�c r( w ✓ 151t lv I ; Legal Description-, - v -O Yl` r✓Z 11. I SS'"y Pt Parcel IVumbeT:_3�03 Subdivision Name Ihv ' Block Lot: —15 Staff Initials: � 1 ` __ �Y FINAL INSPECTION SEPTIC:'-SYSTEM CHECK LIST _ YES NO COMMENTS I') SYSTEM TYPE A) CONVENTIONAL (TRES B) "ALTERNATIVE (MO /SUBSURFACE) A) ' > Five' Ft f'6m- Foundation �( ; E . ' = B) .Foundat:ion-.Tank Line Slope: Cleancut provided if n 't 1-21k C),,�Baffles` Intact / Clean ^, D) Divid'ng Wall .Sealed III) D-BOX — A) Wate Bled B) S ed Level Used IV) FIELD — A) > Ten Ft. from. Foundation B) > Five Ft from Property L,'nes C) Laterals Level to ± 1 inches D) End Caps Present If Not Lo ed E) Square Footage Adequate F) Gravel Depth Adequate �G) Gravel Clean 6 A — �H) PRES$ME WS= q SandYQuality ASTM C-3 3 " 2)` MOUND 'Sand Slope 3 to 1 .Head%,HeigHfC > 24 inches 4,16 ) Cleanouts'-iPresent �63 Obser`vatioh Ports Present V) POTABLE WATER LINES — .- A) >, Ten .Feet From Field , Components.'or Sleeved B) '-WELL > 100 Ft. from Field -d� by e V I) PUMP:, TANR.'t' o _ A) Scr en alled 1) Baske / Effluent Filter ` ' , B) �Risccess Present ' C) "Alarm• Installed • , � ,' VIZJ AS BVILTtREQUqIRED _ 4 Signature Of S itarian, j U Revised: 10/20/92