HomeMy WebLinkAboutSWG96-0480 - SWG Application / Design / As-Built - 7/16/1996 ON-SITE SEWAGE SYSTEM SITE EVALUATION AND DISPOSAL PERMIT
PERMIT NO. SWG - m D
MASON COUNTY DEPARTMENT OF HEALTH-SCRgFCES -- --
C �
Q
/ <
Date
426 '.N. CEDAR/ P.O. BOX 1666/ SHELTON, WA 98584 Receipt No. ` 1 ` o 0
PHONE (360) 427-9670 Amount$ m
CHECK APPLICABLE ITEMS ✓ 3
m
NEW SYSTEM
M ING RES: DAYTIME PHONE: �.
'_� REPAIR SYSTEM
MAINTENANCE REVIEW m
CITY: STATE: ZIP,. �a� SINGLE FAMILY
OTHER z
PROPERTY ADDRESS: ugh
SPECIFY: W 33
SPECIFIC DIRE 10 F R LOCATING SITE: PRIVATE WELL
�1T COMMUNITY WELL/PUBLIC SYSTEM
W7 SYSTEM WFI# Qj
SYSTEM NAME (y
APPLICANT I T
NAME
Name of Lot Zu�ft. x �ft. MAILING AD DR SS _ I�
Installer
Size: acres TELEPHONE s. h
Name of � N er um of SIGNA 07'
Designer L _ Bedrooms X l 1
PLOT PLAN I.t ie$O P)
Draw a dimensional lot pia ly / ou
including: \,� /�� 0 I®
JRW
�l F
❑ ise locatiIJ IC)
I s, showin _1
sured distan
operty boundan
❑�roa�ther I"_
V�ways
cn
N DOTTR
C SY%Mqga
I�T1 �FICIA�TISE ONLY. DO NOT WRITE BELOW DOUBLE LINE. I�
SOIL LOGS Tit 3
7 f t 77 ffz-
o -s--z l,Q v-SY TyrW t,
S t4.V U��✓�U-(.
Depth from Original
Grade to Restrictive
Layer or Water Table: O In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One ( Ra
ST/ o
Soil Type
� Septic Tank Daily 21 V
Vertical Separation d in. Capacity: Z00 Gal. Flow: 3GPD
Slope % Appl, Infilt.
Parcel Size Ac. Rate III, GPD/FTC Area FP
Distance to Shoreline it. Total Inspector Date
COMMENTS/CONDITIONS FOR APPROVAL
•All septic systems must be designed and installed by contractors certified by Mason County Department of Health Services, 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 permit.
•This permit expires 2 years from the date of site review. Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SIT VIEW: DESIGNREVI Approved � NotAp roved IN L TION: Ap roved DATtApproved
BY: DATE:? BY: DATE: �� ,� B 7
TOP: Health Dept. Copy IDDLE: Designer's Copy BO OM: Applicant's Copy
OR6vi/�R ] 8/95
DESIGN'FORA4 - PAGE ONE ✓11130 \7
A design will be reviewed when 3 copies of each of the foll items are tte
• Completed design form that has been signed and C'
• completed Resource Lands and Critical Areas Checklist�� ,��px� ,
• Scaled plot plan, including all applicable items on checkl V
• Scaled layout sketch, including all applicable items on checklist CFf
Cross-section sketch, including all applicable items on checklist
II PARCEL IDENTIFICATION II
��,�/_ 9 Designer's-Name 1✓D �� ���� II
II Permit Number '/ //'' �- �I
�• /UQ7Z LS�c�'A) Prop. Owner's Name Co ch�R E� II
IIApplicant's Name •��e� _
II Mailing Address — O Mailing Address Pa. ,t3a X �I
II 1�'r//ors 4iA5 aB,59 P del F9/2 �A 9B5_z II
CITY
ace sir II
II Assessor's Parcel No. 3e? /21g6aaa�e Subdivision SyRv�y a�/gu yw%y �Z• II
e ae i isin c7 - 11
II
DESIGN PARAMETERS II
✓ II
✓ ✓ �I Designed II
1 / Vertical II
II rLi �� I__J jy' L�J Separation II
II Mound Subsurface Pressure Gravity
Bed Trench
n II
II Septic Tank/Drainfield Specifications 1 Pressure Distribution? LJ Yes U No
IINo. Bedrooms 3 I (If yes, proceed. . . ) ......................till
II Daily Flow O trod I:::::::::::::::::::::::i II
Septic Tank Capacity /�✓rD al
11 Receiving Soil Type (1-6) Z w s q I ICI
IILaterals
Receiving Soil Appl. Rate �•Z opd/ft' I ZG O
II Trench/Bed Bottom Area 3 O0 ft2 I Schedule/Class - /1z ft II
11 Trench/Bed width ft I Length 3 X 3 7�Z L 11
II Trench/Bed Length ft I /�� in II
II I Diameter 3
II Elevation Measurements I Number 3 ft
I Separation
II Original Drainfield Area Slope on Orifices -
Drainfield Area Slope if Altered O g Total Number of Orifices II
II in
5 /3 in I Diameter II
it Depth of Bottom of Trenc�lo8d ps ope I Spacing ��� 11
from Original Grade `''� /3 in I Manifold )D 6 II
II �jp> owns ope I Schedule/Class (o ft II
f-"1 I Length in II
Used? Yes LJ No I Diameter
Infiltrator U
- ' f—I 1 Transport Pipe zd1J II
11 �•` ' _. �"� Yes lJ No Schedule/Class
II Pump Required. e 1 Length tt
in II
(If jam, proceed. . .) .......................... l
11............**... c I Diameter �I
11 I Dosing and Pump Chamber
11 pump/Siphon Specifications
IIDifference in Elevation Between Pump Shutoff I # Doses/Day 6 al �I
�I and Uppermost Orifice _ Z ft I Dose Quantity ;:2fO O oral �I
,! Chamber Capacity
IIUppermost Orifice is 2 higher, U lower 1
�I I Check the following components if they drain
than Pump Shutoff e/ III
3 m I II
II Capacity between doses: ��4
Tot. Pres. Head ft e,
�I calculated Tot. pres. Head i . �FiJ Laterals U M� Q anifold U Transport II
(Attach pump Curve)
DESIGN FORM - PAGE TWO �. `..d °'/'e ss
DESIGN CHECKLISTS li
Plot Plan Scaled Lavout Sketch Cross-Section Sketch
Scaled
III �'EI/ Reference depth from orig-
U Test-hole Drainfield orientation final rade: II
and layout i u Septic tank lid and
Property lines
ram/ U Trench/bed dimensions and drainfield cover depth II
Existing and proposed critical distances within Reference depth from orig-
wells within ft layout i II
of property lines
s LJ final grade and restrictive
II -r�� I D- x/"T"/' L locations- strata: II
L�ritical distance u N
measurements to cuts, Septic tank/pump chamber `I Laterals, trench/bed
II I top and bottom
ba s, surface water I /7771���pcation
I it
Location and orientation rvation port locatio I Cuytain drain collector
of „4Ft— -min and all I Sand augmentation
absorption area U�Cleanout location
Ili components l 2 M, nifold placement i No external reference needed: 11
��
Location and dimension I II II of primary system I Ori ice placement
I U Observation ports and II
and
II I cleanouts I
reserve area
,�,� Lateral placement, with
U Buildings I distances to edge of bed I Additional mound in£ormation: l
I ufr�/Audible/visual alarm I u slope and downslope II
Direction of slope I fi width
Ill i dicator I referenced
u
�I 14 Scale of drawing shown Settle cap depth at �I
Wterlines I I center a edge of bed II
on scale bar
Roads/easements/ I I n
r� driveways/parking Iditional Mound Information: I U Sidewall slope� Critical resource lands Ends a width I Up/downslope bed elevat.(if applicable)
ry/ overall fi dimensions i Completed Resource Lands and II
1 NOrth arrow and scale of I Critical Areas Checklist II
drawing shown on bar
uS DESIGN APPROVAL II
IIThe undersigneddesi.� �does, LJ does not, waive the regirement to be notified by the II
II installer of the -ins al4ionand gi en hours to perform a final inspection prior to
II cover. ._ -
i
r
roved this design on behalf of Mason County of Health
d>; �I
II The undersignehas reviewed and approved
II Services.
Eujn pec or a e II
�I I�
II CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIONS:
THE DESIGN IS STAMPED "APPROVED" BY MASON COUNTY DEPTARTMENT OF HEALTH SSRVICSS I
THE ON-SITE SEWAGE PERMIT HAS NOT EXPIRED; EXPIRATION OF SAID PERMIT IS BASED ON
THE DATE OF INITIAL SITE INSPECTION, NOT ON THE DATE OF DESIGN APPROVAL I
ill �J THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS
OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES
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ILA; Performance Data
12 40
Pump Characteristics
Pump/Motor Unit Submersible 30
AetoneatkModols W25A1 D25A1 8
Horsepower 1/4 --------
Full Load Amps 8.0 1/4HP
Motor Type Shaded Polo(4 pole) 4
R.P.M. 1550 10
Phase 0 1
Voltage 115 -
ff
Hertz 60 0 0
(apedry,US GPM 0 10 20 30 40 SO 60
Temperature 1201 Ambient - Gters/sttsnd 0.0 1.0 20 3.0 --
NEMA Design A
lusulotion Class A m melets/hr 0 2 / 6 B 10 11
Dischorga Size 1-1/2"NPT(38mm) Total Flerad (fee 1) 4 8 12 lb 20 F1,4Solids HaadOng 1/2"(13mm) GPIR(U.S.) 44 3b 24 23 120
Unit Weight 30 Ibs.
Power Cord 18/3,SdTW,10'std. Dimensional Data
(20'optional)
7-t/2 Syre I.dp.dimemioiuMiuhK
—�—4,11 2.G.npo.•ntbmeeti]n:may
..u� my 1/8 ieth
I Nei for.mWudlar.purpou
' 4s� olden taW.ed
3"1."2 � I-V2 NPT 4 DianNan w:g end la:me
Materials of Construction C"'tsj 4, � U6CIIAFIGE oppmxmN
� � 1�f
Handle Stainless Steel I d W:rtzere the 0&to
3a Y2 ¢A,re; eat to cur
Lubricating Oil Dielectric Oil
Motor Housing Cost Iren IJrv.m C7i111
Pump Casing Cast Iron
Shaft Steel
Mecha&A Seal Faces:Cmbon/Ceramk '
Shaft Seal Seal Body:Anodnd Steel a A
Spring:Stainless Steel
Bellows:Bona-11
10sre
Impeller Thermoplastic � „ '
Upper BearingCust Iron Sleeve '-'re ""-"` 2 ,j
za_ '9n PLUP04
Lower Bearin Sin le Row ea0 Bearing +� ..
1 18
Strainer/Base PIOSNcY jn3
OFF
Fasteners Stainless Steel _—
AURORA/HYDROMATIC PUMPS, Inc.
1840 Battey Road, Ashland, Ohio 44805
(419) 289.3042
INSTALLATION 1__MAINTENANO
Pressure Distribution Systems
1. Install laterals with contour of the ground.
2. Install locator tape on top of all drainfield laterals .
3. Install observation ports as indicated on Plot Plan, with
bottom extending to the drainrock\native soil interface.
4. Install drainfield during dry weather and soil conditions,
any soil smearing must be eliminated by hand raking.
5 . Install threaded clean-outs at the ends of all laterals , ( caps
must extend to within 6" of finished grade ) .
6. Install audio/visual high water alarm.
7 . Install 1/8" mesh non-corrosive screen (min. 12 sq. ft . surface
area, preferrably in septic tank at outlet port .
8 . Install check valve in pump transfer line (and manifold when
needed)to prevent system drain-back into the. pump chamber.
9 . Provide a 3/8" NPT (National Pipe Thread) fitting between
check valve and pump for pressure guage connection. Use
pressure guage at time of pressure test to permanently record
the -Perfect System Pressure' , so a comparison can be made
during inspections to determine 'Condition of System' .
Pressure guage may be removed and replaced by pipe plug
between inspections.
10 . Install all laterals with orifices placed at 12 o ' clock. Leave
at 12 o'clock and place suitable shields over orifices ( except
when using Infiltrators ) after pressure test and upon approval
by Health Department .
11 . Filter fabric required over drain rock prior to backfilling.
If the drain rock extends above natural grade, run the filter
fabric at least 2" down the trench wall .
12 . Have the septic tank and pump chamber pumped or inspected
every 3 to 5 years.
13 . Inspect and clean pump screen every 6-12 months as needed.
Inspect floats and test high water alarm every 6-12 months
as needed & use pressure guage to determine 'Condition of
System' .
14 . All materials and workmanship must meet County and State
Regulations.
15 . Deviation from this design without prior approval from the
designer and Mason County Health Department will make this
design null and void.
16 . A dose counting device will be included in the installed
system.
17 . If Pre-Treatment is required, refer to:
I _$TALLATIONLMAINTENANCE
of Pre-Treatment Systems
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
g
..... . ................................. : ::...... : ......:....... ................:3e3e8
3i.............................................................. r, ............
DATE CALLED IN: ( b ct (4-
TIME:
INSTALLER: Y /' ( N�S�_
APPLICANT/OWNER: l'J1 ty' C --D4331 -
_. .. - CALLER. V
PHONE # OF CALLER: I il Uo3t-�C�y,'pf
SWG - .
#: -lA_64ko
.PARCEL NUMBER: � a1 :1, DLO Cy 3d
SUBDIVISION•
DIVISION• LOT:
......................«..««................««..«..«.............«..........................«.....«.........«.............««..«.....««...::•..:«"«:."::::......:::»
SYSTEM TYPE (CHECK ONE) : FM
•-- PRES - GRAVITY .:•
_MPECTION SCHEDULE (CHECK ONE) : IM
APPOINTMENT PLUG IN
.S-BUILT ON-SITS? (CHECK ONE) :
YES NO
3ee«..............................................«........«..«.....«.....=:3?ai.....................................................«..................«........ ............
STAFF INITIALS:
h:callin.0
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
ST&" CaBCR.IST I
I i
CONFIRM® 9Y INSPECTOR? I
Yaa No Co nm
I. ORPTIC TAM 1
A) >5 it from foundation?
a) Bldg stdwut to septic tank: cleanxxMt if not 1-2%7 = I
M Baffles intact and clean?
D) Dividing wall intact?
II. ])-box Leveled with water or speed leveler (circle one)? L✓/�
III. DRAINFIBT.O I
A) >10 ft from foundation and >5 ft from property tines? �.
a) Laterals level to ti inch i end caps present if not Looped? _ _ 1
c) System dimensions the same as shown on the design? =
D) Gravel clean, properly sized, and proper depth? I
a) PRESSURE SYSTEw �[ 1
I) Sand quality ASTH C-337 1- 1
a) Head height uniform and t24 inches? — 1
I) Cleanouts and observation ports present?
1 4) Hound: Side slope 3:17
made
S) Dwner' informed electrical connections must toed by bDL17 - _ I
by owner or licensed electrician and inspect I
I I9. Pon= wATRr T, > I
f.) >tOft from drainf laid, transport line, and septic tank? =
a) Wells 3.1o0ft from drainfield? I
i I
O. Pules 171Q
dV Screen basket orf!!�_tjeg fl (circle one) installed? _
a) Riser Installed for.access? _ 4- '— 1
1_ c) Alarm installed)
i
I vI. As soar REGUJp.EDr I
1
I viz. ors oamoares I
I I
1 1
I I
I I
Canty of Health Services.
The undersigned has reviewed this installation and verifies these findings on behalf of Hason
e or
a e 1/ 1
I
h:callin.w
Revised 02/01/95
AS-BUILT FORM - PAGE ONE Revised 12/14/94
IIPARCEL IDENTIFICATION
I Applicant's Name Y 3 I
II Permit Number SWG9 ii - �)-I i�� Subdivision ame 1v1s1on/ oc7�k7LotT—
II Installer's Name Assessor's Parcel No. we ea�g O OO r II
II Designer's Name n �
II INSTALLER CHECKLIST I
N/A Yes Prior to
I. SEPTIC TANK Completion
A) >5 ft from foundation? II
III B) Bldg stubout to septic tank: cleanout if not 1-2t? II
I C) Baffles intact and clean? II
II D) Dividing wall intact? _
II. D-BOX Leveled with water and/or speed leveler (circle) ?
III. DRAINFIELD II
A) >10 ft from foundation and >5 ft from property lines?
B) Laterals level to ±1 inch & end caps present if not looped? II
II C) System dimensions the same as shown on the design?
D) Gravel clean, properly sized, and proper depth? —
E) PRESSURE SYSTEM
1) Sand quality ASTM C-33? II
II 2) Head height uniform and a24 inches? SW — II
3) Cleanouts and observation ports present? II
4) Mound: Side slope 3 :1?
5) owner informed electrical connections must be made by II
II owner or licensed electrician and inspected by DLI? II
IV. POTABLE WATER LINES
A) >loft from drainfield?
II B) Wells >looft from drainfield? II
V. PUMP/PUMP CHAMBER II
A) Designed pump used, or ached for equivalent pump?
B) Screen basket or fluent filt (circle one) installed? II
C) Riser installed for access? 41 II
D) Alarm installed? —
II CERTIFICATION OF INSTALLATION II
II Installer: Check-box from Row "A," check box from Row "B," sign and date the certification. II
r , II
II A•� I certify that I installed the system u I certify that all deviations from
without any deviation from the rdes�ign� the design stamped "APPROVED" by MCDHS are II
stamped "APPROVED" by MCDHS.& d, shown on the reverse side of this form.
II B•*VJ I certify that I contacted the u I did not contact the designer prior
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
II I further certify that all information contained on this form is accurate. I understand II
II that if the information contained herein is not accurate, there will be just cause for II
II immediate suspension of taller ce tifica io . 'II
igna ure o nstNII,cf
III The undersigned approves th' nsta ation of behalf of Mason County Department of Health II
II Services. 1/?� II
nsp c or a e II
yy �i
AS-BUILT FORM - PAGE TWO ' Revised 12/14/94
I� ARCEL IDENTIFICATION
I II
II Applicant's Name
II Permit Number SWG9 CJ�I Subdivision II
ame IVIs1.on oc o
Installer's Name lg
Assessor's Parcel No. m,*10 r
II 3 a8K' we v
II Designer's Name Anm d VQhj9,
II AS-BIIILT DRAWING II
II
III III
II II
i
33 y
lu
II N, s10
II
�. II
/V
II III
II II
made in the field by the installer are generally
CAUTION: Minor adjustments to septic tank location and drainfield orientation
ceptable to both the department and the designer, but could in certain cases compromise 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
deviations from the design that affect system viability. My deviations from the approved design must be shown above-
AS-BUILT
II S�,, ^y_.,C�HECC(KLIST ,(�y[/) II
II Drain£ield orientation 2Sb ervatl'on port 'location //Undisturbed native soil
II and,,layout p - -� p,�,rQ _ between trenches II
Clea but locat3onV -- � II
II North arrow II II Te nch Dec dimensions and ,��f
II critical distances within Mani old placement Scale of drawing shown
layout ru�..�� on scale bar
II � Orifice placement II
II D-Box/"T"/"L" location n Zn 2 PYr 1&5 " II
I1 emen with Additional Mound Information
La c II
Septic tank/pump chamber distances to edge of bed n
location
U Endslope width II
II oat ion of wells, roads n II
u Overall fill dimensions
II Location of buildings