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HomeMy WebLinkAboutSWG94-2060 - SWG Application / Design / As-Built - 12/14/1994 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG - N 426 W. CEDAR/P.O. BOX 1666/SHELTON,WA 98584 Retceipt No. a PHONE (206)427-9670 Amount$ z m m P '. LO H CHECK APPLICABLE ITEM ✓ m m MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM m 22 2 05- U)o0 n W A A/IJ REPAIRING OLD SYSTEM CI STATE: ZIP: EXPANDING SYSTEM m &� SINGLE FAMILY PROPERTY ADDRESS: OTHER c IIJ61 A55i C SPECIFY: v SPECIFIC DIRECTI S FOR LOCATING SITE: rRan ow &-zrm2 Mvia4L)ewfirrc PRIVATE WELL m JV o EL - A ,P PUBLIC SYSTEM (' -ra"LEFr Go /.Z !c 'b SIDES µA _ra,?FJ L�/T,050 . !nc -to J44r, SYSTEM ID NUMBER IV T N J SYSTEM NAME N 3sD'4v of L o „vyKcP. u2 A?T. �o inl so AjVeLheK APPLICANT D .Soo Fr-. �Ny NAME L I/ Name of MAILING ADDRESS 222 Lot 26y ft.x Q I ( ft. . 9 Installer Size: S I acres TELEPHONE Name of um er o SIGNATURE o Designer utc Bedrooms X ' J PLOT PLAN Draw a dimensional plot plan, I I I I including: I I r' fm Q7 z75 -c v,esz-rse leas _rQA2 ❑Precise location of test IAWNE0k, holes,showing ---A ` measured distances to I r Pf NotEl property boundaries. a3 'rN a gpp ItA1 ❑Entry road;other roads, EAoHAX driveways. i n,S� aavieS x NOTE: DO NOT DRAW IN IXC SYSTEM DESIGN FF ONLY. DO NOT WRITE BELOW DOUBLE LINE. lsffc LOGS yti '-HEALTH SERVICES bl2� sdrre P��s fi��/ 7 'Aa 3 WS 2bor/t- th 7�H 3 a -�y '' �s Zborrr from Original rade to R strictive �O In. �1 G (/ ay arer or W ter Table: DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS FindingFS—co-r-el Designer Level: One *Two Soil Type Separation > Septic Tank Daily Vertical Se in. n P ! !J Capacity: O Gal. Flow: �s5 D GPD Slope / 7 ppl. Infilt. Parcel Size 0�A _� rns o / GPD/FT' Area Distance to Shoreline� fL Total actor Date COMMENTS/CONDITIO S FOR APPROVAL O�Es n � � G� �i°,S�u � c 1 3l lem � ��1 � 1 a rev �n�Pd # ls laa perm 11 An change from the s eci�se of the roe or an site alteration affecting the system design may invalid to this permit. y 9 P P, PnY Y , 9 Y 9 Y This Permit expires 3 years from date of site inspection.Denial of this permit maybe appealed to the Health Officer within 10 days of denial date. SITE:=4D!1s1gn Required ❑Not DE N: roved ❑Not A rov d I AL T Ap roved ❑Not rovgAa BY: DATE: BY: DATE: DATE: TOP: Health Dept. Copy IDDLE: Designer's Copy BOTTOM:Ap nt's Copy MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFI E BOX 1666 SHELTON, WA 98584 (206) 427-9670 FAX 427-7798 APPLICATION FOR RE-EVALUATION DIRECTIONS ...................................................................I.......................................................................................................... 1. Complete Part 1-3 and submit to the Director of Health Services, PO Box 186, Shelton, WA 98514. 2. The on-site lead will make a determination in Part 4 whether a reinspection is justified. when a rein- spection is made, the findings of the second Envirormentat Health Specialist are written in Part 5. A final determination by the lead is recorded in Part 6. 3. Applicants are bitted an additional $40 when a reinspection is required, and are expected to pay for any necessary laboratory costs associated with soil tests, unless the health department is dem)nstrated to be in error concerning soil type. 4. Findings and determinations of the Lead may be appealed to MVrF9n[Sfl L tw f the ad- dress listed above. MAR 1 0 1995 PART 1: REQUEST FOR REINSPECTION .............................................. ................................................................................................... wi�:........... .... i la'al TH (;IV= ll_. • Applicant's Name: AJ, .4e ,;-,-c.vzX Address: AaA 1V1&dWd_VJ A(I-0 '00 IAi,5 hip 102 9IV3*249 Telephone: - 4a 3 2 ,9 4s-s;e-2ssJr-44c-e-71 X6umr_0e-A_ suDaivision Name an Lot NUM)er • Health Department finding being disputed by applicant: r_1 r_1 LJ Anticipated depth of watertabLe LJ Soil type/application rate L-J Depth or presmce of mottling F-1 R�New drainfieLd area to evaluate LJ Other (please specify) PART 2: AUTHORIZATION .............................................................................................................................................................................. APPLICANT DATE h:re-evat.w Revised 08/24/94 PART 3: PLOT PLAN ............................................................................... .............................................................................................. Use this space to draw a detailed plot plan, or attach one to this application. A detailed plot rLan is one that shows the precise location of the test holes, existing septic systems, dimensions of the property, and Location of any wells, roads, or other buildings on the property. z�X 'e ZQ it % 117 70 j '� I U PART 4: DETERMINATION OF LEAD .............................................................................. ......................................................................... ..................... r--1 tJ Reinspection is justified. r--1 L I Reinspection is not justified, for the following reason(s) : On-Site Lead Date h:re-evaL.w Revis-d 08/24/94 PART 5: REINSPECTION FINDINGS .............................................................................................................................................................................. SOIL LOGS TEST HOLE I TEST HOLE 0-30 " 9-an* 10?mzve�i �rz�r i av� , � !n �s� 41t rvd DESIGNER DESIGNATION SCORES Parameter Finding Score Soil Type Vertical Separation 12 S ro 3pe Parcel Size Ac. 1 Distance to Shoreline ft. ] Total: MINIMUM SYSTEM REQUIREMENTS Parameter Requirement Designer Level Septic Tank Capacity So gal. I Daily Flow 6-70 gp d 2 1 Applicaition Rate CJ,G gpd/ft Infiltrative Area 1 �67(55 f t 2 a R I I'l Sl P OTV7 p -YA 1 )2 go 6 It�Env�io mental As.- 1Y Jpbcyl—ali-4tDate PART 6: IVI-APECTION DETERMINATION .............................................................................................................................................................................. On- . e Lead Da_te r Billing Amoi'nt Receipt Number h:re-eval.w Revised 08/24/94 DESIGN FORM = )'AGE ONE Revised 08/24/94 A design will be reviewed when 3 copies of each of the following items are submitted: Completed design form that has been signed and dated m leted Resource Lands and Critical Areas Checklist attache o lan, including all applicable items on checklist sketch, including all applicable items on check ist Cross-se t sketch, including all applicable items on check ist PARCEL IDENTIFICATION II Permit Number ER V 9 -�D Designer's Name �i yG QtiSi /4� c" �" " Applicant's Name104AsLQ.e Prop. Owner' s Name s�ZZ-- II Mailing Address S A1,40. Mailing Address II II Pow Wa. g •a-7 ;;V II city State zip L a ip II II Assessor's Parcel No. e37�0�0 Jl.3U Subdivision II S II l " DESIGN PARAMETERS Initlale - - I II ✓ ✓ ✓ Datp S II Fi-1 FI-1 FLI Desi ned Vertical II u u i—J LJ Sepa ation I) II Mound Subsurface Pressure Gravity Bed Trench in II Septic Tank/Drainfield Specifications / I r1 ,!��,/. I II No. Bedrooms ✓� I Pressure Distribution? LJ Yes u No I Dail Flow (If es, proceed. ) • ..... . .... .. ........................ II Septic Tarik Capacity //S� I Receiving Soil Type (1-6) I II II Receiving Soil Appl. Rate 647 d ' I Laterals II II Trench/Bed Bottom Area e t' I Schedule/Class II II Trench/Bed Width t I Length ft II II Trench/Bed Length 6 7 ft I II I Diameter in II II Elevation Measurements / Number II II Orig. Drainfield Area Slope Separation ft II II Final Drainfield Area Slope Orifices II II Depth of Bottom of Trench/Bed Total Number of Orifices III II from Original Grade P, in I Diameter in II II psi ° / I spacing II II "in I Manifold II II Db&slope I Schedule/Class II II n r•� I Length ft II II Infiltrator Used? Yes U No I Diameter in II II r� I Transport Pipe II II Pump Required? u Yes 191�No I Schedule/Class I) II:: .................. (If yes, Proceed. . .) .......................... i Length ft II II Diameter in II Pump/Siphon Specifications I Dosing and Pump Chamber II Difference in Elevation Between Pump Shutoff I # Doses/Day I II and Uppermost Orifice ft I Dose Quantity gal II II n I Chamber capacity clal II II Uppermost Orifice is U higher, L 'lower I II II than Pump Shutoff I Check the following components if they drain II II Capacity @ Tot. Pres. Head gpm I between doses: Calculated Tot. Pres. Head ft r-1 F--1 r--1 I II (Attach Pump Curve) I u Laterals U Manifold U Transport II DESIGN FORM - PAGE TWO R­ii .d 08/24/94 it=--- -- ---- - — -�i DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch II I � II II n Reference depth from orig- II II LJ Test hole locations Drainfield orientation inal ade: II r� and yout II II � Property lines I I " Septic tank lid and II n Trench/bed dimensions and I drainfield over depth II Existing and proposed critical distances within II wells within 100 ft 1 out Reference depth from orig- I of property lines inal grade and restrictive II u D-Box/"T"/"L" locations strata: II Critical distance n II measurements to cuts, Septic tank/pump chamber a Laterals, t ench/bed II II b ks, surface water location top and bottom II r L P II Location and orientation u Observation port location Curtain drain collector I of curtain drain and all n II absorption area U Cleanout location Sand augmentation II co"onents n II nlo I u Manifold placement No external reference needed: Il II cation and dimension n II II of primary system and LJ Orifice placement a Observation ports and II ve area n cleanouts II Lateral placement, with II dreings distances to edge of bed Additional mounc information: ll II II II Direction of slope u Audible/visual alarm a Upslope and downslope I i dicator referenced fill width II II , II II Wa rlines I LJ Scale of drawing shown I u Settled cap depth at I on scale bar I center and Edge of bed II II � Roads/easements/ II II driveways/parking I Additional Mound Information: I u Sidewall sl pe II II n n I n II II LJ Critical resource lands I f--1 Endslope width I u Up/downslop ,bed elevat. II II ( If applicable) I I I II I u Overall fill dimensions I Completed Resou ce Lands and I IIL North arrow and scale of I I Critical Areas Checklist II drawing shown on bar I I I it DESIGN APPROVAL II � II The undersigned designer L does, L-ldoes not, waive the regirement to be notified by the II installer of the installatio and given 48 ho to perform a final inspection prior to II I cover. /j� II igna u o es gner a e II The undersigned has revi we and pprove i es 'g on behalf o as_on�Count of Health II Services. ea nsl II II CAUTION: THIS DESIGN IS ONL V ID IF STAMPED "APPROVED" BY MASON CO. DEPT. OF HEALTH II II AUS PERC & -DESIGN 10515 Old Belfair Hwy. Bremerton. We. 98312 275-3592 liau,�Nl, ,lo�,aalc . 2 Ss aobdvd u a, A W. P� u c �6o ulz. 9537o-Y Ya0 i n / C(L�NTQ�K Y/4/,N 1/ Gl l�0..•K �• G4Q fYYi AiG�• (, l5� "Yr� 27� t 3s 9,3 aesj �Vi " ELu. 9©& 5 � lfA�t S � J sip E451•µ`� S -, v w yvrKc`� s_ C�,K -d`� �ti.a-S'T /o �rP-,.��. U• v� �a -j- QCb dotdF 3/� Co5 i \\\ �o fj e: d�d L� JLecr/c�' Ct u r 4 •'ti ;<o ew>�;� fiMason County Dept. Health Services v APPROVED THERE IS TO BE NO 3 Initials- / }^ WHEEL VEHICLE TRAFFIC ON �•j� I DRAIN FIELD AREA BEFORE Date �C ` OR AFTER INSTALLATION p ;v � fe d . . �- . I � I ° . � �- � ± \ \ & / � $L� � � t? ` 0^ * K * wf � �f . t \ � * � \ v }/ \ } Q ; ƒ Mason UABePt� Health s,m ± ~ / APPROVED { \ \ � \ { \ aIH \ � � Initials f « ! j INSTALLATION / MAINTENANCE Gravity Systems 1. Install laterals with contour of the ground. 2.. Install trench bottoms level. 3 . Install drainfield during dry weather and soil conditio i s, any soil smearing must be eliminated by hand raking. k 4 . Install locator tape on top of all drainfield lateral . 5. 6. Filter fabric required over drain rock prior to backf llinj. If-the drain rock extends above natural grade,, runthfak filter fabric at least 2 inches down the trench wall: x x.. 7. Divert all storm water run-off away from on-site sewage system. ; 8. No curtain drains allowed within 10 ft. of the up-slo a edge of the drainfield and reserve area. 9. No curtain drains allowed within 30 ft. of the down-slope edge of the drainfield and reserve area. 10. Have the septic tank and pump chamber pumped or inspected every three to five years. 11. - All materials and workmanship must meet County and State regulations. 12. Deviation from this design without prior approval fr m the Designer and mz,S'P.</ County Health Department will maka this design null and void. Mason County Dept. Health Serv;ces APPR®iVJD Initials Date a 0 C11V /4j.� • l�iS� .VLF D,v dPze Al t �T GCE t c SNci TivAr ZJL'lali,l P.tPE Yx�G i ._�• CYO ...__ `1V�' SLe,LE. 18�-1fP �SE6 h1oTE Mason county �e:t Health Serv'.ces `- Initials bat@ � - ruE 1 Si.oPE q .. S,v.00Tt.A Wbt<L- bz-bIn1 PIPE .... OiS�-NnZ c.0 _ Io - 0 raltiAt GLLu-� T o `1 S L E ON—SITE SEWAGE INSTALLATION FINAL INSPECTION .......................................................................... . ................................... . .. ............................ ...... .. .. -7 /^.. . ...,,... ... .. ......................... DATE CALLED IN: ( ` Og TIME: 3 •0 -5 INSTALLER: c1iC).JT�)t CA_ _cey, -.)C APPLICANT/OWNER: .. CALLER: . . . . ..�. . .q PHONE # OF CALLER: :�O�. �D'l� - 63� / SWG #: .9L4- P06 V PARCEL NUMBER: Z2. ✓ I I — —7 6— 00330 SUBDIVISION• DIVISION: LOT: .«.............«......«............«....«................«.................................. ..................................... ......................................«........................ ............ ............... SYSTEM TYPE (CHECK ONE) : ✓ r: INSPECTION SCHEDULE (CHECK ONE) : APPOINTMENT PLUG IN 4S-BUILT ON-SITE? (CHECK ONE) : r—t u YES NO . .................................................».........................�....�,.�- ...................................Be: .. ..r=... .............................. STAFF INITIALS:!`'' h:caltin.w Revi ed 02/01/95 r ON-SITE SEWAGE INSTALLATION I STAFF INSPECTION REPORT I STAPP Ca IST I 1 I CONFIRM® BY INSPECTOR? I 1 I. SEPTIC TA Yes No Comments I A) >5 ft from foundation? 9) Bldg stubout to septic tank: cleanout if not c) Baffles intact and clean? a) Dividing wall intact? rI. a-acx Leveled with water o speed leve (circle one)? _ I I III. DRXTHFX LD _ A) >10 it from foundation and >5. ft from property tines? _ I - a) Laterals level to z1 inch a 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) PRESSORE SYSTEM 1) Sand quality ASTM C-337 1) Head height uniform and t24 inches? 3) Cleanouts and observation ports present? 4) Hound: Side slope 3.17 s) Owner informed electrical connections must be made by owner or licensed electrician and inspected by DLit IV. POTAEI.a WATER LINES A) >101`t from drainfield, transport line, and septic tank? = a) dells >100ft from drainfield? 1 A) Screen basket or effluent filter (circle ono) installed? �. 1 I s) Maw installed for access? 1 - c) Atarm installed? I vI. AS star sne0alnsor —C viz. OTMM Cow ! I I 1 I 1 i I I 1 The undersigned has reviewed this installat and ve If I" 'ndings on behalf of Mason County of Nealth Services. i I I I Hea or a e I I _ h•callin.w Revised 02/01/95 J AS-BUILT FORM - PAGE ONE evinwd 12/14/94 II PARCEL IDENTIFICATION II Applicant's Name II Permit Number SWG9 4 - ZC/c�� subdivision 7,1�A� �F f 3`r�5�// II ame 1v1sI n oC o II Installer's Name .2W2J M LOIrJAX Assessor's Parcel No. 2231 7&OCS30 II II Designer's Name 49L5 A6F�C. t e- 1.gI u er II N INSTALLER CHECKLIST II I N/A Yes Prior to I. SEPTIC TANK II Completion A) >5 ft from foundation? _ �I B) Bldg stubout to septic tank: clearout if not 1-2%? 'I C) Baffles intact and clean? N D) Dividing wall intact? I1. II , D-Box Leveled with water and/or speed leveler (circle)? II ' III. DRAINFIELD II A) >10 ft from foundation and >5 ft from property lines? II B) Laterals level to 11 inch & end caps present if not looped? _ C) system dimensions the same as shown on the design? _II D) Gravel clean, properly sized, and proper depth? II E) PRESSURE SYSTEM II 1) Sand quality ASTM C-33? II 2) Head height uniform and 2t24 inches? ✓ II 3) Cleanouts and observation ports present? V II N 4) Mound: Side slope 3:1? 7 II 5) Owner informed electrical connections must be made by II II owner or licensed electrician and inspected by DLI? IV. POTABLE WATER LINES / II A) >loft from drainfield? / I H B) Wells >100ft from drainfield? V. II PDMP/PIIMP CHAMBER II A) Designed pump used, or specs attached for equivalent pump? ✓ N N B) screen basket or effluent filter (circle one) installed? II C) Riser installed for access? -7- 'I D) Alarm installed? M CERTIFICATION OF INSTAL AXION I I _N Installer: Check box from Row •A,• check box from Row •B,' sign and date th certificatica. w dA. C I certify that I installed the system U I certify that all deviati from p without any deviation from the design the design stamped 'APP m by MCDHs are h stamped •APPROVED• by MCDHS. shown on the reverse side f this form. II r , II h B. U I certify that I contacted the �Z did not contact the designer prior u designer and left the system open for to final cover because the designer II inspection up to 48 bra prior to cover. waived the notification requirement. NI further certify that all information contained on this form is accurate. - I understand U M that if the information coatained:herein' is not accurate,' there will-be Sus xeauge 'for--. -- �I immediate suspension of my installer certif' tion. II 7- ill ru The undersigned approve is ins la 'on of beha o i lf f Masory Co ty Department of Health I' services. II I11 I AS-BUILT FORM - PAGE TWO levised 12/14/94 II PARCEL IDENTIFICATION (' Applicant's Name !J/.//!/� 9) LOn7r�X Permit Number SWG9 Subdivision /kCK ame 1vislo11, occ o �) .L�LUJ />7• LCd+h-in Assessor's Parcel No. Z t0330 Installer's Name we ve- lgI u er II Designer's Name HL iLS ZC6161V I, AS-BUILT DRAWING NNORTH N a n PHONE, P❑WER & WATER LINE N GUTTER ENTRY To URT DRAIN UTTER ENT Y T❑ CURTAIN DRAIN II — — — — HNUSE P RKING N N N NTRY TO ❑ TAIN DRAI UTTER EN Y m CURTAIN DFIAIN NNN PT[C LANK GLEAN ❑ T DEVIATION PR❑M �R"VE1"tF�S1GN - CURTAIN DRAIN EMIT I> 1!1!1!INNNII!1!1! \ CENTER ❑F TANK 15' FR❑M H❑USE 19 FR❑ HO SE W/E -CAP II N ➢-BOX 24' FROM CD N OF HDUSE 3' TREN H fOTH A ➢ES[GNEO :p{ U2 FR FI St LEG MEND-CAP ' 3' THE H I➢iH A DEStGNE[1 SECOND LEG 1 FROM E-H❑X \ 2' FR S ON➢ L G W/END-CAP I N N THIRD LEG 2 ' FROM D-BgN 3' TFE CH I➢TH A DESIGNED N \ � N N DRIVEWAY a - - — — - - - - - �_ _ n 11 A➢I SE TECE N ❑ E .. INS WELL SR �•'� CAUrI 11, Y1AOC AO ementa to septic task lesatica and drainf"Id orlentatioa ands 1a the field by thin tat "r are 9& av saidlot dptoble to both this daFerbe nt and the dsa4nsr, but could In cartain eased O=FrOm fa" the vlabdlity ed the ryatm. It is tba hwt"ller's respsaalblllty to obtain prior written approval fry altber the bsalthi departsmt or the dasi before amkin9 any dsviat,t s from the design that affect "ysttm vlablllty. AW devtetlo,, from the approved deal9n slut be 010100 above. N AS-BUILT CR'BCKLIST u Drainfield orientation v observation port location u Undisturbed native soil N and layout between trenches II i Cleanout location Trench/bed dimensions and t"I U North arrow Q N critical distances within U Manifold placement u layout Scale of drawing shown N Orifice placement on scale r 'I hU D-Box/"T"/"L" location r-1 - II IJ Lateral placement, with Additional M d nformatioa N Septic tank/pump chamber distances to edge of bed u location ram- Endslope width N u Location of wells, roads n N Location of buildings LJ Overall ill dimensions AS-BUILT FORM — PAGE ONE Pavined 12/14/94 PARCEL IDENTIFICATION II II Applicant's Name J7NC'/d nl. LOMHX Permit Number SWG9 Subdivision /ZMC F 35/5.3� II I ame ivlsz n oc o II Installer's Name .EAU//) P). LoI7), iX Assessor's Parcel No. ZZ3 /7(t�U330 II II Designer's Name ti7L�S PF�'C.9 /DES/C�V e- iga. u II II INSTALLER CHECKLIST II N/A Yes Prior to II I. SEPTIC TANK Completion II A) >5 ft from foundation? ✓ �I B) Bldg stubout to septic tank: cleanout if not 1-2&? II C) Baffles intact and clean? J! II II D) Dividing wall intact? _ V"' 'I q II. D-BOX Leveled with water and/or speed leveler (circle)? N III. DRAINFIELD II A) >10 ft from foundation and >5 ft from property lines? ✓ II II B) Laterals level to tl inch & end caps present if not looped? _ II C) System dimensions the same as shown on the design? _ D) Gravel clean, properly sized, and proper depth? ✓ II E) PRESSURE SYSTEM I) 1) Sand quality ASTM C-33? h 2) Head height uniform and a24 inches? ✓ II 3) Cleanouts and observation ports present? ✓ II N 4) Mound: Side slope 3:1? II 5) owner informed electrical connections must be made by owner or licensed electrician and inspected by DLI? II IV. POTABLE WATER LINES II A) >loft from drainfield? B) Wells >10oft from drainfield? II V. PUMP/PUMP CHAMBER II II A) Designed pump used, or specs attached for equivalent pump? ✓ II B) Screen basket or effluent filter (circle one) installed? u q C) Riser installed for access? V _ D) Alarm installed? II CERTIFICATION OF INSTALLATION LATION b Installer: Check box from Row `A," check box from Row "B,' sign and data th certification. N A. LJ I certify that I installed the system I certify that all deviati .from without any deviation from the design the design stamped 'APP ` by MCDHS are II stamped "APPROVED' by MCDHS. shown on the reverse side f this form. NB. U I certify that I contacted the u I did not contact the designer prior p designer and left the system open for to final cover because the designer II II inspection up to 48 bra prior to cover. waived the notification requirement. II h I further certify that all information contained on this form is accurate. I understand u that if the information cbntained;berein' is not accurate; there will-be just-Cause 'for-_=- II b immediate suspension of my installer cert3. tion. III �r 7- DRILLS 2 - II h The undersigned approve hi 'nst 1 tion of behalf of Mas n Co ty Depart ent of Health II I' services. 11 II e r II r AS-BUILT FORM - PAGE TWO Rlwis.d 12/14/94 I( PARCEL IDENTIFICATION II II Applicant's Permit Number SWG9 / - ZO D Subdivision U 1vrsl on oc o s II I me II Installer's Name 1�Av/D M. LO/TW Assessor's Parcel No. 223//7 33o II II Designer's Name n/ �< r• dL d J.�SIL. CI-we ve 1gl u er II I AS-BUILT DRAWING a r AR G NORTH u „ PHONE POWER A WATER INC II N GUTTER ENTRY TO URT DRAIN UTTER ENTRY Tp CURTAIN DRAIN 111' HEUSE PARKING U \ GUTTER�ENTRY TO U TAIN DRAIN GUTTER FAIRY TO CURTAIN DRAIN II EPTIC TANK CLEAN IT T IIDEVIATION FROM �SIGN - CURTAIN DRAIN EXIT )) \ CENTER OF TANK 15' FROM HOUSE N 9' FRO H SE V/E -CAP D-BOX 24' FROM CO.N OF HOUSE 3' TREN H LOTH A DESIGNED 1' „u n 12' FRO F[ ST LEG W/END-CAP II SECOND LEG I ' FROM \-DOX 3' TREN H I➢TH A DESIGNED pp II \ 12' FR S ONO L V/END-CAP N IITHIRD LEG 2 FROM D-BQX 3' THE CH EDTH A DESIGNED i 11 h I u N � � p I�RIVEwAY u u - 1 0' A I E L TTI N ONE F E STING WELL SIT a . CMMW1 atlaec a"eateeets to septic tank lomtim and dralafield oriantetim made In the ffeld by the er are g�av Aa- QW&O" to both the dspattart and the drfgnar, but mind In certain mar mpt'miar the viability of the eyatea. st la the inatallery reaps aibility to obtain prior Witt= epprotal frm eitber the hrlch departamc or the deaf before aaking A11W derlatima frm the design that affect syste• olability. Any deriatlma hob the approved design snot be abo - - I) AS-BUILT CBBC&LIST - p r,p u Drainfield orientation U Observation port location Ef Undisturbed native soil II and layout between t caches h Trench/bed dimensions and u U Cleanout location ra n U North arrow critical distances within u Manifold placement u ry layout scale of drawing shown u �( orifice placement on scale liar u , • ' D-Box/"T"/"L" location r-1 - tJ Lateral placement, with Additional Mo d In. u FK septic tank/pump chamber distances to edge of bed r_1 II location �j " Endslope width II U Location of wells, roads n II II L_.l Location of buildings II Overall fill dimensions