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HomeMy WebLinkAboutSWG94-1343 - SWG Application / Design - 10/5/1994 PERMIT NO. SWG MA;ON COUNTY DEPARTMENT OF HEALTH SERVICES m l'- 0:5, 426 W. CEDAR/P.O. BOX 1666/SHELTON,WA 98584 Date N: o Receipt No. PHONE (206) 427-9670 Amount$ m7 m EAOWN)) ! L J '/0. 7- 9�F CHECK APPLICABLE ITEM ✓ m m INSTALLING NEW SYSTEM MAILING ADDRESS: DAYTIME PHONE: � COS A k 50 JC, 159 VI,c�f, EXPANDING SYSTELD M SYSTEM STATE: ZIP: EXPANDING SYSTEM ^� � CITY: r L1Jf� cF 0 SINGLE FAMILY OTHER $ PROPERTY ADDRESS: ` � {{ SPECIFY: 3 7 C) )J1a [ E_ N iZ�A i� 'She Lio c L PRIVATE WELL SPECIFIC DIRECTIONS FOR LOCATING SITE: ,JLIrj aA T 1-01 I E OF IJI\ C_ c£ �— PUBLICSEM ID SYSTEM D NUMBER I�� SYSTEM NAME j N E IZ I G i 11 There i 5 H, APPLICANT C'-A M 'T k ll_.l' NAME LECAll MAILING ADDRESS 5 i i d Name of !�{I111£t1 L X llt/Nt/!rJ lAl' Lot ft.x ft• I u Installer Size: -�.G acres TELEPHONE f E, Name of SIGNATURE y'0 Designer l�A�L'I�I�+ ExGia�'97/trV Bedrooms X I� PLOT PLPN {� Draw a di ensional plot'plan, including: /NIK L [i'N',c� �; co ❑Precis test --�- — - U�/� holes, g r _ �h1, !)z I I meas stages taS prop ( und'7nes.� I\ ❑Ent ofWr rod%, � I� h 1 NO��r' DDO N2T q�W IN {f� J //\ EMS IGIN L y OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. SOIL LOGS � —7 Z /L >- p-.5 &4roc1 /��gr �J�tiD �CIL? lL u'/6/r.,vc Depth froiestrictive Original Grade to Layerorater Table: � In. DESIGNER DESIGNATION SCORESMINIMUM SYSTEM REQUIREENTS Finding Score Designer Level: ❑One 1&0 Soil Type 4_ Ji Septic Tank Daily Vertical Separation Z. in. Capacity:I; ao Gal. Flow: 3 GIRD Slope 7— % Appl, Infilt. Parcel Size 3 •)y Ac. (, Rate GPD/FT' Area ro O FT' Distance to Shoreline<�)ft. p Total s Inspector Date JJ- 2 3 }'Scy COMMENTS/CONDITIONS FOR APPROVAL Any change from the specified use of the property or any site alteration affecting the system design may inval date this permit. This Permit expires 3 years from date of site inspection.Denial of this permit may be appealed to the Health Officer witith 10 days of denial date. srrE:jkNpovadCj4NWnRequired1 ❑NolApprwed DESI Approved ❑Not Approved INSTALLATION:O proved O Not Approved BY: DATE:/.' -Is 9 H BY: DATE:l &S 51 BY: DATE: TOP: Health Dept. Copy IDDLE: Designer's Copy BOTTOM:Applicant's Cop MASON COUNTY DEPARTMENT of HEALTH SERVICES Shelton,Washington 98584 (206)427-9670• Belfair.275-4467 ENVIRONMENTAL HEALTH PERSONAL HEALTH WATER QUALITY P.O. BOX 1666 303 N. FOURTH P.O. BOX 166E MEMORANDUM 1- ate-e7 DATE: �1 TO: kclo a ce-AC2w i I FROM: Suo-P)e/MCI -3 RE: Design for_ /`l/ e./ / _ Parcel # ✓�' Your design for the above referenced parcel has been reviewed and is APPROVED. ® Your design for the above referenced lot is NOT APPROVED. It does not meet the requirements or needs additional information. DE5TG& FORM - PAGE ONE Revised 12/28/93 A dlesign will be reviewed when 3 copies of each of the following items are submitted: • Completed design form that has been signed and dated • Completed Resource Lands and Critical Areas Checklist .attached • scaled plot plan, including all applicable items on checPklist • Scaled layout sketch, including all applicable items on checklist • Cross-section sketch, including all applicable items on checklist PARCEL IDENTIFICATION Permit Number �� - 13N3 Designer's Name t /L� � C' o,)7)0j) Applicant's Name �ea, nRt,) Prop. Owner's Name rku Mailing Address QS`l33 19' R-e. ,S Mailing Address 7S --Fria a � I SC�<� 21P r GS<Y 5<s<� z1P Assessor's Parcel No. �13`/_ j'/- 0Wo10 Subdivision ' I�eev'�Aw% 1 1 f (2w�lvs—01giL Numbai) (Nsm�/O1v1•SOe�.'HloO k/LO<) DESIGN PARAMETERS J J J J DeanLd Vertical Separtion Mound Subsurface Pressure Gravity Bed Trench in .Septic Tank/Drainfield Specifications No. Bedrooms 3 Pressur t' No Daily Flow () gpd '(1FJQ` Septic Tank Capacity IV(') gal .•...-•.•...: "' •...-.--'•....-.--- Receiving Soil Type (1-6) LLLJJJ �t �� Receiving Soil Appl. Rate (O d/ft2 JAit a�C J Trench/Bed Bottom Area • f t I Schedule/Class Trench/Bed Width 10 ft Length ft Diamete+EALTM SERVIC --in Elevation Measurements Number Orig. Drainfield Area Slope O % Separation ft Final Drainfield Area Slope Orifices Depth of Bottom of Trench/Ngy1,te5 Total Number of Orifices from Original Grade --0,� w( '' o�� in Diameter in y dr" ua�lOPe ;�•i R0� in Spacing " Y4� Manifold '. Schedule/Class Length ft Pump Required? Yes LLk No Diameter in le .......................... ...................... (If yAs, proceed. . . ) Transport Pipe .................... ...................... . Schedule/Class Pump/Siphon Specifications Length ft Difference in Elevation Between Pump Shutoff Diameter in and Uppermost Orifice ft Dosing and Pump Chamber # Doses/Day Uppermost Orifice is 11 higher, 0 lower Dose Quantity gal than Pump Shutoff chamber Capacity gal Capacity @ Tot. Pres. Head gpm Calculated Tot. Pres. Head ft (Attach Pump Curve) DESIGN' FORM - PAGE TWO pevis d 12/28/93 DESIGN CHECKLISTS rscaledlot Plan Scaled Layout Sketch Cross-Section Sketch Reference depth from orig- hole locations Drainfield orientation inal grade: and layout mV \ Property lines u septic tank lid and m Trench/bed dimensions and drainfield cover depth LJ Existing and proposed critical distances within wells within 100 ft layout Reference depth from orig- of property lines © inal grade and restrictive r� D-Box/"T"/"L" locations strata: LvJ Critical distance measurements to cuts, Septic tank/pump chamber Laterals, trench/bed banks, surface water location top and bottom Location and orientation Observation port location Curtain drain collector of curtain drain and all - absorption area Cleanout location A Sand augmentation components Manifold placement No external reference needed: Location and dimension of primary system and Orifice placement EE Observation ports and reserve area cleanouts Lateral placement, with Buildings distances to edge of bed Additional mound information: L Direction of slope Audible/visual alarm E�Upslope and downslope indicator referenced fill width Waterlines Scale of drawing shown q�-Settled cap depth at on scale bar center and edge of bed Roads/easements/ driveways/parking Additional Mound Information: Sidewall slope Critical resource lands 'K Endslope width Up/downslope bed elevat. (if applicable) Overall fill dimensions Completed Resource Lands and North arrow and scale of g1V�eS Critical Areas Checklist drawing shown on bar \5 DESIGN APPROVAL The undersigned designer does, does not, waive the regirement to be not fied by the installer of the install on and giv 48 hours to perform a final inspection prior to cover. ^� ' 1- ! ! 91�ra Cvi� of VD��1glf�z Oster The undersigned has reviewed and approve th' design on behalf of Mason County of Health Services. 5 TvAL z�.onCAUTION: THIS DESIGN IS ID IF STAMPED "APPROVED" BY MASON CO. DEPT. OF HEALTH ---------------- 91 7 i i -il ems_ { aso��o���Y �eP�•Nea�t�^ �;�� � = TSB ��olz � o� v �I 70 I r D _ G G L ` � G a X G C � o �Y O L i h O z Mason County Dept. VCT-% es APpR raj Initials---�'"— pate —�'�� • � I i ill I I � I i z i - z ao � r gecv� es .7 1 OU Date lor— C C ' C