HomeMy WebLinkAboutSWG2002-00172 - SWG Application / Design / As-Built - 5/7/2002 Sol
MASON COUNTY DEPARTMENT OF HEALTH SERVIGES PERMIT NO. SWG y
a
426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date - r2 N: o
PHONE (360) 427-9670 Receipt No. / 7 n rri
Amount$ Z
P RTY OWNER• DAT 3
ER, t' _ _ CHECK APPLICABLE ITEMS �/ m
MAILING ADRRESSCC• DAYTIME PHONE: NEW SYSTEM o
(. . �urJDVI a-• (�+ 9 tea— REPAIR SYSTEM
Cl S ATE: ZIP, TABLE� m
o MAINTENANCE REVIEW
PROPERTY AD_I SS: n - >r (� y 1 �, SINGLE FAMILY 3
OTHER: 3
SP CIFIC DIRECTIONS FO LOCATING SI �
W o pa PRIVATE WELL
COMMUNITY WELLIPUBLIC SYSTEM
f, \ SYSTEM WFI N Loy
SYSTEM NAME
C o Sl (2rNyA Onl \tE INAME
PP T I�
W r
Name of Lot
xl`[) ft. ILINGA DREInstaller
Size: acresLEP NEName Designer um er o N o� Bedrooms I !
OFFICIAL USE ONLY BELOW THIS LINE I L�
DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITI NS
-TA I ), Oct Gs�
aY /� /n jO
'f Hz. �o
> n T IV,/
A
SOIL TEXTURE CODES: "1
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INS OR( int na ) I E T)ON SI URE DATE PERMIT EXPIRATION D TE
r A e a S2OOS
•All systems r&fjire ongoing Operation and Maintenance(O&M)as 6pecified in Mason County On-Site Standards.
•All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer,unless prior approval is granted otherwise
•All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted otherwise.In such ca5es a preliminary on-site
meeting between health department staff and the homeowner is required.
•On-site sewage system design 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 ertnit a fires 3 ears from the date of sNe review.Denial of this permit may be appeatiodto the Health Officer within 10 days of denial Jets.
DESIG W APPR DATE: I ALLAT ON APPPevM Y: DATE:
a. 3 Z 0 C. Iz S O&
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES �;
May 23, 2002 PO BOX 1666 SHELTON, WA 98584
SHELTON (360) 42 -9670
FAX (360) 42 -7798
Robs Excavating ELMA (360) 46 -5269
1871 E John's Prairie Rd. BELFAIR (360) 27 -4467
Shelton WA 98584 SEATTLE (206)46 -6968
RE: Design for KINGERY
Case No: SWG2002-00172
Parcel No: 321347500070 L
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 information.
Please call me at(360) 427-9670, ext. 353 if you have any questions.
Sincerely,
Cindy Waite
Environmental Health
Mason County Health Services
COMMENTS: Technically approved, need recorded attenuation
5/23/2002 1 of 1 SWG200 -00172
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
May 29, 2002 PO BOX 1666 SHELTON, WA 518584
SHELTON (360)427 9670
FAX (360)427 7798
Robs Excavating ELMA (360)482 5269
1871 E John's Prairie Rd. BELFAIR (360) 275 4467
Shelton WA 98584 SEATTLE (206)464 6968
RE: Design for KINGERY
Case No: SWG2002-0 0 1 72
Parcel No: 321347500070
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 information.
Please call me at(360) 427-9670, ext. 279 if you have any questions.
Sincerely,
Amanda Reynolds
Environmental Health
Mason County Health Services
COMMENTS:
5/29/2002 1 of 1 SWG2002 00172
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES -
Environmental Health Water Quality Uerjoealth
Po Box WMELAUN, WKWW
LOCAL(360)427-9670
Application for Waiver/Appeal BELFAIR(3 )275-4467 &4468
YY TOLL F1 BE 1-800-562-5628
)427-7798
Amount Paid:
ReceiptNutnber:
Instructions
I Complete Pests 4 a4d 2. �To tletemxmaaori can bemado ttnttt then 1 � ;���
2 tacsmaybabiltsct!'nx�uatvors�utdappeals,T,asedmrrtho�tr+nrontneuta[haa[ti�fi'k�chrIute.
$rbmtt:Com 1cYtl7a 7tcatlQtiwltlxatlactmentsta.3txefiealtltde arizneatiorrcekv:
PART 1: Applicant/Parcel Identificatio�fn
Name of Applicant Nv,r-e-1, ^� — Date S Q� -
Mailing Address G ! �)owc xt AJ Lr Telephone lr - �a
Assessor's Parcel Number ��
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ On-Site Sewage Requirements ❑ Food Sanitation Requiremen Ls
o Building permit review policies ❑ Solid Waste Requirements
o Location, WAC 246-272-09501 ❑ Group B Water System Reqi irements
o Holding tank WAC 246-272-12501 ❑ Water Adequacy Requireme its
o On-Site Standards ❑ Enforcement Timelines
o Certification contractor(pumper, ❑ Departmental Determination
designer, installer, O&Mspec)requirements 'ZA Other
Description of Waiver/Appeal(include justification,additional material may be attached):
Applicant Signature: Date: -Q Z
H:IWDATAURCHIVEIWA/VERWP Update:April 25,1997
PART 3: Health Department Evaluation (Staff Use Only)
IA. Type of Determination Required: I B. Type of On-Site Waiver(if applicable):
❑ Appeal tOWaiver ❑ None required ❑ Class A Class B ❑ lass C
2. Identificaton of Specific Code/Standard/Determination(include date of determination or latest
code/standard revision): 1)
2 -7 2, —/t o71/ C1,1a1
3. Nature of Appeal:
l?aj,jU ,Cj
4. Hearing Official:
❑ Board of Health %Iealth Officer
❑ Pollution Control Hearing Board ❑ Health Services Director
❑ Certified Contractor Review Board ❑ Environmental Health Manager
5 Mitigating Factors:
6. !have reviewed this waiver/variance request. It is complete, and mitigation required by state 7nd local
policy has been submitted.
Staff: �w Date: //2 a L
PART 4: Determination of the Hearing Official
The hearing official has determined that approval of this request will not adversely affect pub is health and
is hereby grunted This decision is based on the following findings and conditions:
❑ The hearing official has determined that approval of this request could potentially have an adi ersely affect
public health and is hereby denied. This decision is based on the following findings:
Hearing Official � � — Date:
H:IWDATAURCHlVEIWAtVER.WP Upd :April 25,1997
w
On-Site Sewage Systems (Chapter 246-272 WAC)
Request For Waiver From State Regulations
SECTION 1. Z�CO�MPLETED BY APPLICANT
Name:(I) 1 �v t �C� c Local Health Department/District(2)
Address:
Telephone:(N!�V
Signature:
Property Identification:(3) Par 3� 3L1 1C� OC)CTK7
SECRONn. [COMPLETEDBYAPPr1CANT
WAC Number:(4) WAC Requirement:(5) Waiver Sought:(6)
246-272- // S U a y" V cAIIca) Lipt"J Z d
Subsection: a� Ih.t„'c� yyuo�<,r,✓ dc..JA`� f�GUU ciG�.fr�t' u4`�-
Justification(Mitigation measures to be provided):(7) '^/
✓iv" cz�. R /"
SECItON ID. COMP[EIID BY HEALTH OFFICER
Review Criteria(8) Mitigation Measures(m addition to those propo
Comments/Conditions:(10)
Type of Waiver;(11) ❑ClsssA ApassB ❑Gass C-Request DOHreview k&M granft? Ya_ No_
Neighbor Notification:(12) Required? Yes No �jneeded are agreements,easements,eta properlyfiled? Yes No_
SBCIION1v. COMPIErEDBY HEALTH OFFIM
i Vila Request For Waiver From State Regulations has been reviewed according to the provisions of Chapter 246-272 WAC On-Site Systoms•
The review criteria applied,and the mitigation measures proposed ardor required,have been evaluated for their ability to provide V iblic health
protection at least equal to nut provided by this chapter WAC.
Approved/Granted-Subject to all comments,conditions and requirements noted in Section and M.
❑ Denied
Local Health Officer(13�� ,�i�% i��Z�i1. ��r� Date: Z
APPENDIX A
CLASS B WAIVER OF ON-SITE SEWAGE REGULATIONS WAC 246-272
AND
WORKSHEET FOR DETERMINING A REDUCTION IN VERTICAL SEPARATION
This worksheet is used to determine if a site qualifies for a reduction in vertical separation under the Class B Wai er. Please fill out
the worksheet in its entirety. Incomplete worksheets are returned to you and will cause delays in your permit application.
Part 1:Applicant Information
Name of Applicant: �t� ''`�—Date: �a ��—
(`_ �
Site Address: C�a LAC M L—
r
Mailing Address:� G c_ �, (`d A
PO—
City: - �� V� State: � zip:
Assessor's Parcel#: �� `F SWG#
Part 2: Checklist
1) Soil Series 3) Check the soil structure.
'Y Strudrfrsmt+stte smgte)aratired urive k.
�ta1trm;IrrSurrdatrt3ravellYBaadyln�gt>
^�" "x' �ertea �xrFe as tndicate�d'�tthe
_ ` �as`Lt » V�% ashtttc 'tUSL3�u
Single Grained or Weak ........................�
Well structured ......................... .'
Alderwood Gravelly Sand Loam ................
Harstine Gravelly sand Loam ❑ '
••••••••••••••••••• 4) Cheek percent of pnmary/r rve dnmfield
Hoodsport area. `?
Gravelly Sand Loam. ❑
r.
Shelton Gravelly Sand Loam ....
................
❑ _ as 'a.. ,K:a
SinclairOmveffy Sand Loam .................... ❑ It�is>t
Other, ...... Cl '. :r: ?'eik,`���.
2) Cheek the wil type: Less then 3% ................................ ❑ `
P . _
3 si.
a
Greater than 3l)gb ............................. ❑
S) Cheek the a lope Ise paratlo F
Loam ...................................... ❑
LoaarySand .................................. i<
Sandy Loam .................................
Percent Gravel by Volume:
I=than or equal to 60% .................. Less than 12" ....................... ..... ❑ .
Greater then 60%......................... ❑ 12-19.
Greater than IS"
Determined by:
Depth to Hardpan ................ ❑
Depth to Motkling ....:........... ......
Both .............. ........ ❑
6) Check the drainage of the sell. �- lox) Check Horizontal Attenuation Zone.
�iol[s lac fi�bdal 4ol)pelf�IralnBd 3o viap A St) 4t� .4 c /
� 0 1iiMIITi�41..
Is there less than 50 feet between the down gradient side of
Well Drained ................................ ❑ ❑ the proposed primary and reserve drainfield areas and the
Moderately Well Drained .................... Property boundary?
Other0 Yes .......................................
_ No......................................... ❑ ❑ I'+
7s)Check water table level.
If yes,the applicant will need to provide a recorded
#gt xterbk � n$` covenant or easement prior to final
trtlalttltla n�[S tegttli4d vVa(et;ta�afes t halkxver: P acceptance of the on-
{ 2 �regloRallowed: site sewage application.
10b) Record 50 foot zone on dad. .Z
Is the water table: fot .�asot . ._
Above36" .................................: tan a� r b
{
Above 24" .................................. ❑ s�� � : w�� areas}
Above 12" .................................. ❑ srehkai(arfrae 6ra)har%tm laitrcfttgs`z
Arl..: ..rR,..
7b) Is a curtain drain proposed up slope of the primary
drainfield area? " Is the owner aware and in agreement with these termsl rCn
LT
as (home owner initial )
Yes ........................................ 'D p
'w Yes ........................................ :
No......................................... ❑
> No......................................... ❑ ,,.: .
3) Is the property on marine shoreline? y
. ., .�,. e„„.; �. q . . . Is the 50 zone recorded on the deed?
s Yes ....................................
.An o r w 'a W No.
^Y, � k '
Yes ........................ ❑ 3:<; :
................ Q;.._ 11) Check PrOXIMKY to wells.
If yes Ltdicate the distance from the shoreline to primary
dntiafield arras feet
s«
9) Are there any fresh water bodies within,or adjacent to, Indicate the smallest distance from esisti
- the roe r.haundxrles? Proposed wells to the
primary or reserve drainfield areas. _feet
r .
Yes ....................................... �❑,/
No.........................................Jim
if yes,indicate distance from shoreline to primary der .
reserve aces fat
Designer Comments:
}f.
i
H
Part 3: Certification and Approval
Applicant Certification:
i certify,to the best of my knowledge,that the above information is true and correct. I acknowledge that I am solely responsible for maintaining the
rntegnq of the primary and reserve drainfield areas;and that destruction or damage to the drainfield area may result in immCA liate rescinding of the
onsite^ e perm
Desi Date
Applicant Date
Health Department Review:
Preliminary Review For Design Submission: ❑Approved ❑Denied
Environmental Health Sanitarian Date
Waiver is❑Approved ❑Denied
Environmental Health Sanitarian Date
Comments:
DESIGN FORM - PAGE ONE Revised February 18, 1998
A design will be reviewed when 3 cow of each of the following Items are submitted:
%L Completed design form that has been signed and dated *a Scaled layout sketch,Including all applicable Item ion checklist
Scaled plot plan,Including all applicable items on checklist % Cross-seotlon sketch,Including all applicable Items on checklist
Permit Number: SWG 9 00 2- C 01-7 v Designer's Name: \
Designer's Phone#:
Applicant's Name: �p`2 Kl*�41 Assessor's Parcel No.: a1
Mailing Address: a C• �`J1So�I\�A r?,t( r �j-4Twelve•Di it Number)
��nt�ba WA QB � $Jdfvtstdlt
City state Zip ''F._ sme/Divisi n/Blo
DESIGN p/��'tANI 't'
TreatmDlctl ..
ZLira
py••
%*
0 Glendon Biofilter O Sand Filter O Mound O Sa O Aerobic Unit-Make/Model: --- O Disinfection Unit - Make/Model:' 72
NDrainfleld Type
8- C�
Pressure Bed �Drainrock
Gravity Trench Gravelles Chambers
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms c e u lass
Length
Daily Flow
Septic Tank Capacity Diameter
Receiving Soil Type(1-6) Number fi
Receiving Soil Appl.Rate Separation
Required Square Footage Orifices
Designed Square Footage Total Number of Orifices 3
Percent Reduction Taken % Diameter
IZZOPed Width ft Spacing
Clen-cliBed Length n
Elevation Measurements Manifold
c e ul C p Vr
Original Drainfield Area Slope _% Le PP1l® y ® ft
New Slope if Altered I a Diameter MC HEALTH DEPT
Depth of Excavation from 10 in preferred ManiC�tf� p�n Used? Yes ❑No
Original Grade (Up-slope) ujaUC
Designed Vertical Separation in CE.Tr-ansport Pipe
'T (Down-slope) Class
Y••Y
in Lengeng th ft
Diameter in
Gravelless Chambers Required? ❑ Yes No 0 Optional
Pump Required? Yes ❑No Dosing and Pump Chamber
Number of Doses/Day
Pump/Siphon Specifications Dose Quantity al
Difference in Elevation Between Pump Shutoff and Upperqiost Chamber Capacity al
Orifice: Pump Controls: Timer(or) Elapse Time Meter(circle if required)
If Timer: Pump On , Pum Off
Uppermost Orifice is Higher, ❑ Lower thap Pm Shu off
lv t• Check the following components if they drain between doses:
Capacity @ Total Pressure Head: O
Calculated Total Pressure Head: \ NfLaterals ❑ Manifold ❑ Transport
(Attach Pump Curve) V
DESIGN FORM- PAGE TWO Revised February 18, 199g
Scaled Plot Plan Scaled Layout Sketch Cross -Section Sketch
Test hole locations Drainfield orientation and layout \Referenced depth from original grade:
Property lines �l Trench/bed dimensions and critical Ll Septic tank lic and drainfield cover
Existing and proposed wells within distances within layout depth
100 ft of property lines O D-Box/"T f1" locations
Critical distance measurements to cuts, Septic taak/pump chamber location Reference depth rom original grade
banks,and surface water Observation port location and restrictive st ata:
Location and orientation of curtain Clean-out location Laterals,tren ed top and bottom
drain and all absorption components Manifold placement Curtain drain *hector
Location and dimension of primary Orifice placement O Sand augmeni ition
system and reserve area 19 Lateral placement, with distances to
Buildings edge of bed Other cross-section detail:
Direction of slope indicator Audiblelvisual alarm referenced Observation p rts and clean-outs
Waterlines b Scale of drawing shown on scale bar
Roads/easements/driveways/ oNa54SeCfLohihf tgiatioh.fbx nound
parking Lanut9,.nfat�+tatEulnrrnngnl9aCeml syakeat '_
O Critical resource lands(if applicable) ft)f tlitue3ta14n8 f Settl d ca de
North arrow and scale of drawing p f at center atld edge of
shown on scale bar uP sppDr ttnWnslnpe,attd�kftfalnpo bed
til.vY€ I«1 Su#st......
£3 singe and 11! 00l a kteel eievatmil
\Additional Information
® Design staked out
O Operation and Maintenance Notice
Attached
O Waiver(s)Attached
The undersigned designer❑does,�doe give the requirement to be notified by the installer of the ini tall n and given 48
hours to perform a final inspection or
t cover:
3�► �5_- r7-0-2-- -'
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Department of Health Services ete IN in
compliance with state and local on-site regulations, ?
� 100172
,�,�...� � r ,.. „ ROBE TGOODWIW�•f'
�(�Wu�D V 'ZY/p ' ( N. .................
Environmental Health Specialist DFFFFaiiii1e EXPIRES 08-08•C,
Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Department of Health Servic
✓ The On-site Sewage Permit has not expired,the Permit Explration Date is: Z 0
✓ The system is installed by a certified installer, unless prior authorization is obtained om M on County
Department of Health Services.
✓ Drainfreld site conditions have not been altered to adversely affect conditions of des gn approval
= Soil 1109 s
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SECURED LID WITH OAS TIGHT SEAL
240 DIAMETER
l ACCESS RISER
FINISH GRADE
_ — — — — TO PU WP
CRAM ER
FROM SEWAGE 74
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS
SEPTIC TANK
Il VPICALI C
SECURED LID WITH GAS TIGHT SEAL TM"� G®
24•DIAMETER MC HEA DEPT
ACCESS R18ER MAY 2 9 2002
ew
FINISH GRADE
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FROM SEPTIC T DRAINFIELD
TANK
EMERGENCYSTORAGE
HIGH'WATER ALARM LEVEL — — — - — — — —
/� 11 WORKING VOLUME INDEPEN ENT
WI AJClblt, IviJJAv FLOAT STEM
FOR PLC AT
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SEDIMENTS SUBMERSIBLE
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!EXPIRES 08-08. r�,�-
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PRESSURE LATERALS
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LON avUEEP MCPHEA T PR vDCD
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PUMP CHAMBER
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(SLOPING GROUND' MANIFOLD BELOW LeTERALSI 5100172 �.
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EXPIRES 08-08-
S
SKHD150 SP40 SP50
MAX. SOLIDS 3/4"SPHERE MAX. SOUDS 1-1/4"SPHERE MAX.SO DS1-1/2"SPH
1 -1/2 HP 4/10 HP 1 /2 HP
3450 RPM 1750 RPM 1750 RPM
.5100172 �
ROBERT GOODWIN;:.,
I:*•' 1 EXPIRES 08-08- tom-
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• Dual shaft seals standard. Seal • Available in automatic and manual A atic and ma
failure sensor capability available • Oil-filled ball bearing motor A i lI quty ball bear
(to be wired to an alarm device) incorporates automatic reset
• 1.1/2 HP, oil-filled motor thermal overload *��'c,?s in vane cast iron
• Rugged cast iron construction • Non-clog,two-vane thermoplastic tyt'sewge� yeller
• 1.1/2" NPT discharge sewage-type impeller • At s feature oil-isolates
• Spring loaded mechanical seal • Automatics feature reliable I rol diaphragm switch
with,carbon and ceramic faces diaphragm switch with piggyback cast iron housing
• Non-clogging semi-open plug-in • Rugged ast iron construction
thermoplastic impeller • 2" NPT discharge • Mechani al shalt seal with caf
• Pump-out vanes on rear shroud of • Rugged cast iron construction and care nic faces
impeller • Stainless steel shaft • 2" NPT d scharge(3" flange
• For high head septic tank effluent • Completely field serviceable optional)
applications • Residential sewage ejector or high • Complet ly field serviceable
• 1.1/2 HP, 10 230V and 3o 200V, capacity sump pump • All bronz I model(SP50AB1) it
230V,460V or 575V • 4/10 HP, 10 115V or 230V automati , 1 a 115V
• 1/2 HP, to 115V, 200V, 230V
3o 200V, 230V,460V or 575V
1- 22 ]2
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CMAWY-U.S.n.P.M. CAPAWY-U.S.e.►.M. :PACrrY U.S.G.P.M.
1871 E Johns Prairie Road
Shelton, WA 98584
360-426- 697
ARM IN] rNr tlk
i��� il I fllv 1 L.LY Illl I
GENERAL NOTES
1. Rob's Excavating has designed this system in accordance with all-current state
and county Health Department requirements and assumes no responsibility for
its use or longevity. The owner therefore agrees to maintain and make all
necessary repairs to the system at no cost to Rob's Excavating.
2. The contractor shall be certified and approved by the county to install septic
systems.
3. The contractor shall field verify all contours, stub out elevators, and trench
depths in drainfield areas before construction.
4 All construction materials and installation shall conform to all applicable state
County Health Department requirements.
L 'be the installer's responsibility to have a copy of this design on ite at all
t $during construction.
PP ®VE®
15 :`fit shall be the owner's and/or installer's responsibility to no WEA
T11 DEFT
�itcavating and the county Health Department for the required ink ' ,q 2002
before backfilling. C+
7. All required tests shall be successfully run before calling Rob's EXCR mg for
final inspection. All components, including all tank access lids must b
accessible for inspection.
8. Rob's Excavating and the County Health Department shall first approv any
variations to this design.
9. Owner/Installer shall not remove any topsoil in drainfield area. Removal of
topsoil could render the site unusable.
10. Existing utilities shown on the plans have been plotted from the best irdbrination
available to the designer. Accuracy and completeness are not guar teed.
TH
.:.ham ro.,.., r ...pl.., 171} Ili":'' 1$ �<', ..: ♦of �+
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S100172 • 'Fig
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EXPIRES 08-08•
ROB'S EXCAVATING
1871 E JOHNS PRAIRIE RD SHELTON, WA 98584 (360-426-6697)
INSTALLATION/ MAINTENANCE
PRESSURE DISTRIBUTION SYSTEMS
1. Install laterals with contour of the ground.
2. Install trench bottoms level and at all times a minimum of six inches into the na ive
soil.
3. Install locator tape on top of all drainfield laterals.
4. Install observation ports as indicated on the plot plan (minimum two pet drainfi Id
with bottom extending to the drain rock/native soil interface).
5. Install drainfield during dry weather and soil conditions, and soil smearing must be
eliminated by hand raking.
6. Install threaded clean-outs at the ends of all laterals (cap must extend to within E inches of finished grade and be marked with locator tape). APPROVED
MC HEALTH DEPT
7. Install audio/visual high water alarm. MAY 2 9 2002
8. Install 1/8 inch mesh non-corrosive pump screen (min. 12-sq. ft. surface � to
interfere with controls or floats). Er
9. Install check valve in pump outlet line to prevent system from draining back into the
pump chamber.
10. Filter fabric required over drain rock prior to backfilling. If the drain rock extends
above natural grade, run the filter fabric at least 2 inches down the trench wall.
11. Divert all storm water run-off away on-site sewage system.
12. No curtain drains allowed within 10 ft. or the up-slope edge of the drainfield an
reserve area.
13. No curtain drains allowed within 30 ft. of the down-slope edge of the drainfield ind
reserve area.
14. Have the septic tank and pump chamber pumped or inspected every three to five
years.
15. Inspect floats, clean pump screen and test water alarm every 6 — 12 months ede
vAlyAA.
i •AP
51'ROBER GOODWIN
LINE ItJEii
EXPIRES 8-08-
16. All materials and workmanship must meet County and State regulations.
17. Septic tank risers to be at or above finish grade.
18. Deviation from this design without prior approval from the Designer and Mason
County Health Department will make this design null and void.
19. Pump chamber lid to be above finish grade.
20. The on-site septic system owner is responsible for properly operating and mainta ning
the OSS and shall:
a) Determine the level of solids and scum in the septic tank once every
three years.
b) Employ an approved pumper to remove the septage from the tank
when the level of solids and scrum indicates that removal is neces
c) Protect the OSS area and the reserve area from:
1. Cover by structures or impervious material
2. Surface drainage
3. Soil compaction by vehicular traffic or livestock
4. Damage by soil removal and grade alteration
d) Keep the flow of sewage to the OSS at or below the approved des gn
both in quantity and waste strength.
21. High strength waste will increase the depth of the biomat in a drainfi*orabit
v E
decreased flow through the biomat and possible ponding or floodingI Ik DEPT
High strength waste in a residence is usually related to the"lifestyle" o t1-e20U2
home, generally resulting from one or more of the following: YY 9
a) Excessive use of a garbage disposal C+ W
b) Consecutive loads of laundry done all on one day
c) Excessive bleach or detergents with added whiteners
d) Dishwashing, showering, and laundering all at the same time
e) Medications— antibiotics can kill or impair the biological process in
the septic tank.
f) Leaky plumbing (hydraulic overloading)
•,.,,
3'L N
ROBERTGO DWIN%
EXPIRES 08-08- Q,Ih_-
Date Called In: Caller U
Time: t YL> SWG#: ' —
installerf�� tercel#: �' — 7 — 566
26
17 Designer 6-' Subdivision:
Applicant/Owner: _ aA-2a Site Address:
❑ Gravity ❑ Sandfilter
Pr
essure ❑ ATU/Proprietary Filter
❑ Mound ❑ Glendon Biotilter
❑ Sub-Surface Drip
Inspection Schedule:(check one): I ES ❑ O
As-Built On-Site?(check one): YES ❑ O
Staff Initials:
GQ S`t� �i'idyi
Appointment Date: Time:
Comments:
ES
Is building present? ❑ N
Does necessary soil depth appear to have been altered since design approval? ❑ NO
System appears to have been installed under suitable soil moisture conditions? ❑ NO
System has been sited/constmoted to prevent surface/groundwater infiltrarion? ES ❑ NO
If gravel and/or spec sand has been used, is it clean and of proper size/grade? 0 NO
❑ NO
Have all horizontal setbacks been maintained? yy ES -
Disposal 100'from wells/surface water?
Tanks/Transport/Ftlters 50'from wells/surface water?
Have waivers been applied for? ES ❑ NO
If so, have all waiver criteria been met? S ❑ NO
Has the system(layout/components etc.)been installed as-per design? ES El NO
If NOT, has designer concurred with changes? ❑ Y ES ❑ NO
Tanks watertight(all openings w/cast-iir fittings or Risers to grade&watertight?
ent? ❑ Lids secure if contractor not resent? Please secure lids!
leanout installed? ump on block or in vault?
affies intact with adequate clearance for inlet pipe? ischarge line as per design(check/ball valves,etc)?
pf'outlet filter as per design and accessible? lost position correct for dosing&to prevent hang-ups?
Outlet piping sufficiently stabilized to prevent settling? Floats on separate tree,not attached to discharge?
imer, ETK Counter present if required?
Tran rt line correct& installed--prevent settling?
Page 1 of 2
0
O Lateral&orifice placemcetlshieldmg as per design? !•/•Sandfilter has a Ptmrp Wdl:
❑ Squirt height uniform and adequate for orifice size? ❑ Lid of pump well vented?
❑ Clear outs present,accessible and anchored properly? ❑ Discharge line as per design(check/ball valves,etc.)?
❑ Observation ports to proper depths and anchored? ❑ Float position correct for dosing&to prevent hang-ups?
❑ Air coil present if specified on design? ❑ Floats on separate tree,not attached to discharge?
❑ Float level prevents bottom of filter sand from flooding?
Overall depth of pump well= in.
Too of underdrain pipes to bottom of um well= in.
ATU/PROP , Y FI[,TERs
❑ Treatment unit present? ❑ System appears to be installed correctly?
❑ Unit installed by mfg. certified representative? ❑ Disinfection unit present and as per design requirements?
a
❑ '_.
❑ D-Box accessible from finished grade? ❑ Trench/Bed width&length correct?
❑ Speed levelers used? ❑ Lateral/Trcech separation adequate?
❑ Grade of distribution pipe appears correct? ❑ Trench/Bed bottoms appear level and in contour?
❑ Lateral pipe diameter/class correct? ❑ Trench depth correct?
❑ Observation its as desi and anchored? ❑ Gravelless chambers present if aired on desi ?
fared manifold configuration used? leanout ports as per design and anchored?
Manifold length correct? ,Trench/Bed width&length correct?
ID/Yalve box for manifold accessible from surface? /Lateral/Trench separation adequate?
eral pipe diameter/class correct? renchesBed bottoms appear level and in contour?
Orifice spacing?diameter correct? Trench depth correct?
❑ Orifice shields present if required on design? ❑ Gravelless chambers present if required on design?
❑ mom" ,
/n addition to pressure checklist: ❑ 2' minimum from edge of gravel bed to side slope edge?
❑ Side slope 3:1 ❑ Monitoring ports to gravel/sand/soil interfaces present?
❑ Mound constructed perpendicular to slope&in contour?
❑ Is control panel a`Glendon' authorized panel? ❑ Stand pipes present and accessible from surface?
❑ Shape and layout as per design? ❑ If slope>5%is absorption area on downslope only?
❑ Square footage of sand areas correct? Do not walk on Glendon!
❑ SUB-SURFACE`DRIP:
t
Comments:
The undersigned has reviewed this installation and verifies these findings on behalf of Mason County Department of Health Services:
Sanitarian Signature: Date:
Page 2 of 2
AS-BUILT FORM RCViWdJW=y4,1999
...........
. ..........
-
Applicant D A z Fzi Assessor's
Parcel#
L 1 -YL/ Q S GOO 7�
Permit Number SWGA6� 00 f-7,�— (Twelve-Olgit Plumber)
Installer Subdivision (NamelOMsiontl llocklLot)
Designer 0 klN W T�
INSTALLER CHECKLISTNIA Yes PH Dr to Completion
I. SEPTICTANK 0
A) >5 ft.From foundation? . . . . . . . . . . ...... .. . . . . . . . . . . . . . .. . . . . .....
❑B) >50 ft from wells and surface water? ..... . . . . . . . . . .. . . . . . . . . . .... .. 0 0
C) Bldg stub-out to septic tank:clean-out if not 1-2%? . . . . . . . . . . . . . . . . . . . . 0 0
D) Baffles intact and clean? . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 0
E) Dividing wall intact?. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0
F) Risers installed for access? . . . . . . . . . . . . . . ❑ 0
G) Tank Size: it gal.;Manufacture L4-
11. D-BOX )C) 14e,4-
A) Leveled with water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .( El 0
B) Speed leveler used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
111. DRAINFIELD
A) >10 ft from foundation and>5 ft from property lines? . . . . . . . . . . . . . . . . . .
B) >100 ft from wells and surface water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C) >10 ft from potable water lines? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. ..
D) Laterals level to± I inch&end caps present if not looped? . . . . . . . . . . . . . .
E) Gravelless chambers utilized? . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..91-
F) System dimensions the same as shown on the design? . . . . . . . . . . . .. . . . . . . 0 0
G) Gravel clean,properly sized,and proper depth? . . . . . .. . . . . .. . . . . . . . . . .
H) PRESSURE SYSTEMS
1) Sand quality ASTM C-33? . . . . .. . . . . . . . . . . . . . . . . . . . . . 0�- ❑ 0
2) Head height uniform and �-24 inches? Actual head heighoW . . . . . 0 0
3) Clean-outs and observation ports present? . . . . . . . . . . . . . . . . . . . . . . . . 0 0
4) Mound: Side Slope 3:1? . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
5) Owner informed electrical connections must be made
by owner or licensed electrician and inspected by L&1? . . . . . . . . . . . . . .
IV. PUMP/PUMPER A R ❑
A) Screen betHr(e!Tb��ircne)iffin�smtalled?
!,u!ffl�'U_�en iter(cIeo ...�� ). 0
0 0
B) Riser installed for access. .. . .... ....... . ... . ... ............. . .. ...
C) Alarm installed? ....... .. * * *
D) Pump make Pump model5P V 0
E) Chamber a \c, rigal; F�A-c (,q S:t
--!:L�garmch; Chamber Manufacture I
F) Pump chamber draw-down —inches pert
er minute; Height of pump off bottom of pump chaa her inches
G) Pump controls:Timer(or)Elapsed TOMe�(crcli'e\lhlnstalled); If timer is used:Pump On__Pump Oft_
..........
"WLT. pwmfmi�� ,� :
CHECVLW
LI Drainfield&maaWiiild.— 6
orientation &layout f
Q Trench/bed dimensions -1FAN ifCO 2
-
and critical distances
within layout
L1 Septic/pump tank
placement. T 4-
0 Location of buildings.
El Observation port&clean-
out location. �J
Q Location of wells&
roads.
L3 Undisturbed native soil
between trenches.
Q North arrow
0 w,2,,Z-
CLAN OCJ5,
CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer arc nerally acceptable 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 Alain liner written 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
shcrivri above.
ATIONOF INSTALLATION
Installer Check a box from Row"A"and"B",sign and date the certification
A. I certify that I installed the system without any Ll I certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above.
MCDHS
B. certify that I contacted the designer and left the 0 1 did not contact the designer prior to final cover because the
system open for inspection up to 48 hrs prior to designer waived the notification requirement.
cover.
I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certification.
Signature of Installer ate
The undersigned approves this installation on behalf of Mason County De ent of Services.
(2,1-NJ
Sanitarian I Date