HomeMy WebLinkAboutSWG96-0233 - SWG Application / Design / As-Built - 4/8/1996 MASON COUNTY DIEPARTMENT OF7HEALTHRVICES PERMIT NO. SWG 95- oy
m426 W. CEDAR/P.O. BOX 1666/SH98584 Date yPHONE (360) 427-9 Amo pt No.
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PHOPERTY OM DATE: 3 `D
I A S W S�,ut 3— 1 •q CHECK APPLIC77v
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MAILING D.F{E A n. 'v .;�o 0 DAYTIME 2.PH( 1 NEW SYSTEM IP �p REPA R SYSTEM 2.
CITY: � ` SATE:
MAINTENANCE REVIEW °
q SINGLE FAMILY R
PROPERYA �OS. �AIYIS� ly r� t1 SPECOTHEIFY: z
SPECIFIC DIRECTIONS F R LOCATING SITE: y p PRIVATE WELL
W J Lr� ftAAft 4 IYJ �J COMMUNITY WELL/PUBLIC SYSTEM
SYSTEM WFI#
(AAA e Do 'R} SYSTEM NAME I�
APPL ANT
NAM
Name of Lot ft.x a�� ff. MAILING ADDRESS I , .� W
Installer
L Size: acres TEL 0 ` o
Name of Ln
Designer 1 Number of Bedrooms SIG T R j '
PLOT PLAN � e I—f
Draw a dimensional plot plan,
including: tip LU
� b❑Precise locatlp est � �
holes, showi
measured d Oces tQp
property bo s. rn
rr
�W
❑Entry road; dtt�Yoadeo 0
driveways. Vulp
NOTE: OS�SY EI ESIB
] ILL
FFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS
d-ZF SiQNQrLoA,c,- ---
z7-- w4*V- O- -?a 0?(Mvyloaw c - 3f �i�OXdo w
3$— &JG4 6x,, 3s= wC,E1,
Depth fron, Original
Grade to Restrictive
Layer or Water Table: 2 In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One (�vo
Soil Type 2 v
Vertical Separation n. S Septic Tank Daily �1 3
Capacity: w� Gal. Flow: G� GPD
Slope d % Appl Infilt. /
Parcel Size Ac. �1 Rate ' f- GPD/FT2 Area FT'
Distance to Shoreline -�Q It �— Total I Inspector �{ S7 Date 3
COMMENTS/CON IONS FOR APPROVAL
•All septic systems must be designed and installed by contractors certified by Mason County Department of Health Service , unless prior approval is
granted by the department,or the design is by a professional engineer.
•Septic permit approval does not imply other building site requirements (i.e. RLC,Water Adequacy)have been met.
•Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.
This Permit expires 2 years from date of site inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE REVIE DESIGN REVIEW:V Approved -j Not Approved I INSTALLATIO.44KApp,oved O Not Approved
BY: DATE: } Y: ( ' DATE:Y/e 5E BY DATE:y 3u v
TOP: Health Dept. Copy IKIDDLE: Designer's Copy BOTTOM: Ap 1cant's Copy
DESIGN FORM - PAGE-ONE �� 5 - k'A
A design will be reviewed when 3 covies`of- each of the Following items are submitted*
• Completed:�design form-:.that has been signed and dated
- Completed Resource Lands and Critical Areas Checklist attached
- Scaled plot plan, including all applicable items on Checklist
Scaled layout sketch, including all applicable items on checklist
- Cross-section sketch, including all applicable items on checklist
PARCEL IDENTIFICATION I
I
�I Permit Number
Designer's Name
II CC
II Applicant's Name �i��'FM ,�1{$ tTZ. Prop. Owner's Name
II Mailing Address '-ISO d�T iS Mailing Address S II
II II
�I 1yc oA ae ip� iy ae 1 II
11 Assessor's Parcel No. , a13�1-��- 0013D Su}+�i II II ,al, DESIGN PARAMETERS
II ✓ ✓ 'FAj TH ti=-RVICEF ✓ II
Designed II
II �� u Vertical II
j U k Separation II
�I Mound Subsurface Pressure Gravity Bed Trench 24 in II
11 Septic Tank/Drainfield Specifications I I1 11
II
11 No. Bedrooms I Pressure Distribution? Wt es No
IIDaily Flow and (if yes, Proceed. . ) ......................::II
..................
..................
......................
I••
II Septic Tank Capacity lalb cal I II
II Receiving Soil Type (1-6) it I II
II Receiving Soil Appl. Rate .(A and/ft' I Laterals
11 Trench/Bed Bottom Area 1000 ft2 I chedu Class HeaVthSerulces II
II Trench/Bed Width ft I Lent n County Dept.
Trench/Bed Length �(7a ft I PROVED / ��/ in II
DiametAp
II Elevation Measurements I Number Initials �
II Original Drainfield Area Slope O 1 I Separation /O ft II
11 Drainfield Area Slope if Altered Date _des II
II Total Number of Orifices 3 II
11 Depth of Bottom of Trench Bed in I Diameter 3/ in II
from Original Grade ps ope I Spacing L' II
\ in I Manifold II
owns ope
Schedule Class LID
}yy n I Leng ft II
Infiltrator Used? 6CJ Yes U No Diameter Z in77 II
11 Transport Pipe II
�I Pump Required? 19 Yes u No Schedul /Class 0 II
(If yes, proceed. . .) ::::....................:: I Leng �iC ft I.
... .... I Diameter in 11
Pump/Siphon Specifications I Dosing and Pump Chamber �I
Difference in Elevation Between Pump Shutoff I # Doses/Day
and Uppermost Orifice n ft I Dose Quantity al
Chamber Capacity _Ion cal
�I Uppermost Orifice is higher, u lower I
II than Pump Shutoff I Check the following components if they drain
11 Capacity 0 Tot. Pres. Head .3.1 cnm I between doses:
Calculated Tot. Pres. Head ID.47 ft I n
I� (Attach Pump Curve) I Laterals Manifold L.J Transport
DESIGN FORM - PAGE TWO A ..d 07/20/95
DESIGN CHECKLISTS II
I
Scaled Plot Plan IScaled Layout Sketch I Cross-Section ketch II
! Reference deptli from Orig- (!
Test hole locations I U Drainfield orientation I final grade: II
and layout I !I
.J Property lines ! ! IJ Septic to lid and !I
LJ Trench/bed dimensions and I drainfield cover depth I!
� J Existing and proposed ! critical distances within I II
wells within 100 ft I layout ! Reference deptl from orig- II
of property lines I � I inal grade and restrictive II
D-Box/"T"/"L" locations I strata: !!
Critical distance I �cilT,+•+g
measurements to cuts, ! LV Septic tank/pump chamber I U Laterals, trench/bed !I
II banks, surface water I location I top and bottom II
I! ram '
Location and orientationu t location Curtain drain collectorObservation por II
of curtain drain and all i Cleanout location I � II
II absorption area tJ Sand augmentation
!I components i Manifold placement I o external reference needed: ll
II Location and dimension ! I II
!I of primary system awA orifice placement I u observationports and II
cleanouts II
!I ¢ � � A,R ! LJ Lateral placement, with I II
II Buildings I distances to edge of bed i Additional mound information:Il
11
LI Direction of slope I Audible/visual alarm ! Upslope and downslope II
indicator I referenced I fill width II
III 11
Waterlines I � Scale of drawing shown I Settled cap depth at II
! on scale bar I center and edge of bed II
II1u Roads/easements/ I !
II 11
driveways/parking I Additional Mound Information: I Sidewall s ope !I
I '''ram
II Critical resource lands I Endslope .width ! Up/downslo a bed elevat.
II (if applicable) ! I II
Ove f.i"1WS9_ STbns I Co leted Res o ce Lands and II
II North arrow and scale of IMason Coun�`� � I
I! drawing shown on bar I pVED Critical Areas Checklist
I II
— Initials--�
II DPI APPROVAL II
II - r-I II
!I The undersigned designer U does, does not, waive the reqirement to be notified by the !I
II installer of the instal tRna
&and giv 48 hours to perform a final inspecti n prior tocover. q/igne �U -
I! !I
II The undersigned has reviewed and app v�.d this design on behalf of Mason Co ty of Health Is
I! services. t l .0
II e of Mrs
II CAUTION: DESIGN APPROVAL IS 21D ONLY UNDER THE FOLLOWING CONDITIONS:
✓ THE DESIGN IS STAMPED "APPROVED" BY MASON COUNTY DEPTARTMENT OF HEALTH SERVICES
✓ THE ON-SITE SEWAGE PERMIT HAS NOT EXPIRED; EXPIRATION OF SAID PE IT IS BASED ON
THE DATE OF INITIAL SITE INSPECTION, NOT ON THE DATE OF DESIGN APPROVAL
II ✓ THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS
II OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES
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Mason County Dept. Health Services
A,ppROVED
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Initlals--��
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valves i� t,)ttjj
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Start H,,ics /a" Erz ri �rw�xl It oN �1�.'�V' l—,afi.c�ai.
StAat Hs(rs %`/' r2or� ?Rum 1, Js
OePO�t�ecv�ces
W,11 ,a hA S w-st, Mason CoontY LLD
ool?o APP
Initials��
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ICI III�IIIII IIII II I�IIIII IIIII�IIIII� .
NATIVE 12"-18"
BACKFILL
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INFILTRATOR UNIT
Mason County Ppl DePOVEi�eCes
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Initials-�—
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SKHD150 SP40 SP50
MAX. SOLIDS 3/4"SPHERE MAX.SOLIDS1-1/4"SPHERE MAX.SO DS1-1/2"SPHE:F
1-1/2 HP 4/10 HP 1/2 HP
3450 RPM 1750 RPM 1750 RPM
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• Dual shaft seals standard. Seal • Available in automatic and manual • Available i i automatic and manu:
failure sensor capability available • Oil-filled ball bearing motor • Oil-filled, t eavy-duty ball bearing
(to be wired to an alarm device) incorporates automatic reset motor
• 1-1/2 HP, oil-filled motor thermal overload • Enclosed,I wo-vane cast iron
• Rugged cast iron construction • Non-clog,two-vane thermoplastic sewage-ty a impeller
• 1-1/2"NPT discharge sewage-type impeller • Automatics feature oil-isolated
• Spring loaded mechanical seal • Automatics feature reliable level contr I diaphragm switch in
with carbon and ceramic faces diaphragm switch with piggyback cast iron h using
• Non-clogging semi-open plug-in • Rugged ca t iron construction
thermoplastic impeller • 2" NPT discharge • Mechanic I shaft seal with carboi
• Pump-out vanes on rear shroud of • Rugged cast iron construction and care c faces
impeller • Stainless steel shaft • 2"NPT dis harge(3"flange
• For high head septic tank effluent • Completely field serviceable optional)
applications • Residential sewage ejector or high • Completely field serviceable
• 1-1/2 HP, 10 230V and 30 20OV, capacity sump pump • All bronze i nodel(SP50AB1)in
230V,460V or 575V • 4/10 HP, 10 115V or 230V automatic, 10 115V
• 1/2 HP, 1 o 115V, 20OV, 230V anc
30 20OV, 23OV, 460V or 575V
160 32 32
61201-- _- 024
¢ -_.__ _- .- 624
216
216
mt
40
a 8 f 8
0 10 20 30 40 50 60 00 20 40 0 60 80 100 120 0 32 4 96 128 160
CAPACfTy-U.S.G.P.M. ACITV-U.S.G.P.M. PACITY-U.S.G.P.M.
ii`.{ ZIIICL.,l.--111d,ItLT1;'',.1e1t�
Pressure istribution Systems
1 , Install laterals with contour of the ground -
2 Install trench bottoms level and at all times a minim", ofsiX
inches into the native sail .
3 . Install Locator tape on top of all drainfield laterals .
A Install observation ports as indicates on tl:e plot Tait
(minimum - two per drainf ield with bottom extending to the
drainrock \ native soil interface) .
5 . Install drainfield during dry 1 eather ar.ci soil conditions , any
soil smearing must be eliminated by hand raking ,
6 . Install threaded clean-outs at the ends of all laterals
(Ca must to within 6 inches of finished ;trade and he
7 . Install audio/visual high water alarm,
6 . Install 1/8 inch mesh non-co rrps1ve ru ms, screen (min , l2
5uYt . surface area , not to interfere with contro Is or
OAK) ,
9 . Install' check valve in pump outlet Iine t,? rrevent system from
draining back into the pump chamber .
10 , Tee to Tee construction between laterals and manifold with
orifices oriented at 6 o ' clock . Install laterals tn the
manifold with the orifices at 12 o ' clock. (do not glue) , After
a clock) andtglueillateralspto manifold: turn orifices down (6
it . filter fabric required over drain rock prior to backfilling ,
fabric drain
7east ? cinches above
ethettirencn wall run the fitter
12 . Divert al ! storm water run-off awa:: fro;n on-site se,wago
system .
13 , No curtain drains allowed within LO ft . of the up-sloPf edge
of the drainfield and reserve area .
la . ?io curtain drains allowed within 30 A . of the down-slope edge
of the drainfield and reserve area ,
15 , Have the septic tank and puma chamber pumped or inspected
even three to five years ,
16 inspect and clean Pump screen every (i - t2 months as it . eded ,
Inspect floats and test high water alarm, every h - i2 nonths
as needed .
IS . all materials and workmanship M st :legit Count; and State
regulations .
19 . Install seotic tank so list 1n5JBCtiU75 lids
are within 12 incites oC finish grace . it tank rocs are set
deeper then t2 inches frum finish grade - i• Lsers w 11
required .
20 . Deviation om '. nis del Qn _ r v : l . 'iIA:S ,
iNsigner anti .+lasoii rOUi1t;! 1ea . tii JnC3C "'L .
design null and roid , t
a�
L
ON-SITE SEWAGE INSTALLATION
l
FINAL INSPECTION
.......................................................................... ..... .
DATE CALLED IN:
TIME: / ' D ✓
INSTALLER: ✓
APPLICANT/OWNER: / l ! r(�.t�(21.t/�, Sw 4(,
PHONE # OFCALLER:
PARCEL NUMBER:
SUBDIVISION:
DIVISION: LOT.
SYSTEM TYPE (CHECK ONE) :
._..PRES - - GRAVITY ._.- ,.
INSPECTION SCHEDULE (CHECK ONE) : r�
u
APPOINTMENT PLUG IN
AS-BUILT ON-SITE? (CHECK ONE) : r_l
U
YE NO
..
................................................................. ....
: ............::::::............ . ..................................................................................................
......................................... •• ......�... .. ...............
STAFF INITIALS: 1
h:callin.0
Revis r
02/01/95
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
I STA" C c XST I
I
I CONPZ� BY 1NSPSC3'OA] I
I I
I I. sxVr1c ru Yes K.
oc C®eaG 1
&I >5 ft from foundation? —
E) Bldg stubout to septic tank: clean t if not 1-2%? —
I c) Baffles intact and clean? — I
D) Dividing wall intact? —
zx. D-a= Leveled with water or speed leveler (circle one)? — —
1 111. DRAnUU=
I u >70 ft from foundation and >5 ft from property lines? =
I a) Laterals level to :1 inch i end caps present if not looped?
c) system dimensions the same as shown on the design?
I D) Gravel clean, properly sized, and proper depth? I
I a) PRSSSGRS SYSrRa
1) Sand quality ASTN C-337 — —
I z) Read height uniform and 14 inches? = I
1) Cleanouts and observation ports present? I
s) Round: Side slope 3:1?
I s) Owner informed electrical connections Oust be made I
I by owner or licensed electrician and inspected by DLI7 — —
i I
1 rv. Poraana auZR ta1Rs I
1 jL) >10ft from drainfield, transport Line, and septic tank?
I a) Wells >1100ft from drainfield? — I
V. P TA= ..
I jo screen basket or effluent filter (circle one) installed? — I
I a) Riser installed for access? — I
c) Atarm installed? —
I I
I vi. ns eaur RRgvavm? — I
I I
W1. 0r cM0=s 1
I I
I I
I I
I I
I I
I I
i
The unders Igned has reviewed this installation and verifies these findings on behalf of Masai County of Health Services.
YG
I ath Inspector i f Date I
I
h:callin.w
Revised 02/01/95
AS-BUILD' FORM - PAGE ONE Revie 12/14/94
II PARCEL IDENTIFICATION
II Applicant's Name W11110yA
II Permit Number SWG9 - Subdivision ame lvision oc II
..Installer's Name 1 Assessor's Parcel No. 0 II
II Designer's Name a II
II INSTALLER CHECKLIST II
N/A Yes Prior to
I. SEPTIC TANK Completion II
�I A) >5 ft from foundation? II
II B) Bldg stubout to septic tank: cleanout if not 1-2t? II
II C) Baffles intact and clean? II
II D) Dividing wall intact? II
II 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
II B) Laterals level to ±1 inch & end caps present if not looped?
II C) System dimensions the same as shown on the design?
II D) Gravel clean, properly sized, and proper depth? g II
E) PRESSURE SYSTEM II 1) Sand quality ASTM C-33?
II 2) Bead height uniform and a24 inches? �4 II
II 3) Cleanouts and observation ports present?
II 4) Mound: Side slope 3:1? II
5) owner informed electrical connections must be made by u
II owner or licensed electrician and inspected by DLI? II
II IV. POTABLE WATER LINES
II A) >loft from draiafield? II
B) Wells >100ft from draiafield? II
V. PUMP/PUMP CHAMBER II
(I A) Designed pump used, or specs attached for equivalent pump? u B) Screen basket or effluent filter (circle one) installed? _
C) Riser installed for access? II
D) Alarm installed? II
h CBRT371CATION OF INSTALLA=CN _... a
II Install Check box from Rrnr -A.- check box from Row •B,e sign and date the c fication.
g A. I certify that I installed the system U I certify that all deviations Ercm
II without any deviation from the design the design stamped uAPPROVEI;0 ory MODES are II
II stamped -APPROVED* by MCDHS. shown on the reverse side of tais form.
II H. I certify that I contacted the I did not contact the designer prior
II designer and left the system open for to final cover because the designer II
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 con ed:herein' is not accurate,' there will be just: e 'for. II
II immediate suspension of my ler ification.
II /�
IIsignature or Installer Date
II The undersigned approves t is ins a ation of behalf of Mason County Department of Health II
II Services. 3� L1
En nspe r !rjace ��
AS-BUILT FORM - PAGE TWO Ra ..d 12/14/94
PARCEL IDENTIFICATION
Applicant's Name
Permit Number SWG9 - Subdivision
ame ivislon ocx o
�) Installer's Name Assessor's Parcel No. we ve- lgl u e
Designer's Name
II AS-BIIILT DRAWING
IL
II II
�I I�
u
n u
K Ii
CW=CW. rtlnot adj,vta®ta to septte tank location mad drainfield orientation made is the field by the Jim=Idt are gendrelly ao- .
eepeable to both the depsrenent and the dealgur, but could in certain oaaas mopromlae the viability of syato. IC ie the
Installer-s respmcibility to obtain prior written approval fzv either the health depuTmmt or the deffIgn w before making any
deviation from the design that affect cyst® viability. Any devlatiom from the approved design mast be &W= Above.
II - AS-BUILT CBBCX=ST II
Drainfield orientation U Observation port location u Undisturbed native soil
II and layout n between trenches
II I1 u Cleanout location n I�
Trench/bed dimensions and n " North arrowII
critical distances within U Manifold placement rl I�
I� layout u u Scale of awing shown II
II uOrifice placement on scale II
D-BOX/aT"/aLe location
U Lateral placement, with Additional mound Information I�
II U Septic tank/pump chamber distances to edge of bed U ffidslo width II
I� location i--i
n U Location of wells, roads n I�
u Location of buildings u overall fill dimensions �I