HomeMy WebLinkAboutSWG97-0078 - SWG Application / Design / As-Built - 2/27/1997 PERMIT NO. SWG m
MASON-COUNTY DEPARTMENT OF HEALTH SERVICES Q y'
n N
Date
426 W. CEDAR/P.C. BOX 1666 IfSHELTON, WA 98584 ' �
Receipt No. y
PHONE (360) 427-9670 Amount$ Z E
CHECK APPLICABLE ITEMS �/
V NEW SYSTEM
IMI N A S�: DAYTIME PHONEi t
REPAIR SYSTEM
ST ZIP: MAINTENANCE REVIEW
SINGLE FAMILY I m
P ERTY AD E OTHER Cb mer a
_ SPECIFY: f 3
E WELL m
CIFI DIRECTION F R OCAT IT PRIVAT
1^n��S COMMUNITY WELL/PUBLIC SYSTEM. ,I
SYSTEM WFI A f
SYSTEM NAME v
APP ANT
NAME l
Lot �la ft.x
S� ft. M ING A DRESS
Name of �.J
Installer �/tj�(/ �Uyv D Size: - 3 acres TE EPHONE < I�
Name of um er o S ci s SIGNAT c
Designer !A t^ Bedrooms X I h
PLOT PLAN
Draw a dimensional plot plan, 30
including:
cc 0 19
❑Precise location of test
holes,showing N
measured distances to = I O
property boundaries. s
fnb3 0
❑Entry road;other roads,
-
driveways. ( ('
NOTE: DO NOT DRAW IN
SYSTEM DESIGN 4��
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
S IL LOGS
'( P '' t9ddr �1
Gan4 w: raps; 3� - �0o"C1�5s �aars� s2n�
6-- �90rtbra > l07
Jew 1419pler
2 - J,06h 40
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Designer Level: ❑One �fiwo
Finding Score �9�5��'S =JyHsd
Soil Type
Septic Tank Daily
Soil Depth ii_n". 15 Capactty:c�d) # 0 Gal. Flow: !�f �4 GPD
Slope Appl• Infitt.
Parcel Size 0-o X Ac A Rate GPDI Area FT-
Distance to Shoreline/�ft � Total Inspector Date
1
COMMENTS/CONDITIONS FOR APPROVAL
r aw
•AD on-she se a systems must be desi a by a Maso C unTy Certed D igner or a Professional Engineer.
•All on-she sewage systems must be installed by a Mason County Cert'died Installer,unless prior approval is granted for a homeowner installation of a gravity system.
In such cases a preliminary on-site meeting between health department staff and the homeowner is required.
•Ori sewage system design approval does not imply other building she requirements(i.e.RLC,Water Adequacy)have been met.
•Any change from the specified use of the property or an she alteration affecting the system des'�xp�n m!j invalidate this permit.
•This permit expires 2 years from the date of she review.Denial of this permit may be appealed to Me Health Officer within 10 days of denial date.
SITE DES GN RE :,'Approved ❑Not Apr ad INSTALLAMGN�pproved ❑Not Approved
BY: LOW DATE: BY: DATE: 3 t BY: _ DATE:y.ay. )
TOP: Heal pt. Copy IDDLE: Designer's Copy BOTTOM: Applicant's Copy
DESIGN FORM - PAGE ONE
A design„will be reviewed when 3 copies of each of the followinq�4f�a 0 9�a a qubm d:
h 199 IBC( rr
Completed design form that has been signed and dated
scaled plot plan, including all applicable i c ist
scaled layout sketch, including all applicab b �CES
Cross-section sketch, including all applicable items on check 1st
PARCEL IDENTIFICATION 'n/
Permit _Number C r �� �� Designer's Name \`)� 1 , v�.�i,r/G+
�) pp {� " Gam/ �^ II
Applicant's Name � iin �7< �;or�S � Prop. Owner's Name r ! ' � ' .i
Mailing Address ,a< 9"1 -1 Mailing Address
f r
1 y�- a e 7 p / / city a!fie
Assessor's Parcel No. Z 1 23900��{ Subdivision •P S 1-
II a e- gi u e me -VL• 7B1aEk7La'Er— II
II DESIGN PARAMETERS
L
—i Designed
�� U U U Vertical
Separation
�I Mound subsurface Pressure Gravity Bed Trench I _711 in
Septic Tank/D
rainfieldec ications r---1 n ��
II No. BsdrecM ? 2 4 Pressure Distribution? U Yes 1--1 No
y y.......................
II Daily Flow (� U d :.. (If yes, proceed. . .) ........................II
........ ...... ..... ...........
....... ....... .....
septic Tank Capacal
Receiving Soil Ty /�Receiving Soil ApA � qpd/ft° Lpaap� 'Trench/Bed Bottom �(U 6 ft' chedule/Clp►yhTrench/Bed Length9 ft ''rLength Maso . / t ftTrench/Bed Lengthft{�Lfl�/ Diameterwoo
s" / in
Ele Lion Me eur ents Y Number X jr
original Drainfield Area Slope t Separation R ft r
II Drainfield Area Slope if Altered C) t Orifices
u otal Number of if ices
Depth of Bottom of Trench/Bed in Diameter �A/,qr' /{��,�� `' in
from original Grade p spacing , r S� �(o�� Ar
in I Manifold
II wns ope I Schedule/Class
71/ Length (fl ft
II Infiltrator Used? U Yes u No I Diameter / in
II r_1 Transport Pipe
II Pump Required? Yes U No /� Schedule/Class 2 O O
(If yes, proceed. . .) ........................::I Length 20o ft �(
Diameter I 7-t, in
II Pump/Siphon Specifications I Dosing and P Chamber
4' I,I/
II Difference in Elevation Between Pump Shutoff I -# Doses/Day ¶
II and Uppermost Orifice ft Dose Quantity rjlH 9� O sal ,'/
II �/ n I Chamber Capacityr exln ��(� 7 o o sal N"
II Uppermost orifice is u'y1i'gIher, U ow r I C�GI aa''a II
II than Pump Shutoff �jf 11R V$ I Check the following compoKents if they drain 0
II Capacity 0 Tot. Pres. Head ,0 apm I between doses: u
Calculated Tot. Pres. Head ft I r II
Q(Attach Pump Cu ry I U Laterals �--1 Manifold Transport II
,
ASIGN FORM - PAGE TWO R".,i""d 08/17/95
DESIGN CHECKLISTS II
Scaled Plot Plan Scaled La out Sketch Cross-Section Sketch II
u — Reference depth from orig-
II Teat hole locations I U Drainfield orientation I inal grade:
and layout II
P operty lines ,—,/ U Septic tank lid and
L-J/J Trench/bed dimensions and drainfield cover depth
Existing and proposed critical distances within
wells within 100 ft layout Reference depth from orig-
of property lines inal grade and restrictive
D-Box/"T"/"L" locations -strata:
Critical distance I-1 u
II
measurements to cuts, Septic tank/pump chamber Laterals, trench/bed
banks, surface water location top and bottom
Location and orientation ,. Observation port location ( eaACurtain drain collector
of curtain drain and all
absorption area Cleanout location E2 Sand augmentation
components r }
ry/Lo 4� Manifold placement No external reference needed:u
cation and dimension
of primary system and l rifice placement l� Observation ports and
I� reserve area �/ cleanouts
LL��JJ Lateral placement, with
Buildings i distances to edge of bed i Additional mound informationdl
it (Direction r�of slope I u.•.Audible/visual alarm O Upalope and downslope
' indicator I .referenced i fill widthEr 0
Waterlines +, Scale of drawing shown Settled cap depth at
on scale bar I center and edge of bed
I� Roads/easements/ I ��
u 1� driveways/parkin g> i Additional Mound Information: i Sidewall slope II
Critical resource lands 8K Endslope width Ip Up/downslope bed elevat.
(if applicable-)
Overall fill dimensions Completed Resource Lands and U
El/II North arrow and scale of I Critical Areas Checklist
drawing shown on bar I �'
P
DESIGN APPROVAL
II The undersigned designer U does, u does not, waive the reqirement to be notified by the
installer of the installatio nd given hour to perform a final inspection prior to
cover. 2S 7
II I n o s e �I
I� The undersigned has review d a appr v is d sign on behalf o M on County of Health
Services.
CAUTION: DESIGN APPROVAL I V ' ID ONEY UNDER THE FOLLOWING CONDITIONS:
�� , ✓ THE DESIGN IS S ED "APPROVED" BY MASON COUNTY DEPTARTMENT OF HEALTH SERVICES
✓ THE ON-SITE SEWA PERMIT HAS NOT EXPIREDt EXPIRATION OF SAID PERMIT IS BASED ON u
THE DATE OF INITIAL SITE INSPECTION, NOT ON THE DATE OF DESIGN APPROVAL
✓ THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS q
OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES
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, ORENCO SYSTEMS® �� � p��� CONTROL PANEL
ORENCO SYSTEMS®Simplex Control Panels offer fine quality
components for reliable automatic pump operation. Standard functions -----
include circuit breaker,manual,off and automatic motor control opera-
tion, plus an audio/visual high-water alarm circuit with audio silence and
automatic reset upon correction of the high-water condition. .
A selection of optional features offers flexibility for a variety of pump-
ing applications. k
ORENCO SYSTEMS®control panels are specifically engineered for j 0 f77
pressure sewer(STEP)systems,for controlling pumping into convention-
al gravity collection systems and for on-site systems such as intermittent
sand filters, recirculating gravel filters, low pressure drainfields,as well
as for simple uphill pumping to standard drainfieids.
ORENCO SYSTEMS®control panels are designed for use with mer-
cury float switches or any standard dry-contact switching method.STANDARD FEATURES, UL O
-Listing: -
Underwriters Laboratories, UL 508.
UL-Canada Listing available.
-Rating: �
Model S-1 rated at 115 VAC, 1 Hp, 16 A,Single Phase,60 Hz. 3
Model S-2 rated at 230 VAC,3 Hp, 16 A,Single Phase,60 Hz.
-Motor-Start Contactor:
Rated for 24 FLA,Single Phase,60 Hz.
-Current Limiting Circuit Breaker: .'.
20 amp,OFF/ON switch, DIN rail mounting with thermal magnetic tripping
characteristics. (Single Pole/115 V;Double Pole/220 VI - - -
-Toggle Switch:
A SPOT HOA switch with a 20 amp motor rating.
-Fuse Disconnect:
5 amp(10,000 AIC)fuse with DIN rail mount.
-Audible Alarm:
Panel mount with a minimum of 80 db sound pressure at 24 inches,warble tone sound.
-Visual Alarm:
NEMA 4-rated,7/8-inch diameter, red lens,oil-tight with push-to-silence feature.
-Audio-Alarm Silence Relay:
115 VAC,automatic reset,with DIN rail mount socket base.
-Alarm Circuit:
120 VAC,wired separately from the pump circuit,so that if the pump's internal overload switch or
current-limiting circuit breaker is tripped the alarm system remains functional.
-Enclosure:
NEMA 4X-rated,fiberglass with hinged cover. Noncorroding. Dimensions: 10" High X 8"Wide X 5-1/8' Deep.
External mounting ears. M
•Padlockable Latch: ason
Constructed of noncorroding stainless steel. �uafY �, �
AP
OPTIONAL FEATURES: fq/ �V
-Elapsed Time Meter: O
115 VAC, 7-digit,nonresettable-
-Counter:
115 VAC,6-digit,nonresettable, horizontal base mount.
-Programmable Timer:
5 amp, 110 VAC, DPDT relay output, repeatable cycle from 10 sec.to 10 hours with four time ranges.
Separate variable controls for ON and OFF time.
-intrinsically Safe Control Relay:
Intrinsically Safe Panels are UL 913 Listed. The secondary circuit limits the current to 2.3 mA at 11 VAC.
Other custom features can be provided.
ORENCO SYSTEMS, INC. 814 Airway Avenue Sutherlin, OR 97479 503/459-4449
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Submittal
Biotube('-' Screened Pump Vaults Data Sheet
For use with OSI 4" Submersible Effluent Pumps Deno systern;
Incorporated
General
614 AIRWAY AVENUE
Side Yew Cutaway View OSI Biotube Screened Vaults are
composed of a PVC cylindrical vault SUfNERLIN,OREGON
support } With a fiberglass base,a Biotube 920a-9012
pipe I float nem
trip screen cartridge and two support
pipes.Effluent enters through the
inlet hales around the perimeter of TELEPHONE:
the Biotube vauR and flows through
flow the Bictubes to the flow inducer.OSI ISsq 4594449
wtsa iodueer BioWbe Screened Vaults are cov-
ered by US patents 9443M and
5492635. FACSUAHE!
N
l (541)468-28M
i o Applications
eiotuao: OSI Biotube Screened Vaults are
iAtnL
m O
►olaa ~� I ! used to screen effluent being
pumped from septic tanks in STEP
b systems and on-site wastewater dis-
daiapat posalsystems.
aAsem6ly �I
Fib°'�'• Models
base
i a Model Code Nomenclature:
SVT1548-18FI, SVT1560.18FI,
SVT1560.24FI,SVT1560-241FIFI,
SVT1572.24FI,SVT1572-24FIFI
SVT XX XX -XX FI
Fiou aiam0o<crteepa
. Ai'tAf lint
Specifications naeasasr.u�Le,�r1m
laaiaus raoa n�mnar Inl
When pumping from a single compartment septic tank,the discharge rate should not exceed 30 gprrL 'Righer flow rates
require a watertight baffle or multiple tank arrangemem typically with an effluent filter in the primary tank
Maio
Materials of Caraft dorr
Vault PVC.
Bictube Cartridge: Nauual polypropylene.
Vaultsasol Injection moldedfibarglass.
Resin; UV stabilized polyester p0%oflsminatebyweight).
Fiberglass: Continuous stand glass mat W%of laminate by weight). -
Row Sum! Sch.40 PVC
Support Pipe: SO.80PVC
OrainportRapcheck Neoprena rubber
ESU-SYi/5067
Par.1.1,O !1A IA
pep.t of 2
co
Construction Note
For Pressure Distribution
1 . Install drainfield ditches with contour of ground. Keep ends
level .
2 . Keep 1/4 inch per foot fall from house to septic tank .
3 . Keep 1/8 inch to 1/4 inch per foot fall from tank to pump
chamber or drainfield .
4 . Observation ports to extend from service to drain rock and
original ground interface .
5 . Audio visual alarm required .
6 . Install 1/8 inch mesh screen around pump not interfering with
float operation .
7 . Always use T to T type construction.
8 . Install check valve in pump outlet line to prevent system
from draining back .
9 . Filter fabric required over drainrock. If drainrock extends
above natural grade , run filter fabric at least 2 inches down
the trench wall .
10 . Install threaded cleanouts at end of all laterals no deeper
than. 6 inches and mark .
11 . Divert all storm water and run off away from on-site sewage
system.
12 . Install drainfield during dry weather conditions . Avoid
smearing . Any smearing must be eliminated by hand raking .
13 . Inspect septic and pump chamber every 3-5 years . Pump septic
as needed .
14 . Inspect and clean pgmp screen every 6-12 months . Inspect
floats and alarm every 6- 12 months .
15 . Install septic tank and pump chambers lids within 12 inches
of finished grades or install risers to surface .
16 . Deviation from this design without prior approval from the
Designer and Mason County Health Department will make this
design null and void.
17 . Sund and Son ' s will not be liable for septic system if
the design is installed by some other contractor .
ON—SITE SEWAGE INSTALLATION
FINAL INSPECTION
....................................... ..............................
boa ....................., .. ..............
.... ............ .. .. .....
DATE CALLED IN: 1111
TIME:
��Z3 •ill.
INSTALLER: ��- JLJ✓ l�
APPLICANT/OWNER: 1 l/1�'�ln n
p C�
PHONE # OF rnTa(m�z CODE;,: C�
.PARCEL NUMBER: 3��✓ 1 3 l lW��
SUBDIVISION-
DMSION: LOT:
••"...«::«««••«::••.......«.««.....«.......«.....«....«..«........«...«..........«..............«....................«.....««..« «..«•:::
ITSTEM TYPE (CHECK ONE) :
-^PRESSUR8- - GRAVITY
;MPECTION SCHEDULE (CHECK ONE) :
API?O. 2 ffi� PLUG IN
ti-BUILT ON-SITS? (CHECK ONE) : Q
YES NO
fie:»««...»:«:«8e33e333e»«i �e....................... —_'s3e i :?�(://eii�3e: 9„\/:��•• «:. ......::8:9:::«'ie:::.° :::'.: i :r »:. .�= 3w:
STAFF INITIALS! ` y
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ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
BYAFr CffgCR.xSY
I I
CONFIaHED BY INSPECTOR? I
I. Snnc TAM Yee No Coamaentm
A) >5 ft from foundation? 7 _ I
a) Bldg stubout to septic tank: cleanout if not 1-2x?
c) Baffles intact and clean? 7 — 5,'AU. dA c,^_
D) Dividing wall intact? — )c I,
xx. D-aox Leveled with water or speed leveler (circle one)?
III. DRxnna= I
A) >10 ft from foundation and >5 ft from property Lines? X — I
a) Laterals level to tt inch i and ups present if not looped?
c) system dimensions the same as shown on the design? x — I
D) gravel clean, properly sized, and proper depth? k —
I a) PRESSURE SYSTSK II
I) sand quality ASTX C-33? x - I
x) Read height uniform and t24 inches? laie" I
I) Clemvxrts and observation ports present? Y I
a) Hound: side slope 3:17 — _ I 0 I
s) owner informed electrical convections must be made
I by owner or licensed electrician and inspected by DL17
I 1
I xv. P07=4 "Alas axxxs I
A) >tOft from drainfield, transport line, and septic tank?
a) Veils >100ft from drafnffeldi _ — iVSlniwt.e._
- 1
I v. ram8 I
Severn basket effluent fitter (circle one) installed?
I a) Riser installed for.access? _ I
C) Alarm installed? _
vx. As a=? RROUn m? I
I - - I
vxx. axffie woman; l I I I
I I
I I
I I
I I
I I
I
The undersigned has reviewed this installation and verifies these findings on behalf of Mason Canty of Health Services. i
I • I
°i�
ResitH Inspector Date I
m
h:caiiin.w
Revised 02/01/95
r
,AS-BUILT FORM - PAGE ONE zevised 12/14/94
Irr �
PARCEL IDENTIFICATION �I
II Applicant's Name
II Permit Number SWG9 - 07r' Subdivision )
--kName ivision ocT/'�QLl—
II Installer's Name Assessor's Parcel No. ��33/2 � 9Dv2
II Designer's Name
II j' INSTALLER CHECKLIST II
'I
N/A Yes Prior to II
I. SEPTIC TANK Completion II A) >5 ft from foundation? IZ
_
B) Bldg stubout to septic tank: cleanout if not 1-2%?
C) Baffles intact and clean? L II
D) Dividing wall intact? —Z _ II
II II. D-BOX Leveled with water and/or speed leveler (circle) ? _e_-, I
III. DRAINFIELD
A) >10 ft from foundation and >5 ft from property lines? II
B) Laterals level to ±1 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?
E) PRESSURE SYSTEM
1) Sand quality ASTM C-33?
2) Head height uniform and x24 inches?3) Cleanouts and observation ports present?
II 4) Mound: Side slope 3:1? II
5) Owner informed electrical connections must be made by II
owner or licensed electrician and inspected by DLI? / II
II IV. POTABLE WATER LINES
A) >10ft from drainfield? II
B) Wells >100ft from drainfield?
V. PUMP/PUMP CHAMBER
II A) Designed pump used, attached for equivalent pump? II
B) Screen basket or luent filte (circle one) installed? _
C) Riser installed for access. II
II D) Alarm installed? �I
I�
CERTIFICATION OF INSTALLATION II
II Installer: Check box from Row -A, - check box from Row eB,e sign and date the certification. II
II r i II
II A. U I certify that I installed the system U I certify that all deviations from II
II without any deviation from the design the design stamped -APPROVED- byMCDHS are II
stamped "APPROVED" by MCDHS. shown on the reverse side of this form.
II r, r, II
B. u I certify that I contacted the U I did not contact the designer prior II
II designer and left the system open for to final cover because the designer II
II inspection up to 46 hrs prior to cover. waived the notificat��i''oW requirement. II
I further certify that all information contained on this form is acA rate. I understand II
(I that if the information contained herein is n accurate, theme will be just cause for II
II immediate suspension of my instal,13r certif' do
II zgn a s a e e
II The undersigned approves this installation of behalf of Mason County Department of Health II
II Services. 1J �
�I
AS-BUILT FORM - PAGE TWO fl vi.ed 12/14/94
PARCEL IDENTIFICATION
II Applicant's Name ✓1
II Permit Number SWG9 / - VC)-] if Subdivision
II a e/ U>.vl.s>.on/Slock/Lof7— II
II Installer's Name _ U� Assessor's Parcel No. .3Z.33/z3 On,Z
IDesigner's Name -" 7Iw ve- z.g.lL vumDer) II
i
I( AS-BIIILT DRAWING II
I
I
dl
I
_ 4 I
II ;9' I
" � I
war II
tl II
II � II
II
II � II
/ IIII
I� II
CAUTION: Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generally ac-
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. Any deviations from the approved design must be shown above.
II AS-BIIILT CHECKLIST II
II I'1 f-'l
II I__I Drainfield orientation LJ Observation port location U Undisturbed native soil
II and layout n between trenches II
II u u Cleanout location
II Trench/bed dimensions and n u North arrow II
critical distances within u Manifold placement r 7 II
II layout r-7 U Scale of drawing shown II
II n U Orifice placement on scale bar II
II U D-Box/"T"/"L" location n
II 11 LJ Lateral placement, with Additional Mound Information II
Septic tank/pump chamber distances to edge of bed 11 II
II location n u Endslope width II
uU Location of wells, roads
Location of buildings U Overall fill dimensions l
,