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HomeMy WebLinkAboutSWG93-1685 - SWG Application / Design / As-Built - 12/28/1993 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG _ y 426 W. CEDAR/P.O. BOX 1666/SHELTON,WA 98584 Date J `, 0 Receipt No. PHONE (206)427-9670 Amount$ z r C r � _C�3 CHECK APPLICABLE ITEMS MAILING ADDRESS: DAYTIME PHON INSTALLING NEW SYSTEM c S h f- _S 73 a ,y REPAIRING OLD SYSTEM CITY: TATE: ZIP: EXPANDING SYSTEM m ,Slwdior y SINGLE FAMILY 8 PROPERTY ADDRESS: OTHERSPECIFY: 3 ��a SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m proc�L(y�f� "b zf"sen — fotr) r i — Lo�s Qr2 gU055 PUBLIC SYSTEM 11 SYSTEM ID NUMBER (N s+re,e,+ to cS tpr ttr Sr h SYSTEM NAME APPLICANT NAME w Name of Lot ��y ft. x ?fly ft. MAILING ADDRESS / n S Sl`/ Installer q { Size: ! . 3 acres TELEP NE 7- 196 Z Name of Number or SIG U o IN Designer Bedrooms -3 X PLOT PLAN 1 97,` O I IN Draw a dimen t plan, N including: LU U I_Q ❑Precise locajR test v holes,show! M > [� Id measured dies 1 T propertybouces. oo My An A*Laf� r I© ❑Entry road:otmroagsd C/) S tr N;II be- AWK¢o driveways. _ T W;f4 5, a &f �1 ;a v 1 NOTE: DO N RAWJN C> Zy r SAY SYST ESIGN C)WIVAk1A* OFFICIAT USE ONLY. DO NOt RITE RELnV1DQHj3LFx } III TZ SOIL LOGS -� N3 11 C t 1 5 ©-�Sft- (-D�41M S✓��� q 0-�� W Ajtr 19- y �/ lS � ��-33 coo � spa I V Depth from Original Grade to Restrictive Layer or Water Table: In DESIGNER DESIGNATION SCORES MINIMUM SYST EOUIREMENTS Finding Score Designer Level: ❑One wo Soil Type +y� Separation ) in. � Capacity: Tank Daily Vertical Se P � Capacity: Gal. Flow:-3 630 GPD Slope L 5-% (� Parcel Size I Ac. Rat l e C7 GPD/FT' Area L(,SO FT- Distance to Shoreline n. Total In actor Date y COMMENTS/CONDITIONS FOR APPROVAL ( I- (n�1hv� JET Nun S-Vto) �d l� t/j,4'�f � . & (MLQS - fW� 5o�A-S. 4S' iwivvll¢d OJ TIA "3 �7fl siA, kW lvnk v� ws — - Of 2-3" I,i,A,\ Pn are. No rel�c�o, AnY change from the specified use of the property or any site alteration affecting the system deal may invalidate this permit. This Permtt expires 3 years from date of she inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. SITE: n Required O Not Approved I DESIGN: Approved ❑Not Approved JINSTALLATIONU Approved ❑Not Approved BY: � DATE:I BY:il.� 1 -- DATE:2_jg-qy BY: �� DATE:(,.t4,p1,1 TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy DESIGN FORM - PAGE ONE a iced 17?28/93 A design will be reviewed when 3 copies of each of the foll q,sy�mitted: • Completed design form that has been signededy �� �y� , • Completed Resource Lands and Critical Are ecklist .att� 1 • Scaled plot plan, including all applicabl i4E is� • Scaled layout sketch, including all applicable items onchec ist • Cross-section sketch, including all applidp'kW EA s checklist PARCEL IDENTIFICATION Fnd ctu»e �icLirb�cY x ZQ20 12- SI[9� 93— /lo�S� A L.LLmk Permit Number Designer's Name p/,/p)12w L ,A M02 Applicant's Name T Prop. Owner's Name Mailing Address 7 S 9 Mailing Address 21 L ZDA C].ty $CaCa Zip / C/lty 1 /State 21p Assessor's Parcel No. Subdivision .S7ShC- 17_P .�>< (Tvalva—pigl� Number) (Nam e,vice DESIGN PARAMETERS initials_7� J J J J Date —01 Designed vertical Separation Mound Subsurface Pressure Gravity Bed Trench /Z in Septic Tank/Drainfield Specifications No. Bedrooms Pressure Distribution? Yes No Daily Flow SOD and :i::::i:::::::::i::::::::..................: Cif yes, Proceed. . . ............. Septic Tank Capacity /Z Dn gal Receiving Soil Type (1-6) S Receiving Soil Appl. Rate gpd/ftz Laterals Trench/Bed Bottom Area ftz Schedule/Class 20 D Trench/Bed Width ,� ft Length 37 ft Diameter in Elevation Measurements Number y Orig. Drainfield Area Slope % Separation min ft Final Drainfield Area Slope / % orifices Depth of Bottom of Trench/Bed Total Number of Orifices 7La from Original Grade 2 in Diameter _3///o in "pe"pa Spacing 2-4 Z in Manifold �ovraa lope Schedule/Class 2DD Length Z9 ft Pump Required? Yes El No Diameter 2 in ...................... (If yes, proceed. . . ) .......................... Transport Pipe Schedule/Class ;76/? Pump/Siphon Specifications Length -Jja ft Difference in Elevation Between_ Pump Shutoff Diameter Z in and Uppermost Orifice 9 ft Dosing and Pump Chamber �,�'}� # Doses/Day Z Uppermost Orifice is E--'higher, lower Dose Quantity /84n, gal than Pump Shutoff Chamber Capacity 3o o gal Capacity @ Tot. Pres. Head 4s gpm Calculated Tot. Pres. Head ft . (Attach Pump Curve) DESIGN FORM - PAGE TWO naa,.d 12/28/93 DESIGN CHECKLISTS rscaledPlotlan Scaled Layout Sketch Cross-Section Sketch Reference depth from orig-locations Drainfield orientation inal grade: 21' and layoutlines Septic tank lid and 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 LJ D-Box/"T"/"L" locations strata: Critical distance �y� measurements to cuts, Septic tank/pump chamber Laterals, trench/bed banks, surface water —�(/location top and bottom Location and orientation u Observation port location Curtain drain collector of curtain drain and all absorption area R�Cleanout location Sand augmentation components Manifold placement No external reference needed: Location and dimension of primary system and Orifice placement Observation ports and reserve area cleanouts Lateral placement, with EJ Buildings �-7�distances to edge of bed Additional mound information: Direction of slope l Audible/visual alarm El Upslope and downslope indicator referenced fill width waterlines 1;T Scale of drawing shown ❑ Settled cap depth at on scale bar center and edge of bed Roads/easements/ driveways/parking Additional Mound Information: Sidewall slope Critical resource lands El Endslope width Up/downslope bed elevat. if applicable) ❑ Overall fill dimensions Completed Resource Lands and North arrow and scale of critical Areas Checklist drawing shown on bar WdL ,l 7,a,,_, .✓A� DESIGN APPROVAL initials The undersigned designer ❑does, does not, waive the reqirement to be notified by the installer of the installation and given 48 hours to perform a final inspection prior to cover. //-- The undersigned has reviewed and approved this design on behalf of Mason County of Health Services. X®s1 Gl� n------- Ds CAUTION: THIS DESIGN IS ONLY VALID IF STAMPED "APPROVED" BY MASON CO. DEPT. OF HEALTH I � ys' Arcs _ U S ti N P v 14 � I�p ysb f� F Y yt Lop IVd r'yD]e0 M -c aZSy -tom a o c� QoLSC- RoM f r.on re L-ot 5��7 4��k1 Jf- 77-7Z. 32132 - 3-2 — cDO -lq F Vj - 2 - — - - m� �g L � W % j 0 O 2 O -I- oo } O 2 � � � W z= z c V cod Cam- v`� o _ Cl) N N I+ S to (\9 W O o� N n-�Ol C � i U Z u < IY � � LY v \ \1 m o UFnLL0wZ N ° a oZW �WZ :S Lto) J u LTI W L.L = Qz LU U tL o R ) II -- - __ .� •- H al p ib p 1 E 3s 4 � 5 � L C Z7Z ez I w W S j x C I o K 6 J 2 �' 1 N 7t L EMik z w '�d- � 3 FINAL INSPECTION - SEPTIC SYSTEM a OD DATE CALLED IN• Is � TIME: IS� INSTALLER: APPLICANT/OWNER: C— CALLER:�!� 1 \� PHONE # OF CALLER: SWG#: 93 PARCEL NUMBER ID L'Ai -*t- f L,L=*e CA, 1 ) SUBDIVISON: 3a13a-3%�-ri3 , �U Division Lot 7a �� PRESSURE or GRAVITY (Circle one) APPOINTMENT or PLUG IN (Circle one) Staff Initials_ AS-BUILT FORM - PAGE ONE Revised 07/12/93 ` PARCEL IDENTIFICATION Permit Number SWG9 - Subdivision (Nsana/DivYcioza/Hlook/Lot) Installer's Name �l,N,�,� , YM Pnn" co T Assessor's Parcel No. Designer's Name (swelva—Digl� N,,,.,caz> INSTALLER CHECKLIST I. SEPTIC TANK Yes No N/A A) >5 ft from foundation? _C B) Building stubout to septic tank: cleanout provided if not 1-28 C) Baffles intact and clean? ✓ D) Dividing wall intact? II. D-BOR A) Water leveled? B) Speed levelers used? -� III. DRAINFIELD A) >10 ft from foundation and >5 ft from property lines? _ B) Laterals level to ±1 inch? C) End caps present if not looped? D) System dimensions the same as shown on the design? _ E) Gravel clean, properly sized, and proper depth? F) PRESSURE SYSTEM 1) Sand quality ASTM C-33? 2) Head height uniform and >24 inches? 1� 3) Cleanouts and observation ports present? 4) Mound: Side slope 3:1? IV. POTABLE WATER LINES A) >10ft from field or double sleeved? B) Wells >100ft from drainfield? 1� V. PUMP TANK A) Screen basket or effluent filter (circle one) installed? B) Riser installed for access? JL C) Alarm installed? CERTIFICATION OF INSTALLATION Installer: Check box from Row "A," check box from Row "B," sign and date the certification. A. '�' I certify that I installed the system I certify that all deviations from without any deviation from the design the design stamped "APPROVED" by MCDHS are stamped "APPROVED" by MCDHS. shown on the reverse side of this form. B. W/ I certify that I contacted the I did not contact the designer prior designer and left the system open for to final cover because the designer inspection up to 48 hrs prior to cover. waived the notification requirement. 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 c rtification. ataata Zr.atsllar � (Data The undersigned approves this ' stallation of behalf of Mason County Department of Health Services. Haal F irn� r Data S-BUILT FORM - PAGE TWO Revised 07/12/93 PARCEL IDENTIFICATION Permit Number SWG9 - Subdivision (N�ma/Oivynioii/Bloch/Lot) Installer's Name -SoHo✓� +MADDoe [o,� Assessor's Parcel No. Designer's Name (sW®lva—r,lglt NumUaz) AS-BUILT DRAWING N � _ zr I I I I i I ,10N: Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generally ac- table to both the department and the designer, but could in certain cases compromise the viability of the system. It is the in- .ler's responsibility to obtain prior written approval from either the health department or the designer before making any devi- �ns from the design that affect system viability. Any deviations from the approved design must be shown above. AS—BUILT CHECKLIST Drainfield orientation Observation port location Undisturbed native soil and layout ❑ between trenches Cleanout location Trench/bed dimensions and North arrow critical distances within Manifold placement layout El Scale of drawing shown D-Box/"T"/"L" location �rifice placement on scale bar Lateral placement, with Additional Mound Information "J Septic tank/pump chamber distances to edge of bed location ❑ Endslope width Location of wells, roads ❑ Location of buildings Overall fill dimensions