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HomeMy WebLinkAboutSWG93-1595 - SWG Application / Design / As-Built - 12/6/1993 PERMIT NO. MASON COUNTY 70—,, RTM NT OF HEALTH RVICES = y SITE EVAL ATJO DESIGN I TA CATION m 426 W. CEDAR, OX 1 A 8584 Date /� �!? (Date s. N Receipt o. o Receipt o. PHONE (206) 427-9670 Amount$ Amount$ mPHUPLFW f VV m r , - CHECK APPLICABLE ITEMS ✓ m m MAILING ADDRESS: / AYTIME HO E: INSTALLING NEW SYSTEM !/ E ,f/D V - / REPAIRING OLD SYSTEM CITY: STATE: ZIP: EXPANDING SYSTEM m SINGLE FAMILY PROPERTY ADDRE5 ;: OTHER z SPECIFY: 3 SPECI IC }RgECTIONS FO LOCATING SITE: PRIVATE WELL m c PUBLIC SYSTEM SYSTEM ID NUMBER &,-x2 Q � - f^-8 r-- SYSTEM NAME I� r, I q -�!�!f/o APPLICANT NAME i,f p Name of Lot x 17D ft. MAILING ADDRESS ` Installer Size: /•DD acres TELEPHONE o Name Bedrooms of um er o > XIGNATURE o P Designer Bedr J APL N n v _2 J7Lu EiIfO, ll©: t1 G _1 �INSDr nsional an, COT 4T ao lo � i J/ Zinc ❑ cse f � shoum •b� UWAgU red Wance ftrul9efty bQypdarie ❑ � © � � PL oada p ro�lc - K1 ays.W J� (5 ca Nqoffl DO NOT D ~IN YSTEM D it/ OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. SOIL LOGS Lc pZ �M Ste,k C2�'h (YZZ �'►�£ ��q 3 � Se,►� 9� �L1. Q�Sa Cam£ S Z� '3 ► � 2�ti Z 31 Depth from Original 4 Grade to Restrictive Layer or Water Table: In. DESIGNER DESIGNATION SCORES MUMS STEM REQUIREMENTS Finding Score I esign�Level ❑Two Soil Type /�gw Septic Tank Daily Vertical Separation i. __a_- Capacity: ,Z� Gal. Flow: 3Z' GPD Slope '"L -&- �y Appl. Infilt. Parcel Size 0dG Rate GPD/FT2 Area 3� FT2 Distance to Shoreline.2�44V -19-- Total J Inspector S Date COMMENTS/CONDITIONS FOR APPROVAL Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit. This Permit expires j jars from data of site inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. SITE: ed D equred ❑Not DESIGN Approved ❑Not Approved 1NSTALLATIONIApproved ❑Not Approved BY: DATE: 6 ? BY: DATE:/�q-491 1 BY: A ��l_ DATE:y_a2gy TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM. Applicant's Copy VART 3: HEALTH DE RTMENT REVIEW (OFFICIAL U. 'W�ONLY) .........................................: i.c.......................;......:::::................::::::::: ............................................... SOIL 1LOGS AND SITE CHARACTE�RIISTICS aor I 3•a�-1 v�-l. car a -{ I,0 OC. car 8 t.0 J}C. let LF t 10 — — Test Pit A Test Pit A Test Pic A Test pit A n Q I`l o � �'{��' w�dt� �•qs�' :4-3i�1 � �y� l Sc-il fJ�({K --}yf21 j(;It Icy-4'^) ,�Jl� G ,' CobMZ1 �'d d�S {n 3CJ j Depth of soot pen.: 3oe Depth of root pen.: �S�j, Daptn of coot p.n.. y`�L Depth of root peu.t 52 Depth at Mtcling: 1'{• Depth of mottling: - Depth of settling: Depth of sottllegt Depth to tsat. layer: Ma Depth to rest. layer: 3S Depth to net. layer: Depth w test. layers _ Yloll type (WDA): I soil type (VSDA): sail type (USDA): soil type (USDA)s Test Pit B Test Pit B Test Pit B Test Pit ! Na colde) V2 h� U.4J-it 54.-1 ''ALAS tb r�L : Depth Of soot pen.: Depth of root pen.: 5 Depth of zone pen.: Depth of zmt pea.: Depth of mttliag: Depth of mottling: Depth of mttllw: Depth of mottling: Depth to r1at. layer: Depth to rest. layer: — Depth to rest. layer: Depth to test. laystt 1 sail type (UNDA): Soil type (USDA): I Sail type (USOAI: Soil type (USDA)$ Certain drain needed? (, I� Cu tain drain needed? �j Curtain drain needed? pN Curtain drain needed? slope (s): N slop. (e): slop. Slope (%)t aborellns? (Y/N): ahcrallne? (YIN): shoreline? (Y/N1: Shoraliast (Y/ll)e N M1h1ma lot size:^ Hinimum lot sire:^ �j minimum lot size.^ N_ sislas— lnt aiza:^ 1 �/ m MLMLI•••M lot size applies W nw subdivisions and is defined as tha minimum allowable land area par residance or rrldam- tial equivalent (450 gallons par day). CMDONTS LrrrS 2 , 3 < <-I �NAV\J 1 Iy I soil ouxi do m4 P+ 4, 1o+-Iv -WfL 54-k�' ( wnU y>/e(S nn ) wV II of /YUulrtd $ L'� mil' lti�/IC i..l U' -9 'I✓1 L+ 'f �)010cl,.. FTy rewtc rnn alga n�}(n StSk hM=d Il f M(( I�r Revised 09/01/92 MASON COUNTY DEPARTMENT OF H CES MASON 000711, 426 W.66DAR P.O. BOX 1"4 SMFL7014 WAS/NN070N 99594 (206)427-%74 Aft 427.9425 f x DATE: I CJ L( l x TO: ju a A7is SLR. { x FROM: - - - Guy Grayson - - - x DESIGN FOR: PARCEL #: 3y 13 - S 2 YOUR DESIGN FOR THE ABOVE REFERENCED PARCEL HAS BEEN REVIEWED AND IS HEREBY APPBOf'AD R DESIGN FOR THE ABOVE REFERENCED IYOURCEL HAS BEEN REVIEWED AND CANNOT APPBOI6Q THE REASON(S) ARL V42'I1UK S4 '_� iaN I Ef1Pr&IiJi L.4 Lt4L 31 -MCI AZ,.IIL Lt Slit.,) fG � >✓� _ CLU Ly -il.41 - ----DESIGN FORM - PAGE ONE a•v19tl 09/17/93 1 '0 •A design 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 checklist • Scaled layout sketch, including all applicable items on checklist • Cross-section sketch, including all applicable items on checklist .ScG t PARCEL IDENTIFICATION o Permit Number .S G ' / �T Ai0�5_ Designer's Name Applicant's Name 1'Y) Prop. Owner's Name Mailing Address r y/ e. Prop. Street Address CYCY �t nCo i1D� // O1tY �l�Co ily Assessor's Parcel No. 3.2 1.32 32 9 005?Z. Subdivision sfywl y-/-" (1w�lvo-D ipi! pomb�s) (N-m�/Divl�len/lloo]t/Lot) h5ds DESIGN PARAMETERS rrAU_ YLL _ J J J 1Sate Designed Vertical L`� Separation v Mound Subsurface Pressure Gravity Bed Trench b in Septic ToWPrainfield Specifications No. Bedrooms .3 Pressure Distribution? ❑ Yee! 344LEE,) No Daily Flow -'---j •:ieiiie' iiiiiiiieiEii (If yea, Proceed.. . Septic Tank Capacity Qgy cal Receiving Boil Type (1-6) Receiving Soil Appl. Rate /•7- god/ft, Laterals Trench/Bod Bottom Area 319 ft1 Sc dule/Class Tronch/$ed Width _T ft Len ft Diamet in Elevation msaauramegts Number Orig. Drainfiqld area Slope 0 1/i Separation ft Final Drgtaffield Area Slope i Orifices Depth of Bottom of Trench/B /// ' /, Total Number o Orifices from.Origin;l Grade n //Diameter _#g A Q /y`�' ee. 3 Spacing 3f� in d�� DeY"'lea' Schedule/Class Length ft Pump Re lr �; ed? Q Yes '—' No Diamete in ': ei: :.. ::: (If yea, Psoceaci ) ...... ......... T>��pa�p�t Pi Schedul Class Pump/Siphon Specifications Length (((���� ft [aln-d� ifference in Elevation Between Pum utoff Diame r in rmost Orifice ftf D see/Day �esmeer Orl 1e.,1 fiches, lower Do puantit al han Pump Shutoff Chamber Cap al apacity i con. Read go alculate ot. Pro*. Read ft Attach Pump Curve) ��(�y ,aiSIGN FORM — PAGE TWO arms" 09117/93 DESIGN C81CSLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch r7l�— Reference depth from orig- = Test hole locations Drainfield orientation anal grade: and layout B Property lines 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 r�/ inal grade and restrictive � Cr L�D-Box/"T"/"L" locations strata: itical distance �—y/ measurements to cute, 9 Septic tank/pump chamber gals, trench/bed banks, surface water loc tion top and bottom Location and orientation Observation port location Curtain drain collector of curtain drain and all /� —y/ absorption area Cleanout location Sand augmentation components El ��ifold placement No external reference needed: Location and dimension LVr. of primary system and orifice placement D Observation ports and cleanoute ren rve area �,�� '--' Lateral placement, with Buildings distances to edge of bed Additional mound informatio El Direction of slope Aadd ble/visual alarm slope and downel —7/ind/icator ��,yref�erenced fil width Waterlines '_' Scale of drawing shown Settled pth at —y/ on scale bar center an a of bed u Roads/easements/ d�rivewaye/parking Additional Wound Iaf on: ❑ Side 11 slope ElCritical resource lands Endelope w p/downslope bed sieve (if applicable) �� Ova 1 fill dimensions leted Resource Lands and North arrow and scale of Critical Areas Checklist i drawing shown on bar DESIGN APPROVAL The undersigned designer 9-does, does not, waive the regirement to be notified by the installer of the installation and q 48 hours to perform a final inspection prior to cover. Qe.t.ar� er .iveer n e i The undersigned has reviewed and approved this design on behalf of Mason County of Health Services. Y.�16h Se.y�oter G�b� CAUTION: THIS DESIGN IS ONLY VALID IP STAMM "APPROVED' BY MASON Co. DEPT. OF HEAT"-" i i f i D I r F . , J r - - - - - lfl L-7 r C4 , ,M c i 1 l of ZE I v � I h i a V, i _l �rF o a � A S Z L S r � � • O o n va I I v W I I I y cz Mason _ a County Uc;t, lle ' ` I Ap.C"� taith b'errices ROvLiT Initials LLJ i Dat0 -� +►661 0 L N'd f a � a � s O 7:r- Q-- JA O 90btrt MC l 6L �n Aj e� ore° e 'C: dG" Tr Pi 00- 1 trwch lFtl s301n83S a Level I & 11 Septic Systems Design • Perc Holes Bob Paysse, Sr. P.O. Box 1789 (206)427-5429 Shelton, WA 98584 12/26/1993 Designer Comments : Robert Mc Kibbin: The designer uses apparent property lines as they are represented by others . The property owner is responsible for establishing necessary property lines to assure proper placement of the system. 2 . See attached addendum for the installation and maintenance of gravity systems . 3 . Property owner is responsible for the locating of all utility lines (water, sewer, power, phone, and gas) before installation of the system is begun. 4 . Sewer delivery pipe shall be four inch ASTM 3034 PVC PIPE and shall have a one/ eighth inch fall per foot except it shall have a one quarter inch slope per foot the ten feet preceding the septic tank . where excessive slopes are involved a series of forty five degree drops shall be used. 5 . The septic tank may be moved as is necessary to allow for future home building . Access to septic tank lids must be held to a maximum of twelve inches below the finished grade. Tank Elevations may be adjusted slightly to accommodate foundation so long as setbacks and fall restrictions are observed. Depth of lateral trenches must be maintained as shown. 6 . No existing wells are in the area of the drain-field. This parcel is served by Stone Brair Community Water System. See plot plan for location of Stone Brair Community wells . closest well is shown. 7 . NOTE: Use of gravity delivery for this system will depend on the location of the home on the lot and the depth of the foundation. These items must be considered during layout of the home on the lot . The position of the home shown on the plot plan only shows area available for a home while maintaining set backs from wells and other critical areas . Robert R. Paysse INUALLMON / XhnnMEANCR Gravity Systems 1. Install laterals with contour of the ground. 2. Install trench bottoms level. 3. Install drainfield during dry weather and soil conditions, any soil smearing must be eliminated by hand raking. 4. Install locate tape on top of all drainfield laterals. 5. Install observations ports as indicated on the plot plan (minimum - one per drainfield with the bottom extending to the drainrock \ native soil interface) . 6. 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. 7. Divert all storm water run-off away from on-site sewage system. S. No curtain drains allowed within 10 ft. of the up-slope edge of the drainfield and reserve area. 9. No curtain drains allowed within 30 ft. of the down-slope edge of the drainfield and reserve area. 10. Have the septic tank and pump chamber pumped or inspected every three to five years. 11. All materials and workmanship must meet County and State regulations. 12. Deviation from this design without prior approval from the Designer and Mason County Health Department will make this design null and void. FINAL INSPECTION - SEPTIC SYSTEM DATE CALLED IN• //�� 7 TIME• D : `/O INSTALLER: I��YL APPLICANT/OWNER• CALLER: /l / �J��✓ PHONE # OF CALLER: Y(\� SWG#: PARCEL NUMBER: SUBDIVISON• Division Lot PRESSURE or GRAVITY (Circle one) APPOINTMENT or PLUG IN (Circle one) Staff Initials FINAL INSPECTION SEPTIC SYSTEM CHECK LIST 2) SYSTEM TYPE YES NO COMMENTS A) CONVENTIONAL: / FIELD) _ B) ALTERNATIVE: (MOUND/SUBSURFACE) II) SEPTIC TANK — A) > Five Ft. from Foundation _ B) Foundation-Tank Line Slope: Cleanout provided if not 1-2% _ C) Baffles Intact / Clean _ D) Dividing Wall Sealed III) D-BOX — A) Water Leveled B) Speed Levelers Used IV) FIELD — A) > Ten Ft. from Foundation B) > Five Ft. from Property Lines _ C) Laterals Level to ± 1 inches x D) End Caps Present If Not Looped E) Square Footage Adequate F) .Gravel Depth Adequate G) Gravel Clean H) PRESSURE SYSTEM 1) Sand Quality ASTM C-33 2) MOUND: Sand Slope 3 to 1 �JA 3) .Head Height > 24 inches 4) Cleanouts Present 5) Observation Ports Present. _ V) POTABLE WATER LINES A) > Ten Feet From Field Components or Sleeved B) WELL > 100 Ft. from Field VI) PUMP TANK T — A) Screen Installed _ 1) Basket / Effluent Filter _ B) Riser For Access Present _ C) Alarm Installed VII) AS BUILT REQUIRED COMMENTS { unn t I FSeJ Jp\A --LAX n AA " ��tl�a- U^3 Inrh+Y� IAt.1 h, l� dWC d tl'PYII _qy Signature Of Sanitarian Date vised: 10/20/92 _ASoBUILT FORM - PAGE ONE Revised 07/12/93 G �� PARCEL IDENTIFICATION Permit Number SWG9 ,9 - /Sq�S Subdivision a2 wa...a/n y..ya rani wyook/x.a< Installer's Name ipEl ln; ssessor's Parcel No. ga/32329009� Designer's INSTALLER CHECKLIST I. SEPTIC TANK Yea No N/A A) >5 ft from foundation? B) Building stubout to septic tank: cleanout provided if not 1-28 C) Baffles intact and clean? D) Dividing wall intact? II. D-BOX A) Water leveled? L/ B) Speed levelers used? III. DRAINFIELD A) >10 ft from foundation and >5 ft from property lines? C� B) Laterals level to tl inch? f/ C) End cape present if not looped? 1/ 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? t/ 2) Head height uniform and >-24 inches? 3) Cleanouts an observation ports present? 4) Mound: Side slope 3: 7 IV. POTABLE WATER LINES A) >10ft from field or double sleeved? G� B) Wells >100ft from drainfield? L�- ~ V. PUMP TANK A) Screen basket or effluent filter (circle one) installed? B) Riser installed for access? C) Alarm installed? CERTIFICATION OF INSTALLATION Installer: Check box from Row "A," check box from Row "Bl" sign and date the certification. �ertify 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. E4 I certify that I contacted the El 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 certification. H lgnatuta oL Sna< Services. lac Ds<a The undersigned approves this installation of behalf of Mason County Department of Health 4-2Q 9� X awlth Lnapaotoc Ow<a -AS-UILT -FORM - PAGE TWO revised 07/12/91 PARCEL IDENTIFICATION _/ [Delr3 emit Number swc9 3 - I 5 95 Subdivision S�oNE g2(2 2 �J T ( AIZ-Divl•YOef/0lpple/Lot) nstaller's Name 2i - 1"IAI/ /MLAeseseor'e Parcel No. 's igner'8 Name G <s+•s •-o syst n n•z> AS-BUILT DRAWING W EU_ EA,os ARE OAPPEb E--- 50' PE k F - —� � _ aoY •� X• J10 �$Q'PERF k e C (NE O 3' Sblip �;,PF �D, LDeoc Rob A Z ObS(t,2VG. ON PO(Z:{s X C IeA IJ-ouT 9� fir) ct,� T F2 I C/z � W flT �z S S-T E CAUTION- Minor adjustments to septic tank location and dralnfield 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 in- staller's responsibility to obtain prior written approval from either the health department or the designer before making any devi- ations 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 u< n iPturbed native soil and layout � b ween trenches '——Cleanout location Trench/bed-dimensions and North arrow critical distances within Manifold placement out ❑ � Scale of drawlag�_ Ori ice placement scale Dar D ox/"T"/"L" location NOT '1"o S'A� h� Lr3 Lateral placement, with Additional Mound Information Septic tank/der-- diet nces to edge of bed loc tion FLI_ 1:1Endslope width Location of wells, roads ElLocation of buildings Overall fill dimensions