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Home My WebLink AboutSWG93-0802 - SWG Application / Design / As-Built - 6/22/1993 MASdN dOUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG m a G C N l0 - 1. a 0 426 W.'CEDAR/P.O. BOX 1666/SHELTON,WA 98584 Date W N Receipt No. m PHONE (206)427-9670 Amount$ w PHQPLHTY OWNER: DATE' Donohue Construction Co. , Inc. 6/15/93 CHECK APPLICABLE ITEMS ✓ m m MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM X 4 730 Sleater-Kinney Rd, SE 438-3493 REPAIRING OLD SYSTEM rt CITY: STATE: ZIP: EXPANDING SYSTEM � m Lacey, WA 98503 SINGLE FAMILY m 8 PROPERTY ADDRESS: OTHER Stonebriar Pl. Shelton SPECIFY:WA 98584 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL h m Hwy 101 - Right on Shelton Springs Rd - Left PUBLIC SYSTEM SYSTEM ID NUMBER Pending n on Brockdale - Right on Jensen Road - Left on SYSTEMNAME N APPLICANT Stonebriar. Place NAME Donohue Const . Co. ~ Name of Lot 313 .80 R.X 139 .07ft. MAILINGADDRESS Same as aboye Installer G Size: 1 .0 acres TELEPHONE _ o Name of um er o SIGNAT o Designer Bedrooms 3 X PLOT PLAN m I w Draw a dimensional plot plan, a, o including: �J rt ao Please See Attached Plot Plan ❑Precise location of test holes,showing O �g /G rr o measured distances to 3 V a N property boundaries. �/ <2 N I o ❑Entry road;other roads. �� driveways. eO a NOTE: DO NOT DRAW IN p I P SYSTEM DESIGN OFFICIA USE ONLY. DO NOT RITE BELOW DOUBLE LINE. �l SOIL LOGS r yt it s A 20 Q�a1s �a6" Depth from Original Grade to Restrictive Layer or Water Table: In. DESIGNER DESIGNA ION SCORES 7Tank UM SYSTEM REQUIREMENTS Finding Score f.Capacity: ❑Two Soil Type �1 �^ Vertical Separation 3� in. �� Flow: U14V GPD Slope 7i % ppl. �l Infilt.Parcel Size +� AC. - 2 Rate • (� GPD/FT' Area goo FTR Distance to Shoreline-----,j,4>ft Total ✓ Inspector Date Set 6 COM MENTS/CONDITIONS FOR APPROVAL s1w ��s-lPeLV A1�4 AZ3L" PUIP A#t�- Any change from the specified use of the property, y site alteration affecting the system design may invalidate this permit. This Per It expires 3 years from date of site inspection. ni of his permit may be appealed to the Health Officer within 10 days of denial date. SITE: Design Required ❑N DESI N: Approved ❑Not proved INSTAL roved ❑Not Approved BY: DATE BY: DATE:y-(/� BY: DATE:)-, (if TOP: Health Dept.Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy q. CD . I i. o f I UU -tq .Q- 1 � x -E SD f Cf-) 1'1CIrL.. 1 ( L),- FLU 1 < A resign will be reviewed. when ; ropie^ o° ,- ors the following items are submitted: ;.I Camp=.meted des gn _lox.. tha_ has teen e_gned and dated . Scaled plot clan, including all applicable items on checklist j r] s spy► i Na'ec� ayout sketch, �_nc1..dyna all applicable items on checklist IU/' u fl,�� '{'{[!$v_,ss sec_ion sketch, zncludine all applicable items on checklist AUG 0 9 10 PAp.CEL ?D.c.rlTIVICATION I t S W( c+ 3 _ p Designer's Namep21, WElJ�t12 Fr perm•_ Number r =_i Ano icant' s Name DONOHu.1= L�"_� CO. Prop. Owner's Name SPekoW, jai e±P, vai_ina Address �^ �,�t'4!'rE12_K�eJ•��1 R3...5• Prop. St-set Address ��o STDLJFr 4 �Li u_Cfc-03—�P Ass,_.scr' s Parcel No. Z� �3 ?. 32t rbo4`t_4s Subdivision S73Na6l4Are tt-eT Y SP 32tp� -- - ,aa kri services z Vn.�%'r DESIGN PARAMETERS 10IJatc Date � 7esiq_ned Vertical Separa, on Mound. Subsurface Pressure Gravity Bed Trench U " -r in Septic Taa'</Drainfield Specifications j No. BedroomsPressure Distribution? Yap No ........................ . ............... Daily Flow (If yes, proceec:. . Septic Tank Capacity IZoo C;L . 7ec,::_vino .'.'oil_ Type (1-6) iS• ^-.eceiving So'_- A�nl. Rate 1.�- god/-`-t Laterals 'Tench/_'.ed 3ottcm Area boo `.=' Schedule/Class _re=h/".ed Width _ ft Length ft L; neal Footage .�O(Y _'t ! Diameter in Number Elevation Measurements ',,parati_on Orig. Drainfield Area Slope to 8 - Orifices F_.nal ^rainfie_d Area Slone '-�!/, Number/Lateral Pair ^,�pth of Downs-lone Sdae or.' Diameter -.rer.ch/Bed from Orig. Grade ��1P i.n Bpac.;= it Manifold Pump Required? -7 Yes No Schedule/Class /If yes, proceed. . . Length Diameter Pump/Siphon .^.nec:_fi.cations Transport Pip' Difference in Elevation Between Pump Shutoff Schedule/Clans and Uo_oermost Or_`iCe _. Ler^"t _ ft -- r, D 4,1_meter Uppermost Orifice is —hiQher., — 'lower Dosing and Pump Ch:n�per y than Pump Shutoff ? Doses/Day Ca,^ac_ty @ Tot. Pres. Head apm Doso Quantity ?•, r_a. c. ,.ate., "lot. Ares. 'lead Ca_�acity (Attach Pump Curve) +-_ Cross-Section Sketch scaled Plot Plan Sca._ed Layout SXP ch .. 7 Depth from original grade of 'Test hole locations - — Drainfield orientation following system components and layout j Property lines Building stubout Trench/bed dimensions and -7 3xisting and proposed critical distances within. — Septic tank lid j we!'-.;, nclud_na layo''''t ac!,acent properties' Laterals D_?ox/"T' / r," location li kff Cr '-:.ca1 distance Trench/Bed bottom 7 mea._urements to cute, Seocic tangy/pump chamber ban'(-, surface war(- '_oc. t4.on — Trench/Bed top 77 N� Loca^ _on and orientation k- 0!,-orvat'-Cn port location Drainrock depth of curtain rra.4 n anc' a<1 r, absorPti-on ..rea. C'_ear.ou`. 1oc.,.tion _ — Cover depth co .ponents Manifold placement Restrictive layer I! ' _ —' Loceten and dimension of p _m:•.ry sy,tem and orifice placement Curtain drain reserve area ram, j Lateral Placement, Observation ports and Su' ldings w'th distances to edge of cleanoutss Sed Poads/easements r—, Sand augmentation ' Audib'_e/visual alarm Driveways/parking Additional Mound Information — North arrow r Power/gas/waterlines I Upslope and downslope — Scale of drawing shown fit_ width Reference point location on scale bar Settled cap depth at North arrow Addi-tional Mound Information center and wine of bed n F Scale of drawing, shown — Endslope width Sidewall elope on s�a_e bar r t Overall fill dimensions Up/downslope bed. e:_evat. a•ui eiv ces — ---- — a��) ZflVED Iniiiai5 D::SIc4 7LrP^OVAL The undersigned designer does, does not, waive the regirement to be notified by the in^ta11e- o` the insta.'_'-atinn ans. gi-ven =H . ours `.o ner`_orm final inspection prior to covF..r. The undersigned has reviewed.. a d an .ov d this design on behhaallf/ of Mason County of Health H u..n ..t'.M1 Sr.0 Dact.ur O.rC� CAUTION: THIS nFSIGN TS O"^.Y VALTD TF STAMPRD "APPROVED" BY MASON CO. DFPT. OF ELNLTH e' �r A 4 A E 0£ ti i�2o0 GPL n) I �i ��@ui�t7 W(• $T U�} n�aS I PRu Po IE� {+ouSE Lo pyFTbON rie&oi ;,vfvxes \ APPROVED Initials. Date —� i � Ii/(cW Hy p coNcae,E \ 1p�a 0 SGN�E N07t- Ti57' ,Hoc[ LD44r,6 )f ri - 29 .. .. -- yvoM. rx+Nr� e5�2VE — io 30 --5 --`-- - - - -- 1 Ao' -- - -- - -- 1 ^T _ NO _S ua LE_ v J-- — — .�-r--�'--�..Y,_- �L —/ —. �— I - .�R{L IT7R� _- •.- YfCdiGr__- ` 1 ✓ �Y�� 1 _�— .-__.—..��iJ.�� IJ 4'C RTA�.- ��t��OLiG�+.,....�,ii _ ... - .—___i - - TSottGti+�t-_' y - I - - -- - -4- - 1U;. -i -1 i I tt.L'�VII urz -,T. 83h�1 _—_- -J CIR S$ ' `�. w SOIL I I, pAl� ---1- - - ly MASON COUNTY b DEPARTMENT of HEALTH SERVICES Shelton,Washington 98584 (206)427-9670 • Belfalr.275-4467 / (�/ I z •MRONMENTAL HEALTH PERSONAL HEALTH �l ( ITS' O. BOX 1666 303 N. FOURTH P.O. BOX 1666 FINAL INSPECTION Septic System 3 e.( m Date: 1 93 Time: � . Installer: w Ip Applicant\Owner: �S> 11 rt\ � Name of Requestor: 1Iy � W Phone # of Requestor: Legal Desription: Parcel Number: 3L v Subdivision Name: ��{�� G ✓ Div. Blk. Lot Staff Initials: FINAL INSPECTION SEPTIC SYSTEM CHECK LIST YES NO COMMENTS I) SYSTEM TYPE A A) CONVENTIONAL (T FIELD) B) ALTERNATIVE: /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) BOX A) r '(A® A) Water Leveled ' B) Speed Levelers Used _ IV) FIELD A A) > Ten Ft. from Foundation — B) > Five Ft. from Property Lines C) Laterals Level to ± 1 inches En fps Present If Not Looped — E) Square Footage Adequate — F) Gravel Depth Adequate _ G) Gravel Clean H) PRESSURE SYSTEM 1) Sa uality ASTM -33 _ 2) MOUND: d e 3 to 1 — 3) Head H 4 inches — 4) C outs Presen 5) bservation Ports Present — V) POTABLE WATER LINES A) > Ten Feet From Field Components or Sleeved — B) WELL > 100 Ft. from Field — VI) PUMP TANK A) Screen nstalled, -- 1) Bask ituent Filter se — B) Rir Fo cess Present — C) Ala stal — VII) AS BUILT REQUIRED COMMENTS jaal a^ rfi- SignatureY" anitaFrian Date Revised: 10/20/92 S-e4iLT FOEM - PAGE ONE Pevised 04/21/93 PARCEL IDENTIFICATION a Dofoo"-LLE Permit Number SWG9 Installer' s Name U1=Rer,3 i-wa-cT Assessor's Parcel No. f2oV4Lf Subdivision (xw_1v_-�iqi� Nunb_z) (N_"_/Oivlslon/Hioo]c/Loc) II INSTALLER CHECKLIST Hes Na NA. I. SEPTIC TANK ✓ A) >5 ft from foundation? - — B) Building stubout to septic tank: cleanout provided if not 1-2% _ C) Baffles intact and clean? —F- D) Dividing wall sealed? — II. D-BOX 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? A — E) Gravel clean, properly sized, and proper depth? F) PRESSURE SYSTEM 1) Sand quality ASTM C-33?(j000 — 2) Head height >-24 inches? — 3) Cleanouts and observation ports present? — 4) Mound: Side slope 3:1? — IV. POTABLE WATER LINES A) >10ft from field or double sleeved? v = B) Wells >100ft from drainfield? V V. PUMP TANK A) Screen basket or effluent filter (circle one) installed? B) Riser installed for access? — C) Alarm installed? — CERTIFICATION OF INSTALLATION iF I certify that I installed the system without any deviation from the design stamped i "APPROVED" by Mason County Department of Health Services. I certify that all deviations from the design stamped "APPROVED" by Mason County Department of Health Services are shown on the reverse side of this form. Ii I further certify that all information contained on this form is accurate. I understand jthat if the information contained herein is not accurate, there will be just cause for immediate suspension of my installer certification. ign The undersigned approvess this in a ation of behalf of Mason County Department of Health services. ti_uith Sn_D_o<os �� b_t�� AS-BUILT FORM - PAGE TWO Revised 04/21/93 ' Periait Number SWG9 - �tJc/Z Installer's Name U37X►J�taL6- Assessor's Parcel No. 3213E -32 -�00%(/ Subdivision �j 7aNE Ri APT L/ (2'velva—Digit NYanb�L) (Naanr/Dlviolo n/E10ok/Lot) AS-BIIILT DRAWING V� 00 V cAUTioN: Mingr 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. 1t 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 below- AS-BUILT CHECKLIST El Drainfield orientation Observation port location Undisturbed native soil li and layout ❑ between trenches Cleanout location ElEl Trench/bed dimensions and North arrow critical distances within Manifold placement ❑ Scale of drawing shown layout El ❑ orifice placement on scale bar D-Box/"T"/"L" location ❑ ❑ Lateral placement, with Additional Mound information Septic tank/pump chamber distances to edge of bed ❑ location ❑ Endslope width ❑ Location of wells, roads ❑ Overall fill dimensions Location of buildings