HomeMy WebLinkAboutSWG93-0670 - SWG Application / Design / As-Built - 5/27/1993 i
MASCIN COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. — N
' SITE ALUATIO ESIGN AND IN ILLATION m
vi y
426 W. CEDAR/ P.O. BOX 1666/SHELTON;WA 98584 Date — - Date
y.
PHONE (206)427-9670 Receipt No. Receipt No.
Amount$ Amount$ m
PROPER FY UWNFR: DATE:DAB E-- 4-AND964 DR-"" CHECK APPLICABLE ITEMS V R m
MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM f% o
313o 4a1702(0 REPAIRING OLD SYSTEM kA
CITY: STATE: ZIP: EXPANDING SYSTEM m
b tin r 4 WA . 9g5D 6 SINGLE FAMILY +� p,
PROPERTY ADDRESS: OTHER p5 c
cj SPECIFY: �, 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL Cr
(Z N f c q(L T-0 zfyt S op PUBLIC SYSTEM (�
SYSTEM ID NUMBER
Tok,N R.t h t t/y 'NI I • D>J LaP' roe- SYSTEM NAME 57'0rj"2/A1t 2- a p ,
APPLICANT -i
Q2jaR Pl gc�. NAME iLLS co-w5r.. Znvc..
Name of MAILING ADDRESS 313o Sub 2A A
Installer Lot )�E n ft. x 3 {i ft. wA ��6 p„
Size: 1,00 acres TELEPH NE 106 1 4,1170 26
Name of Bedroum er o SIGNATURE o
IY
Designer oms X ' IW
PLOT PLAN
Draw a dimensional plot plan,
including: m ^
n ly'
❑Precise location of test
holes,showing t1/�[ (i�il- b,
measured distances to
property boundaries.
❑Entry road;other roads, °
driveways.
NOTE: DO NOT DRAW IN I�
SYSTEM DESIGN
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
r SOIL LOGS
of w T h,
cola bl es Zr S I ....i (A-'
K 1
31 .40 o'kil COf, A4A
SA'Ad Depth from Original
a . Grade to Restrictive
Vv� /'
k -f ,3-1 Layer or Water Table: 3� In.
DESIGNER DESIGNATION SCORES UM SYSTEM REQUIREMENTS
Finding Score Des ig_�er Levne ❑Two
Soil Type -- 3
Septic Tank Daily ?
Vertical Separation _ Capacity: 2CaD Gal. Flow: J GPD
Slope Appl. Infilt.
Parcel Size (•251k. } Rate 1 . Z GPD/FT' Area 300 F72
Distance to Shoreline Total Ins ector Date
Ak^ De inf �8- 3
COMMENTS/CONDITIONS FOR APPROVAL
1V1Q � ✓�evtGl�QS I �4i1 a7 T d f` e -33 -.540J, P S
Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.
This Permit expires 3 years from date of site inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE:P ed •gn Requred G NotApproved I DESIGN: pproved ❑Not Approved INSTALLAT1100 Approved U Not Approved
BY: DATE: b.SJ� BYJ �A=� DATE:1_31 yty BY:�y� DATE:
3
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy
MASON, COUNTY DEPARTMENT OF HEALTH SERVICES
POST OFFICE BOX 186
SHELTON, WA 98584
(206) 427-9670
FAX 427-8425
M DATE:
E I
M 1n
® To: �IIIF c a�aG�nei U��c �l�Cw��
R
A
1�q FROM:
v
M ® RE: Design for _O,q�bytuj(T Parcel
lilllIIIllllit!!!1lIIIIlII 11l11111ll ImIll I I111111 IIIIIIIIIIII]III I IIIIIIIII 1IIIII11111111l11!l111!li11111l IIIIIIi1INIllllllllli!!71!ifl11ll!!it I1111lIIilllllllilllllll11i111I1
Your design for the above ref anted parcel has been reviewed and is,
ereby approved.
EDYour design for the above referenced parcel has been reviewed and is
hereby conditionally approved_ The condition(s) for approval are:
S rIt
1�
a -
o
aYour design for the above referenced parcel has been reviewed and
cannot be approved. The reason(s) for not approving the design
are:
a
a
a
'`': My verl:,:ed:w
state sitetnnclve aye tam guSdelSnea moat be clearly Stlancl:Sad Sn the
daelrn and just1 taehnlcal data, The ndequary aC tecMteal JuetlCScatlon vlll ba asaesnad
[ry Che health within the contaxL oC current acre tad tleal
p qn practicae, depntapol:ry, And Led Too Oaalgn standards.
kti
. xy
2-5 (;AaroJ BANE,.
I
I-
i s
---->
lyo
koPro
18 �
PRt�
°0 �nT �, 1�i1LL5 coNST, I►x
`, �b SrrJ"6 BRIAR PLAc6 SICt PlAn7
cpg Rh, cL. o oo,, s_ 2--7 —y 3
DESIGN FORM - PAGE ONE PH i.•d 12?2e/93
•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
•,.,:.00mpleted Resource Lands and Critical Areas Checklist attached
'. `. , aled plot plan, including all applicable items on checklist
`,$�aled layout sketch, including all applicable items on checklist
u
*" � � 4'• -tross-section sketch, including all applicable items on checklist
PARCEL IDENTIFICATION
Permit Nu m Y tt-e 93 d670 Designer's Name /LJ/.ems /.gLOC.S/E/e
w
ApplleaAt'4's Name <on/577 Prop. Owner's Name
Mailing Address 3/ B,Qy,eD. Mailing Address 3/ 3,�) So. 8Ay .E>.
o�y�tP/4y wA. 98522 wA.4Rsa
C l.ty Htsta Lip C1Cy Ststa Zlp
Assessor's Parcel No. 3Z(3Z 90 /// Subdivision V7 >A,,t5WAC/A)e Lo'T
(Twalva-biq l< NYmbai) (Nsma ��1Counl'y kept HeL'n 1�
n1
DESIGN PARAMETERS Initials
Date d1al-1
Designed Vertical
u Separation �/
Mound Subsurface Pressure Gravity Bed Trench Z4 in
Septic Tank/Drainfield Specifications
No. Bedrooms ?J Pressure Distribution? Yes No
..................:::::: ........................
Daily Flow 360 gpd (If yes, Proceed. . . )
Septic Tank Capacity /2-entt-7> Zy/ gal
Receiving Soil Type (1-6) /
Receiving Soil Appl. Rate /•Z- gpd/ft' Laterals v
Trench/Bed Bottom Area 300 ft2 Schedule/Class CGQ55 ZO
Trench/Bed Width e/ ft Length 33 ft
Diameter /• 2'S'" in
Elevation Measurements Number 3
Orig. Drainfield Area Slope Separation ft
Final Drainfield Area Slope ,Z $ Orifices
Depth of Bottom of Trench/Bed Total Number of Orifices 33
from Original Grade in Diameter in
�p'1=per Spacing 3/0 /^/•
/Z in Manifold
Schedule/Class
Length 6 ft
Pump Required? /Z Yes No Diameter Z W in
(If yes, proceed. . . ) ........................ Transport Pipe
Schedule/Class GG.QS5 Zee"
Pump/Siphon Specifications Length /p ft
Difference in Elevation Between Pump Shutoff Diameter •7- in
and Uppermost Orifice 3.75 ft Dosing and Pump Chamber
(]� # Doses/Day
Uppermost Orifice is /-higher, lower Dose Quantity gal
than Pump Shutoff Chamber Capacity 30o gal
Capacity @ Tot. Pres. Head /9 47 gpm
Calculated Tot. Pres. Head g.. 94 ' ft94 ' ft
(Attach Pump Curve)
UFSIGN FORM - PAGE TWO Fa�i�d 12/28/93
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Reference depth from orig-
/`-' Test hole locations Drainfield orientation inal grade:
and layout
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 ❑ inal grade and restrictive
D-Box/"T"/"L" locations strata:
Critical distance �j'
measurements to cuts, Septic tank/pump chamber Laterals, trench/bed
banks, surface water location top and bottom
Location and orientation Observation port location Curtain drain collector
of curtain drain and all absorption area Cleanout location 7 Sand augmentation
components
ILJ Manifold placement No external reference needed:
Location and dimension rnrn
of primary system and Orifice placement Observation ports and
reserve area cleanouts
Lateral placement, with
Buildings distances to edge of bed Additional mound information:
Direction of slope Audible/visual alarm Upslope and downslope
indicator referenced fill width
Waterlines W 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 ❑ Endslope width El 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
DESIGN APPROVAL�J(
The undersigned designer does, X�does not, waiv41Ahe,,rM%irempnt to be notified by the
installer of the installation nand/given 48 hours to perf4o a,,-fi' Y:iH9p�MMcDon prior to
cover. LL--jj,,.i��Z
.lgnet..r_ o: o_.lgn_r ials
Date
The undersigned has reviewed and a)Aaroved this design on behalf of Mason County of Health
Services.
X--1<!a Zn�p�ctor Ost—
CAUTION: THIS DESIGN IS ONLY VALID IF STAMPED "APPROVED" BY MASON CO. DEPT. OF HEALTH
m -4,
N lil
\ N
\ U
_Z
a
°°
\ Q
QL
Ar
K N Y1 y 14 lUJ L O C W u ui. y \ f....ho a,
n
lI
�• '• a �-' (^ t-• � � yi
Q �U J �•'• - .'' '�Q � N•, Z� e � wr�rtr
�; s .
Q W `
�rN E• 000P � aw � HowA ozH nj a
a I� rzioRwrzi � �'' QcnaHzH HOu • , , �' �!1 i�
„ waooHE• H �n xaW
4. > wxE. aaTQP4EF waa
Ca wxxQiu a U)
v� <n o yip
FFP � � QZ W 4' 44 � aGMQQC7 �w �o
uF aw > Rwua w .�.
ul
P0c >4oW W
2 � PCQ x z4 W � XH OO >+ OC914 QC HI� Q ' ` ; . O U ww ..
W WHw2 auQo FQZQo • wa .: " z :z. (� M Q p
1 a H Q FE- UW :c W3GF U. "7 .pH a � � N \ N � A11tJa wr; Y aE+ Ems., Y
w Fxaa aaz ai„y u� FzOw O FwLQ .2 WQ [Hw+. Zq xu� a Qw ry,
fo Ozo u zo z G uHa00 O S p zKHWwaaa' wWa,E¢+ _aA�s'••+ QHHw• �Ow+ ao�:QHwa aoQ FoRK aw A gnu o . aF W
OHfF/) HUG1 •��2wot; >AHF.faaHAFU 2F �: E" dzO A
W � waC] KE+ A Z 0 1- E r4 wo H a0 a 0 -1 .ao u uC W U) u) af W QZn2w.4W w FHH Qwti ? naHwH
Q C. i_ ( r O O
ONDx " WLVOZ4 C IAQ .4 xa ( aaa a. Aa2•,>¢:,
�Q4LuZFH /) .tQ Z Z .4 O ' D
OOowxrlOH� x awsK oO ua U) uuQ W \ F E+ 0Q > E+ E+ E• t WgFU *
� W WawHH (a„X Lnu UUHW M4. f, - Z CZZH
y:vl^'VkQ
t
.4 v) H HHCA o a, N ri a ,� ,� ,; a as xaaoQQa: a ow raxw .4o w M
w OO .aaao. s � o � „� a )., wwiiGWC+ 66 �1
FINAL INSPECTION - SEPTIC SYSTEM
DATE CALLED IN•
TIME•
INSTALLER•
APPLICANT/OWNER• I
CALLER: j
PHONE # OF CALLER:
SWG#: 06 26
PARCEL NUMBERA a --2'I ` 5G
SUBDIVISON• V�ov
Division Lot
CPRESSURE o GRAVITY
(Circle one)
• AP I UG IN
Staff Initials
•
FINAL INSPECTION
SEPTIC SYSTEM CHECK LIST •
I) SYSTEM TYPE YES NO COMMENTS
A) CONVENTIONAL: (TRQM!)
B) ALTERNATIVE: (M �—
II) SEPTIC TANK �d
A) > Five Ft . from Foundation
B) Foundation-Tank Line Slope:
Cleanout provided if not 1-2a
C) Baffles Intact / Clean x
Dj Dividing Wall Sealed
III) D-BOX
A) Water Leveled
B) Speed Levelers Used1�
IV) FIELD
A) > Ten Ft . from Foundation
B) > Five Ft. from Property Lines IV _ _
C) Laterals Level to ± 1 inches D) End Caps Present If Not Looped _
E) Square Footage Adequate -7— _
F) Gravel Depth Adequate X _
G) Gravel Clean -7— —
H) PRESSURE SYSTEM
1) Sand Quality ASTM C-33 y'
2) MOUND: Sand Slope 3 to 1
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
A) Screen Insta
1) Basket / tttjUent Fil r _
B) Riser For Access Present
C) Alarm Installed V
VII) AS BUILT REQUIRED —f—
COMMENTS
Signature OE -Sanitarian — Date
vised: 10/20/92
'AS-DUILT FORM - PAGE ONE Rwie"d 07/12/93
' PARCEL IDSNTIFZCATION
Permit Number swGg 3 - 0,6 749 Subdivision�TdNC`�.Q/Q/� �T Q
Installer's Name(�$j�fr7iJCG Assessor's Parcel No. 3Z�3Z �Z /�II�
Designer's Name /*,Lie' /
INSTALLER CHECKLIST
I. SEPTIC TANK a No N/A
A) >5 ft from foundation? _
B) Building stubout to septic tank: cleanout provided if not 1-2% T
C) Baffles intact and clean? Z
D) Dividing wall intact? 2L _
II. D-BOX
A) Water leveled? T�
B) Speed levelers used?
III. DRAINFIELD
A) >10 ft from foundation and >5 ft from property lines? _
B) Laterals level to tl inch? _
C) End cape present if not looped?
D) System dimensions the same as shown on the design? L _
E) Gravel clean, properly sized, and proper depth? _
F) PRESSURE SYSTEM
1) Sand quality ASTM C-33?
2) Head height uniform and >24 inches? 8 �r
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? _
V. PUMP TANK
A) Screen basket or effluent filt (circle one) installed? /
B) Riser installed for access? _
C) Alarm installed? L _
CERTIFICATION OF INSTALLATION
Installer: Check box from Row "A," check box from Row "B," sign and date the certification.
A. 0 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 aide of this form.
B. 2� 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 certifigtgn.
The undersigned approves this installation of behalf of Mason County Department of Health
Services. n
AS-BUILT FORM - PAGE TWO
Revised 07/12/9-
PARCEL IDENTIFICATION
7=installerla
SW29 3 - 0,6 70 Subdivision dNEy�Q/�- �7 ,-
(N�n,�/nivYeion/nleek/LOC)
ameO/'f� S��f%� Assessor's Parcel No. �6Z.RZ9O!/1
me �/j,Lrf= /J• '/il/',G/ c:,.,��„�_p�o�< x,,,,,e��)
AS-BUILT DRAWING
/✓o✓sE �
Sr /•S'f.�a'L► BED
/zooz7�
Fr�TE� /N
w/G 30o AA L wrTh/ E/'o4j/ Aji ro
IS Z'/Pvc
LIQA/A/Fi�Gp � /
CAUTION: Minor adjustments to septic tank location and drainfield orientation made in the field by the imtoller are generally ac-
ceptable to both the department and the designer, but could in certain canes 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 frmm the design that affect system viability. Any deviations from the approved design moat be shown above.
AS—BIIILT CBECRLIST
Drainfield orientation Er Observation port location Undisturbed native soil
and layout between trenches
Cleanout location �{
Trench/bed dimensions and K 1 North arrow
critical distances within Vr Manifold placement
layout Scale of drawing shown
orifice placement on scale bar
D-Box/"T"/"L" location
ELateral placement, with Additional Mound Information
Septic tank/pump chamber distances to edge of bed
location Endslope width
Location of wells, roads n Location of build inns