Loading...
HomeMy WebLinkAboutSWG2007-00261 - SWG Application / Design / As-Built - 4/27/2007 ONSITE SEWAGE SYSTEM APPLICATION MASON COUNTY PUBLIC HEALTH Official use only ( m 426 W. CEDAR STREET PERMIT NUMBER: G ��� I a PO BOX 1666 1 0 ' SHELTON,WA 98584 DATE RECEIVED: AMOUNT RECEIVED:$ 35� 0 (360)427-9670, Ext. 352 O or APPLICANT DATE CHECKAPPLICABLE ITEMS Z f m m NEW SYSTEM 0 3 REPAIR SYSTEM -m r MAILING ADDRESS DAYTIME PHONE O TABLE 6 REPAIR C O TANK REPLACEMENT CITY ` STATE ZIP ( O RV HOLDING TANK ONLY (requires waiver) m O INSTALLATION PERMIT ONLY SITE ADDRESS v (((v"""'''��� SINGLE FAMILY I Z O OTHER Please describe L 3 NAME OOF^DESIGNER 1 \ PHONE NUMBER DRINKING WATER SOURCE < Il NAME OF INSTALLER X PRIVATE INDIVIDUAL WELL < O PRIVATE TWO-PARTY WELL p ,� ^ 0 COMMUNITY/PUBLIC WATER SYSTEM NUMBER O)F1 BEDROOMS LOT SIZE: ACRES �����\)))FT X FT SYSTEM WFI#: 1' �--i bs �{,ccc���,,,���yly� � \ SYSTEM NAME: yr�JA`�� SPECIFIC DIRECTIONS FOR LOCATING SITE. N 10 \C hYs p Site must be flagged from main road and test holes must be fla ed with test hole numbers p r Official use only below this line » 10 SOIL LOGS COMMENTS/CONDITIONS o -Z?A -7 zs I K� r lC \ z n Fh, N 3© ' Go V C-t 2- d m•' SOIL TEXTURE CODES: V =very G=oraveliv S=sand L—loam Si=silt C=clay E=extremelyd� INSPECTOR SIGNATURE DATE DESIGN EXPIRATION DATE DESIGN APPROVED BY ATE INSTALLATION FEMPAID DATE INSTALLATION EXPIRATION DATE INSTALLATION APPROVED BY DATE Revised 1/1/2007 MASON COUNTY DEPARTMENT OF HEALTH SERVICES May 18, 2007 Dale Tahja Design 2450 W Deegan Road W Shelton WA 98584 RE: Design for CHAMBERUN Case No: SWG2007-00261 Parcel No: 321330090023 Your design for the above referenced parcel has been review and is APPROVED. Please refer to the comments section of this letter for any additional information. Please call me at (360) 427-9670, ext. 279 if you have any questions. Sincerely, Amanda Reynolds Environmental Health Mason County Health Services COMMENTS: 5/18/2007 1 of 11 SWG2007-00261 DESIGN FORM-PAGE ONE IF A design will be reviewed when 3 copies of each of the following are submitted: .-•!.Completeddesign.form-that-has been signed and dated. - -- •'!•Scaled layout.sketchi including all applicable items on checklist- Scaled plot plant.including all ap licable items on checklist. Cross-section sketch,including all applicable items on checklist. Permit Number: SWG �� Designer's Name: Applicant's Name: 1 Aesigner's Phone Number: \-, Mailing Address: Designer's Address: h W City Sta a Zip City State nZip Z) Assessor's Parcel Number: `a1� QQ - �SCQdrJ '#p Treatment Device ❑Glendon Biofilter ❑Sand File w T Mound ❑ Sand Lined Drainfield ❑Recirculating Filter,Type: ❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other: Drainfield Type ❑Gravity ❑Pressure ❑Trench ❑Bed ❑ Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms Schedule/Class JO,�i -- —tcl Daily Flow gpd Length �J)pRO ft Septic Tank Capacity gal Diameter M4► H�A in Receiving SoiLType(1-6) Number MAY 1 S 2 Receiving Soil Appl.Rate gpd/ft Separation Required Square Footage Orifices Designed Square Footage ftZ Total Number of Orifices Percent Reduction Taken % Diameter \ in Trench/Bed Width ft Spacing in Trench/Bed Length ft Manifold Elevation Measurements Suss Original Drainfield Area Slope % Length ft New Slope,If Altered % Diameter in Preferred manifold configuration used? ❑Yes l!3No Depth of Excavation (lip-slope) in from Original Grade (Dw-uope) AJ in Transport Pipe Designed Vertical Separation �-- in 9chednlelC'tass . Gravelless Chambers Required? ❑Yes ❑No';6 Optional Length C ft Pump Required? ❑ Yes-ji�No Diameter in Pump/Siphon Specifications Dosing and Pump Chamber Difference in Elevation Between Pump ut and Uppermost Number of doses/day Orifice Ft Dose quantity gal Uppermost Orifice❑Higher ❑Lower than Pump Shutoff hgmber Capacity gal Capacity @ Total Pressure Head � gpm P controls: Timer(or Elapse Time Meter Cir equired Calculated Total Pressure Head ft if, Pump on Pump off Comments na! - -A PIA GFSIGNF_R - . DESIGN FORM—PAGE TWO Assessor's Parcel Number:�a 1� - QQ - `�Q� Permit Number: SWG Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch -i�, Test hole locations Drainfield orientation and layout Reference depth from original grade: -Jd Soil logs Trench/bed dimensions and -A Septic tank Property lines critical distances within layout -J4 Drainfield cover -� Existing and proposed wells D-BoxfValve box locations Reference depth from original grade. within 100 ft of property1 Septic tank/pump chamber and restrictive strata: Measurements to cuts,banks, and locations 1 Laterals,trenchlbed,top and surface water and critical areas Observation port location bottom Location and orientation of Clean-out location Curtain drain collectorN4 curtain drain and all absorption JO, Manifold placement . Sand augmentation components Orifice placement Other cross-section detail: Location and dimension of Lateral placement with distance -�Q Observation ports/clean-outs primary system and reserve area to edge of bed Other Information Buildings Audible/visual alarm referenced Yes No Direction of slope indicator Scale of drawing shown on scale ❑ Design staked out Waterlines /` bar ❑ ❑Recorded Notices attached Roads, easements,driveways, ❑ ❑ Waiver(s) attached parking ❑ ❑ Pump curve attached North arrow and scale drawing ❑ ❑Evaluation of failure shown on scale bar - Non-residential justification ❑ ❑ Waste strength ❑ ❑ Flow The undersigned designer-does, ❑ does not,waive the requirement to be notified by the installer at time of installation. Signature of Designer ° Date The undersigned has reviewed this design on behalf of Mason County Department of Health Services and determined . it to be in compliance with state and local on-site regulations: Environmental Health Sp6cialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Department of Health Services. ✓ The.Onsite Sewage Permit has not expired,the Permit Expiration Date is: Zl i �'' 21 l' (C) ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. Please Note: The system must be installed by a certified installer,unless prior authorization is obtained from Mason County Department of Health Services. An Installation Permit is required. Revision Date:223/06 �1 J h' v D i vv' I 1 y I � 1 PROVED MC H MAY 1 S 2007 AOR I i (^IVl1\Jn I I I I I Y. &IJ �ise�cs x } a c {s. •. f 1 r pROVEDDEPT m---rg--ZN7- -- ADR WAS w tx 51N214 TF DALE. L. TAHJA � I (-FNHF) DESIGNER EXPIRES; - 4D AV �G TBhja, RA .S W W,WA W SHH ION,WA➢!!H MNN:(Jf�YL0.5M0 Fex:pt@ 130dN9 i. INSTALLATION / MAINTENANCE GRAVITY BED SYSTEM 1. Install bed bottom level. 2. Install locator tape on top of all drain-field laterals. 3. Install drain-field during dry weather and soil conditions. Any soil smearing must be eliminated by hand raking. 4. Install effluent filter in septic tank outlet as specified in tank details. 5. Filter fabric required over drain rock prior to back-filling. If the drain rock extends above natural grade, run the filter fabric at least 2 inches down the trench wall. 6. Divert all storm water run-offs away from on-site sewage system. 7. No curtain drains allowed within 10 ft. of the up-slope edge of the drainfield and reserve area. 8. No curtain drains allowed within 30 ft. of the up-slope edge of the drainfield and reserve area. 9. Have the septic tank inspected every three to five years. 10. All materials and workmanship must meet County and State regulations. 11. Deviation from this design without prior approval from the Designer and Mason County Health Department will make this design null and void. 12. The prepared plot plan is not a survey, it is the owner's responsibility to verify property line locations prior to installation. Any discrepancies must be reported to the designer immediately. / v ,( eo, cr (� S S �.l co - (� 6� D,o6,}' C� CC _d � o 3 o o L v O°' d d0 2L - �au�t r v �- ASBUILT FORM Mason Count Public Health ,Permit Number S WG OZ)26-/ Assessor's Parcel# 321 3 3-O-O— 9M23 (Twelve-Digit Number) nn ,� Subdivision ��TT 22r1� �Ot Applicant's Name !V(unn�'f' UJRoa ,LGrt (Name/Division/Block/Lot) Applicant Address S.� ✓�� 5"/[ etJ sc,oQ BLO Installer's Name City, State,Zip Designer's Name t/I— N/A Yes Prior to Completion I. SEPTIC TANK >5 ft. From foundation?............................................................. ❑ ❑ >50 ft from wells? ................................................................... ❑ ❑ >50 ft surface water? ..............................................................- ❑ 18 ❑ Building stubout to septic tank: cleanout if not 1-2%? ................... ❑ or- ❑ Baffles intact and clean?............................................................ ❑ )� ❑ Dividing wall intact?................................................................. ❑ ❑ Risers installed for access?........................................................ ❑`. ` a ❑ Screen basket ordlue t nstalled?(circle one) .. ................. ❑ 10 ❑ Tank size:_ (24V gal.; Manufacture: GU .. �n Y lter� II. D-BOX Leveled with water? ........................................................... ❑ ❑ Speedleveler used? ......................................%..................... ❑ ❑ III. Drainfield >10 ft from foundation?....................................................... ❑ 19 ❑ >5 ft from property lines and easement lines? ............................. ❑ 6sl ❑ > 100 ft from wells?............................................................ ❑ 19 ❑ > 100 ft from surface water? ................................................. ❑ 1s ❑ >10 ft from potable water lines? ............................................. ❑ ' P ❑ Laterals level to+1 inch&end caps present if not looped? .............. ❑ 5a ❑ Gravelless Aambers utilized? ................................................ 1X ❑ ❑ Gravel clean,properly sized, and proper depth?........................... ❑ J ❑ PRESSURE SYSTEMS Sand quality ASTM C-33? ................................................. ❑ ❑ Head height uniform >24 inches? Actual head height la ❑ ❑ Clean-outs and observation ports present?......................... D ❑ ❑ Mound: Side Slope 3:1? ............................................. `Zl ❑ ❑ Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I?............... 15K ❑ ❑ IV. PUMP/PUMP CHAMBER Pump make , Pump model .� ❑ ❑ Chamber size gal; Manufacture ❑ ❑ Height of pump off bottom of pump chamber inches Pump chamber draw-down gallons per inch per minute Pump capacity gallons per minute Pump controls: Timer, Elapsed Time Meter,Counter? (Circle all that ❑ ❑ apply). If timer: Pump On Pump Off Riser installed for access?......................................................... ❑ ❑ Alarminstalled?........................................................................ ❑ 0 - / CHECKLIST C� Drainfield& manifold orientation / & layout N] Trench/bed dimensions and ` critical distances within layout Septic/pump tank placement I IS Location of I r buildings I Observation port& clean-out location I Location of wells& roads t Undisturbed native soil between trenches 1 North arrow rr b �O5 t� CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the in are generally acceptable to both the department and the designer, but could in certain cases compromise the viability o(the system. It is the installer's responsibility to obtain prior written approval from either the health de artment or the designer before making any deviations from the design that affect the system viability. Any deviations from the approved Z ign must be shown above. Installer: Check a box from Row"A"and`B", sign and date the certification A. 1t I certify that I installed the system without any ❑ I certify that all deviations from the design stamped deviation from the design stamped"APPROVED'by "APPROVED"by MCPH are shown above. MCPH B. ' I certify that I contacted the designer and left the ❑ I did not contact the designer prior to final cover because the system open for inspection up to 48 his prior to cover. designer 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. S' ature of Installer Date The undersigned approves this installation on behalf of Mason County Public Health. to !"7 Signature o Sanitarian Date Revised January 2007