Loading...
HomeMy WebLinkAboutSWG2007-00176 - SWG Application / Design / As-Built - 3/20/2007 MAR 2 ?���'� ONSITE SEWAGE SYSTEM APPLICATION ENVI'r4tVi & �iCtTYPUBLICHEALTH Official use only r HEALT%6 W. CEDAR STREET 7 LP Q m PERMIT NUMBER: SWG a m PO BOX 1666 i < m SHELTON,WA 98584 DATE RECEIVED: _ AMOUNT RECEIVED:$-352 _ v O (360)427-9670, Ext. 352 O w 7 APPLICANT DATE CHE KAPPLICABLEITEMS Z Cr m m �7 NEW SYSTEM 3 < 'Ae)'e/ ho'eol en �fQJ' 3 2' O O REPAIR SYSTEM O MAILING ADDRESS DAYTIME P E 0 TABLE 6 REPAIR G 7-0 e? -L-0 3— 0 TANK REPLACEMENT CITY STATE ZIP 0 RV HOLDING TANK ONLY J (requires waiver) 0 � m Sd.�//Dh �9 ��v INSTALLATION PERMIT ONLY N O SITE ADDRESS O�SINGLE FAMILY Z 0 OTHER Please describe C NAME OF DESIGNER PHONE NUMBER m �i1A,i/s E'/s 6G jF DDR�IIN-K/NG WATER SOURCE NAME OF INSTALLER O-OR VATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL 10 IN O COMMUNITYIPUBLIC WATER SYSTEM .� NUMBER OF BEDROOMS LOT SIZE: ACRES FT X FT SYSTEM WFI j SYSTEM NAME: K l4.-� Z�/(i tL• SPECIFIC DIRECTIONS FOR LOCATING S /'M-��", t /�• " CrvSS' �,2 !'�kri�S — �Z wt i /�'Ya� �/kv.EJ I . I 0 off r7ij. Site must be flagged from main road and test holes must be flagged with test hole numbers? I 0 10 Official use only below this line 0 SOIL LOGS COMAIENTYCONDITIONS N T Q ["� Vq SOIL TEXTURE CODES: V =very G=gravelly S=sand L—loam Si=sift C=day E=extremely IT 51NSTT10N SIGNA ?0 3(2� TE DESIGN EXPIRATION DATE DESI APPROVED BY DATE 1 FEE PAID DATE INSTALLATION E I TIO DATE TION AP VED BY DATE 7 7 0 7 i> Rev wd 11112007 ' MASON COUNTY DEPARTMENT OF HEALTH SERVICES March 29, 2007 Advanced Engineering 3427 Mud Bay Rd SW Olympia WA 98502 RE: Design for ALPINE EVERGREEN CO., INC. Case No: SWG2007-00176 Parcel No: 321330090024 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. 547 if you have any questions. Sincerely, \Penny Orth, Environmental Health Mason County Health Services COMMENTS: Installation fee required prior to installation 3/29/2007 1 of 1 SWG2007-00176 ECEIVEti DESIGN FORM—PAGE ONE A design will be reviewed when 3 conies of each of the following are submitted: MAR 2 02007 Completed design form that has been signed and dated. Scaled layout sketch, din all a lica s on checklist Scaled plot plan, including all applicable items on checklist. ✓Cross-section sketch, in�l c ms on checklist. Permit Number: SWG 07-17 t.P Designer's Name: Applicant's Name: 6014 le-0 4e� Designer's Phone Number: 3,fZ— 3 CC.9 Mailing Address: X, 1 /4 Designer's Address: 3Y z7 51�fi�v Cl city State Zip City State Zip Assessor's Parcel Number: 3 2 L 3 3 -- _!e n i i/�� �o Treatment Device endon❑Gl iofilter ❑ Sand Filter Mound B-Sand Lined Drainfield ❑ Recirculating Filter,Type: ❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other: Drainfield Type � ❑Gravity ❑Pressure ❑Trench aced ❑ Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms Schedule/C ZpD Daily Flow %,50 gpd LengthA O R O V E YB ft MC HEALTH DE F Septic Tank Capacity /z�n gal Diameter l-,j. in Receiving Soil Type(1-6) / Number MAR 2 9 2007 5, Receiving Soil Appl.Rate 60 gpd/ft' Separation p O ft Required Square Footage y d 0 ftz ■ Orifices Designed Square Footage -9B p ft, Total Number of Orifices BO Percent Reduction Taken O % Diameter ��,� in TrenchT5POVidth A, ft Spacing in TrenchV Length V f ft Manifold Elevation Measurements Schedule/Class �j0 Original Drainfield Area Slope t� % Length 7, 5 ' ft New Slope,If Altered O % Diameter Z• in Depth of Excavation (Up-slope) Z in Preferred manifold configuration used? ❑ Yes mi 0 from Original Grade (Down-slope) 2/ in Transport Pipe Designed Vertical Separation 2 in Schedule/Class 2jp Gravelless Chambers Required? ❑ Ye Optional Length 1 7 dam' ft Pump Required? GWe^s ❑No Diameter Z in Pump/Siphon Specifications Dosing and Pump a her Difference in Elevation Between Pump Shutoff and Uppermost Number of doses/day Orifice yz3 Ft Dose quantity gal Uppermost Orifice ❑ Higher ❑Lower than Pump Shutoff Chamber Capaci 2Oo gal Capacity @ Total Pressure Head 6 y,p gpm Pump control imer o pse Time Meter Circle ifrequired Calculated Total Pressure Head •D ft If Timer: Pu p on � 4d.S�iTPump off Comments T �/Yr7711C y4 j7oy 3 ' W d_ DESIGN FORM—PAGE TWO Assessor's Parcel Number: .3 2 / .7 2 -- 42 O Permit Number: SWG Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Test hole locations lYDrainfield orientation and layout Reference depth from original grade: 11'<Oil logs L�rench/bed dimensions and p� is tank E Pro erty lines critical distances within layout �nfield cover �Existin and proposed wells D-BoxNalve box locations g P P Reference depth from original grade within 100 ft of property eptic tank/pump chamber and restrictive strata: Measurements to cuts, banks, and locations 01�Laterals, trench/bed,top and surface water and critical areas I��O�bservation port location bottom Location and orientation of 1�3-<�ean-out location JY Ceyrtain drain collector curtain drain and all absorption ti7iiManifold placement Sand augmentation cc Portents rifice placement Other cross-section detail: U ocation and dimension of feral placement with distance E1-10�servation ports/clean-outs �� primary system and reserve area to edge of bed C�Buildings � � Other Information CH-'A�udible/visual alarm referenced Yes N��o__�/ Dir ction of slope indicator OiScale of drawing shown on scale ❑ L9­Design staked out aterlines bar ❑ worded Notices attached 13_,K,6�ads, easements,driveways, ❑ aiver(s)attached parking ❑ Pump curve attached D-<orth arrow and scale drawing ❑ ED-1 valuation of failure shown on scale bar Non-residential justification ❑ ❑ Waste strength ❑ ❑ Flow The undersigned designer ❑ does, 1311does not,waive the requirement to be notified by the installer at time of installation. /) ature 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: �)a 9/07 Environmen l ealth Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Department of Health Servic S. ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ✓ 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:2/23/06 C o •f 6,�� � � I,• Qp � 0�2 , J of-- o� ® It �� Z d4 A p�F V a % w p u V m G2, R �Q N ® (\�`�7\ g ��' �I II Id II vv .`1 4 O N CVa. a 3 Q \ h LL. „ W V u \' o = I I Z �1. `V I YNON (O U V7 y o Q oa. •o a ��v u ua V a ® ,o uii tau z < u ap dd y (J M g o \p N �` Q V PRO �h N I a r � . 5 _ a e i 1 i / ----_ Ln W m / W Z o (In 4 Oa W Co rn / WQ o , ro \ > o V r '� W Z3 OP I U ro M S•li L6.Q �t �O I I Q. in, aW 'p>rfFZWaW m Nrxi J� T2 1J -t' r^I< L ym 'O O� -:R on< Z wa Fx -wT _.9, /I w•O}�.Ny�SW6 K 06 �i F NqC <O rgiW V'O tWi C 3W [s a Q O m / O�N 6NF3 -Z 6 UW F W W qa LLS SJ E42 `� !�- O q FNJaN JF < Jq <� M:yY NW OV{- F oO 6N , ,xyW NLL2V Q- <aiu«i m <x �u wF• ur S' �� « FJ <.<W z ]W .� m ppFq rFivFi < V20 Fq NH.JJ aOW NU'JZ N NFI J>� r 6 F Q a.. z zo w< ZW� W U OS „aF w6 N 000 Nm m � „WZZ F q � W O< <V � UWHO x:+ 1 Rir '® F<OZO „N W tC F a Z U tjZ -0. „ >,O„ FFO OJWF J<2 Fv„i >OFN q6 N <t2 p qqN a q ZZ CN qµ KNw•OyTfFjr J V1VFJ WUZ S4. U ul rUiF 0ZzFN W<< VF W<V NW `^2 WN(LLL mWZN p2 aOj OO \/ N <W FN_F yy O JJ WO LLL<Lf! J ON NW F6 ZZ 6J qS wq� <<W alN 0.NF <m .<N Jz OFW< <O§U S xpS> 9 � UWHVvi JJ J00 a„F• <� 20q NU OU< FW JW xN} <UVWF y JYz M. > JJ J'�+'-� FJ FN O 2 V JC NWV M O:rJ� 6 NW W SF N6 w O2 6 /0<¢<¢ U�WCa NN N>°• tw MO FFja NOjm F>F H W wWJ Op• \/ CJ WOW WROW M WN x <O WC<F O J U �� O 8p .UM2q WS J< OJO WN p� Nu F Nwx q aww In x wu�< V� „w 00 O w F<W F2 W� 6 O F W.M w Y U FF F i a F2 mrt OU f+q JC.J S W F„ �o ..F20 M a NO� Sa 0 2 V2„W p� Iq�F Fq.S FF OF Jm O JOH W °.�•yy�� \//\� \ -:�W< NONW 2� 20� ZS J <NOt O<F'� <WO H�F MOWF ruq FzuWaw 00 0 LL oaF zgFa Nzuu uuN »x mow.. wzz zggo z uu u z uoq wF o w WWN OF gzti F u< :+Z>U<NW6ZV2, SW SW WH< J2< U2 NWN J u N6t W<W xNONi F UKt�Oq�CW I-•F FNO <UO N6U 'Fig FH_ <10-'-Zit <°d2 00� WSPO i �O p p� 09 ^ N Y YI N h 0 N, 0. d Ilk Z: LL `' 00 N 4 L0�1 Ouvii � � W IL VJ ,1' Q cv M H'JJ MG W 0MM �_���`���� VX a K vu Yw v � -j = J I a m u NM U U. W �>, Z j O O J JI 6 0 w <IJ w MQ 111 0 - 4W) ii c a c Ir g ��[�aii n.lry Nry nrvva • g w a t9 /h it m3 II r1pINi1b1F-rmgm0 >� 'l w,a W IINm OipFNpN if jNF ON$ o oilq-V I:w� 'n'wN$ a m ! H oo � W M m '�\• ii a n I� x may.N O xw a l a r ii . . . „ ,Zn Q N \j '• l n �im' R Ilaw.V..V.0 p au>�a F m ' Qo V N O£- u<n ii FNIwi°• FWS VFU¢ 3 U II �} �•) W W 4�Oo0 a a34 %,zlB „ iRm n N nrvnmamm Z a m qm o w ur1 0 ° asy � �a�,v n.l naNm rmwo p {V mN S 8 i ii :° a * z m m o w�4 n o rr w 0 PI 4 W '� iaafff r vrfi i m�•r � ]] ii Q Q � •Y1 \j° s Y�aYY O £.1„L aWmo q � Raa urNi tmVal�(IbOPONN a U ; m_JO'�'Ej a uFi aaN ii .n rao L y O l-1 iiNF 5 o V o n NF�h Ai �0:.1`Il .tirvna Nw rmo.l n�nlrvit (a\`^Yw1 j < e a oln a In a o o g G .I amrvo, pN ry £��p mo � K� oII NNyy a. n a N g' iiNn ry £rry °.Hry mwq °i iiF-13o'�' ya.lmmmr:o:aNN mEEE Cl x — u nP Fo o � mo� ii In lnaaocoeoo ti0i.o.00 �' J N zmo ' Owl: a000 G M p 1 L II AGymym Nam Q „ ' 3p°E pmq �R >� > IXi apape� II Y �r.10� Irmmy.Lm a � 3IXCEll mmmudi.Fi umimn HUM V1 R o aN''�aJw r]P 4LOZZ, IImWp £ ' Sw FF.i lm Nrm.lrvnn EWUN F£wmw��m £ rM .]_N ii n.�.r.vnrvrvrvN .0 N£ y� Na pN m m POW > w0 fir, gFm, W ELP H N F II ��w� �w aam�o .xiaa � �aaz_ I Fw ii"rv�a mw�m mo r N m I •13+NI OY3N 1Y101 ASBUILT FORM Mason Count Public Health Permit Number SWG ©7 Assessor's Parcel# 32J33 CEO 9� ?1L /� /L (Twelve-Digit Number) Applicant's Name gob LlpOvr,/f�2Cr Subdivision ` (Name/Division/Block/Lot) Applicant Address 9- 30)/�(/'✓�+/4,1"d' I✓CL/d+j Installer's Name /�1! IZI �CttCufe7�loc✓LLG �41Q&W " /04011a"Ct &Li/GYtiA!tKkIL��� City, State,Zip / !r Designer's Name Isom N/A Yes Prior to Completion I. SEPTIC TANK >5 ft. From foundation?............................................................. ❑ ❑ >50 ft from wells? ................................................................... ❑ ❑ >50 ft surface water? ................................................................ ❑ ❑ Building stubout to septic tank: cleanout if not 1-2%? ................... ❑ Re ❑ Baffles intact and clean?............................................................ ❑ d ❑ Dividing wall intact?................................................................. ❑ EY ❑ Risers installed for access?........................................................ ❑ ❑ Screen basket o e uent flit installed?(circle yone)n..........._.......:_ ❑ p� ❑ Tank size: 2.ov gal.; Manufacture: C_LW0b P4VAZ> _ II. D-BOX Leveled with water? ........................................................... ❑ ❑ Speed leveler used? ............................................................ 0 ❑ ❑ III. Drainfield >10 ft from foundation?....................................................... ❑ I, ❑ >5 ft from property lines and easement lines? ............................. ❑ lY ❑ > 100 ft from wells?............................................................ ❑ 0� ❑ > 100 ft from surface water? ................................................. ❑ 931� ❑ >10 ft from potable water lines? ............................................. ❑ ®' ❑ Laterals level to±1 inch&end caps present if not looped? .............. ❑ fl3' ❑ Gravelless chambers utilized? ................................................ jW_ ❑ ❑ Gravel clean,properly sized,and proper depth?........................... ❑ 93� ❑ PRESSURE SYSTEMS Sand quality ASTM C-33? ................................................. ❑ ❑ Head height uniform _>24 inches? Actual head height 4tf~ ❑ ❑ Clean-outs and observation ports present?......................... ❑ 0 ❑ Mound: Side Slope 3:1? ............................................. ❑ ❑ Owner informed electrical connections must be made by ^ >' owner or licensed electrician and inspected by L&I?............... ❑ Pt Z IV. PUMP/PUMP CHAMBER � o �„� O Pump make Pump model -Se !f(J�¢ ❑ ❑ U Chamber size /bt) gal; Manufacture CLA-L* a4kulc ❑ ❑ r Z Height of pump off bottom of pump chamber 1 Z" inches w O Pump chamber draw-down to gallons per inch per minute N Pump capacity 35— gallons per minute w Pump controls: Timer, Elapsed Time Meter, Counter? (Circle all that ❑ ❑ apply). If timer: Pump On — Pump Off Riser installed for access?......................................................... El Alarminstalled?........................................................................ ❑ 0 CHECKLIST gk'Drainfield& manifold orientation & layout _ V� Trench/bed �t dimensions and critical distances within layout 9� Septic/pump tank �,QQ placement • OVA Ur Location of buildings a/Observation port& at`� J clean-out location Ito Location of wells & `V roads Ltd Undisturbed native soil between 6� iitrenches I �ytue��t North arrow q Id I It A Id t 6011 �t Iv CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generally acceptable to both the department and the designer, but could in certain cases compromise the viability of the system. It is the installer's responsibility to obtain prior written approval from either the health department or the designer before matnng any deviations from the design that affect the system viability. Any deviations from the approved design must be shown above. Inst�allerr- Check a box from Row "A"and`B", sign and date the certification A. gr 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. An/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 brs 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. $/ A nature of Installer Date The undersigned approves this installation on behalf of Mason County Public Healt Si�nah�re Sanitarian Date Revised January 2007