HomeMy WebLinkAboutSWG96-0587 - SWG Application / Design / As-Built - 8/16/1996 CJ6
MASON COUNTY DEPARTMENT OF HEALTH SERVICES ` PE IT NO. SWG IF- — m a
C N
Is-I to-� a
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date_ N
y o
PHONE (360) 427-9670 Receipt No. .�1
Amount$ Ami m f
a O _ _ CHECK APPLICABLE ITEMS �/
3 �
m �
MASNG ADORES �aS+ O r AYTIME PHONE: NEW SYSTEM
1 REPAIR SYSTEM
CITY: STATE: � ZIP: MAINTENANCE REVIEW m
SINGLE FAMILY m
PROPERTY ADDRESS- OTHER z
SPECIFY:
3
SPECIFIC DIRECTIONS FOR LOCATING SITE: n�1 PRIVATE WELL m
* L.e L e CL- COMMUNITY WEL#PUBLIC SYSTEMSYSTE
i k le RcC A Le�t �} �dd rr5s p��� SYSTEM NAME p
APPLICANT
} pk- Road - e► C NAME /- I�
Name of Lot ft. x ft.
MAILING ADDRESS
Cl qjW
Installer( - _- w Size: acres TELEPHONE - O
Name of a um er o SIGNATURE o
Designer �� Bedrooms ' 3 UP S gn X
PLOT PLAN _ W
Draw a dimensional plot plan,
including: m
o
x
❑Precise location of test 7S`
holes, showing IQ
measured distances to
property boundaries. r'
❑Entry road;other roads, r boo � y o
driveways. 39/ a l
NOTE: DO NOT DRAW IN \
SYSTEM DESIGN nEIS
'kKI- s
OFFICIAL USE LY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS Th'>
� /6SAul�La <� D-IC)
sanro>'LaG�
O-Lt'SRNDYL��w�
<14
4 a�-P5� T /ft
t/er C�vS� L �F—b TY/, 1,4
/J Fug S4k9e�G� TAUd � SRNO�(,� •L
-s rYrtz1ya G 7 - 73 jE:7, .,t
z/,so sraND f6Y4 vtc-
�7r°•-1 Y!
'n �� Depth from Original
Grade to Restrictive
Layer or Water Table: �b In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One (fwo
Soil Type �/ Z
Vertical Separation in. / Septic Tank Daily 2 U GPD
Capacity: �,y DU Gal. Flow:
Slope 3 % Appl. Infilt.
Parcel Size z •s AC. Rate ' GPD/FT7 Area 00 FT'
Distance to Shoreline 29 it. Total 7 Inspector� Date 2-
COMMENTS/CONDITIONS FOR APPROVAL
•All septic systems must be designed and installed by contractors certified by Mason County Department of Health Services, unless prior approval is
granted by the department,or the design is by a professional engineer.
•Septic permit approval does not imply other building site requirements(i.e. RLC,Water Adequacy)have been met.
•Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.
•This permit expires 2 years from the date of site review. Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE REVIEW: roved INS ALLAT c1 DESIG REVIEW 'Approved -i Not Approved Approved ❑Not Approved
BY: g- � 3 ' v DATE. BY: DATE: �9 BY DATE:// �3
TOP: Health Dept. Copy IDDLE: Designer's Copy BOTTOM: A cant's Copy
DESIGN FORM - PAGE ONE R.vi..d 07/28/95
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
�(j, tyoution sketch, including all applicable items on checklist
,��l�y111�11 ILa� IRVN !UI o �LJ�.tion sketch, including all applicable items on checklist
IISEP I j
a�1 PARCEL IDENTIFICATION II
II y'E"A•�1'L1,1ER\j�fjS 9!(0 �05 �7 Designer's Name L/3y,L� J/l II
II Applicant's Name /NOA /'/. VoMaS Prop. Owner's Name 41A,60,oI/'/• �'19MB5 II
II Mailing Address S� 30 AY £�Y57 k Mailing Address �F, y AS7
II .e/-"4. tt)/F
i"zy Scace 41p
IIAssessor's Parcel No. 3.7/ 39-13 ' 94/00 Subdivision
II a ve- igi u er me i si - c o I
J
II DESIGN PARAMETERS
✓ / ✓ ✓ II
Designed II
r Vertical �I
II u 126 u u separ tion II
it Mound Subsurface Pressure Gravity Bed Trench in
II septic Tank/Drainfield Specifications I rtn n II
II No. Bedrooms I Pressure Distribution? 'i-T Yes. U No
II Daily Flow Q d Ic::9cciiiicEcii:ii:cEc:i (If yes, proceed. . .) ..II
II septic Tank Capacity gal
c•39
Receiving Soil Type (Rat u
a ft' i Laterals �I
II Receiving Soil Appl. Rate - �Q .
II Trench/Bed Bottom Area 3/i!J ft' I Schedule/Class / ft II
II Trench/Bed Width 9 ft I Length 40- fo- 4o
Trench/Bed Length 4D ft I �I
III I Diameter /¢ in
II Elevation Measurements I Number 3 II
II Original Drainfield Area Slope 5; t I Separation 3 ft II
II Drainfield Area Slope if Altered -Q- % I Orifices ¢ II
II .l I Total Number of Orifices
II Depth of Bottom of Tre� in I Diameter ''��� in II
II from Original Gra%pd Ps ope I Spacing 30 ' II
0 . l,�� � ;2 in I Manifold II
II � y owns ope I Schedule/Class
��p �6O II II ,wr Q Q n �7'I I Length ft
II Infiltrator e3 /U Yes bl No I Diameter n
r-1 I Transport Pipe �QD II
�I Pump Required? ale Yes U No I Schedule/Class II (I ) ILength
j ft
...................... s, proceed. Eccc...:iccc9iEcii:S9Sc II
? II
Diameter in
pump/Siphon Specifications I Dosing and Pump Chamber
II Difference in Elevation Between Pump Shutoff I # Doses/Day a1
�I and Uppermost Orifice o��1 ft I Dose Quantity
I1 i Chamber Capacity / q0 cial
II Uppermost Orifice is Mi higher, U lower
II than Pump Shutoff 3 I Check the following components if they, drain II
II Capacity m Tot. Pres. Head C:5�tF m I between doses: �--��� ICI
Calculated Tot. Pres. Head ft I r0O s
II (Attach pump Curve) I "I Laterals Manifold Transport II
DESIGN FORM - PAGE TWO R.vi..d 07/28/95
II DESIGN CHECKLISTS II
II Scaled Plot Plan I Scaled Layout Sketch I Cross-Section Sketch �I
� Reference depth from orig-
TeLZJ st hole locations I Drainfield orientation I inal grade: II
n I and layout I `[�
I l� Septic tank lid and
Property lines II
I Trench/bed dimensions and I drainfield cover depth II
Existing and proposed I critical distances within I II
II wells within 100 ft I layout I Reference depth from orig- �I
�I of property lines I I inal grade and restrictiveAJ II
D-Box/"T"/"L" locations I strata: II
Critical distance
II I Septic tank/pump chamber I Laterals, trench/bed
measurements to cuts,
II top and bottom
banks, surface water I location
�n�7Lyn - I I
/yam Location and orientation I � Observation port location i /4H Curtain drain collector
II
III of curtain drain and all I n Sand augmentation II
�I absorption area _ I Cleanout location I
II components
Z Manifold placement I No external reference needed:11
II LJ Location and dimension I I n
Orifice placement I Observation ports and II
II of primary system and I � cleanouts 11
11 reserve area I
I [�?l Lateral placement, with
11 1I � Buildings I distances to edge of bed I Additional mound informati
11
I Audible/visual alarm I U slope and downsl a II
II Direction of slope I indicator referenced I fi width 11
II
11 I
Waterlines I Y'" Scale of drawing. shown I U Settl d cap pth at II
�I
on scale bar I center nd dge of bed II
II Roads/easements/ I I U Side s Pe II
driveways/parking i dditional Mound Info I II
U /downslope b elevat. II
II � Critical resource lands � U En s width
11
(if applicable) i n
IJ verall fill di sions I - o leted Resource L s and II
II Critical Areas Checklist
North arrow and scale of I I II
I� drawing shown on bar I I
DESIGN APPROVAL �I
II �� � Y does, LJ does no waive the reqirement to be notified by the
II The undersign es
& II
II on given ae o s to perform a final inspection prior to
installer II
O II
II cover.
II \n\ s\S na e e a II
III The undersigned has reviewed a approved thi sign on behalf of Mason County of Health I�
�I services. "/J 11
a np or a e
II
III CAUTION: DESIGN APPROVAL IS VALID Y UNDER
MASON OWING
CONDITIONS: OF HEALTH SERVICES
STAMPED n II
THE DESIGN IS APPROVED
f THE ON-SITE SEWAGE PERMIT HAS NOT EXPIRED; EXPIRATION OF SAID PERMIT IS BASED ON
THE DATE OF INITIAL SITE INSPECTION, NOT.ON THE DATE OF DESIGN APPROVAL II
f THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS II
II OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES II
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Performance Data
12 40
Pump Characteristics
Pump/Motor Unit Suhmerslbk 30
Automatic Models W25A1 D25AI 8
Horsepower 1/4 -
FuR Load Amps 8.0 t/eNI
Motor Type Shaded Polo 14 pok) 4
R.P.M. 1550 10
Phase 0 1
Voltage its -
0 0 -
Hertz 60 Copo iv,BS GPM 0 10 20 30 40 50 60
Temperature 1204 Ambient - lters/serond 0.0 1.0 2.0 3.0
NEMA Design A
ad mete s/hr 0 2 4 6 8 10 12
lusulotioa doss A
Dischorga Size 1-1/2"NPT(38mm) Total Head fleet) 4 8 12 16 20 [_124
SoOds Handling 1/2'(13mm) GPM(U.S.) 44 36 24 23 12 0
Unit Weight 30lbs.
Power Card 18/3,S1TW,10'std. Dimensional Data
(20'opliosral)
3.1f2 5-7/6 I.At dimemiote in aches
—�4.1/2 1.(umpo tdioenSau may
�i
z , ray±I/1 x.sh
7.Not lx mmtrvcAar purpose342 1Y mlm joss
a, 1-::2 NPT # Oi.nensans end•cehY ale of Construction I � �,ioszV'N uiscsunoe grro,mae
�.F .• t, s.m;ratL,daa,,.nN�e
Handle Stainless Steel strz 6 Wx reww the title to
.t as6c a:cwa;io our
Lubricating Oil Dielectric 00
Motor Noting Castron i _- -- '- w•:II¢oiiom.
_ �" �� Islmrm C1i40
Pump Casing Cast Iron
Shaft Steel
Mechantul Seal Faces:Carbon/Ceramic
Shalt Seal Seal Body:Anodized Steel
Spring:Stainless Steal
Bellows:Buna-N .�.. ¢.
�, '� # fir. ' lose
Impeller Thermoplastic F ''
e
7-7/8]re 4 ]-].re
Upper BearingCa Poea
(list Iran Sleeve ;sir - P oN
fRR{ 4 —�
Lower Btarin Single Raw Ba0 Beori
3-318
Strainer/Base Plastic s p I PUMP OFF
Fasteners Stainless Steel — J
AURORA/HYDROMATIC Pumps, Inc.
1840 Baney Road, Ashland, Ohio 44805
(419) 289.3042
INSTALLATION_1__MAINTENANCE
Pressure Distribution Systems
1. Install laterals with contour of the ground.
2. Install locator tape on top of all drainfield laterals.
3. Install observation ports as indicated on Plot Plan, with
bottom extending to the drainrock\native soil interface .
4. Install drainfield during dry weather and soil conditions,
any soil smearing must be eliminated by hand raking.
5. Install threaded clean-outs at the ends of all laterals, ( caps
must extend to within 6" of finished grade ) .
6. Install audio/visual high water alarm.
7 . Install 1/8" mesh non-corrosive screen (min. 12 sq. ft . surface
area, preferrably in septic tank at outlet port.
8 . Install check valve in pump transfer line (and manifold when
needed)to prevent system drain-back into the pump chamber.
9. Provide a 3/8" NPT (National Pipe Thread) fitting between
check valve and pump for pressure guage connection. Use
pressure guage at time of pressure test to permanently record
the 'Perfect System Pressure' , so a comparison can be made
during inspections to determine 'Condition of System' .
Pressure guage may be removed and replaced by pipe plug
between inspections.
10 . Install all laterals with orifices placed at 12 o'clock. Leave
at 12 o'clock and place suitable shields over orifices (except
when using Infiltrators ) after pressure test and upon approval
by Health Department.
11 . Filter fabric required over drain rock prior to backfilling.
If the drain rock extends above natural grade, run the filter
fabric at least 2" down the trench wall .
12 . Have the septic tank and pump chamber pumped or inspected
every 3 to 5 years .
13 . Inspect and clean pump screen every 6-12 months as needed.
Inspect floats and test high water alarm every 6-12 months
as needed & use pressure guage to determine 'Condition of
System' .
14. All materials and workmanship must meet County and State
Regulations.
15 . Deviation from this design without prior approval from the
designer and Mason County Health Department will make this
design null and void.
16 . A dose counting device will be included in the installed
system.
17 . If Pre-Treatment is required, refer to:
INS PTALLATION1MAIN.TENANCE
of re-Treatment Systems
b '
ON-SITE SEWAGE INSTALLATION
PRE-INSPECTION
........................................................... 1 ��/+
DATE•CALLED IN: IQ13l r`l/
TIME: //2-Y Ay—,
INSTALLER: Y SV L/�
APPLICANT/OWNER: U Ad
CALLER: clo
PHONE # OF CALLER: L1. v� �
PARCEL NUMBER: 1 ` �"'� _ 100
SUBDIVISION:
DIVISION: LOT:
SYSTEM TYPE (CHECK ONE) : r1 IJ
u
PRESSURE GRAVITY
INSPECTION SCHEDULE (CHECK ONE) :
u u
APPOINTMENT PLUG IN _
AS-BUILT ON-SITE? (CHECK ONE):
YES NO
.................................................
'E .... .....................
,STAFF INITIALS: ^(1✓ ��1. �(G �2
"-7ar
heeellin.w
Revised 04/09/96
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
I GTAPP C110CMUST
I
COWPIMIED BY xRSPacroa?
I I
X. Banc Twor - Yu No Comments
A) >5 ft from foundation? J _
a) Bldg stubout to septic tank: cleanout if not 1-2%?
c) Baffles intact and clean?
D) Dividing wall intact? V _
xz. D-soz Leveled with water or speed leveler. (circle one)?
I
xxx. Dnntrxzm
A) >10 ft from foundation and >5 ft from property lines? V _
3) Laterals level to xi inch & end caps present if not looped? `T _
c) System dimensions the same as shown on the design? V _
D) Gravel clean, property sized, and proper depth? _
a) PaasaDas Starr?
1) Sand quality ASTM C-33? �L
2) Head height uniform and a24 inches?
s) Cteanouts and observation ports present? _
I 4) Mood: Side slope 3:1? _ I
s) Owner informed electrical connections must be made V
by owner or licensed electrician and inspected by DLI?
xV. POTaara "&= LxHas
I A) >10ft from drainfield, transport tine, and septic tank? V _
a) Wells >100ft from drainfield? J _
V. PID@ TAM
I A) Screen ske or effluent filter (circle one) installed?
I a) Riser led for access?
c) Alarm installed?
Vx. As aDILT 2a0oz3sn7 V
1
Vxx. OTC CCIamIT9 I'
I
I
t
( I
The undersigned has reviewed this installation and verifies these findings an behalf of Mason County of Health Services.
lnspwxov
a e I
h:callin.w
Revised 04/09/96
• r
AS-BUILT FORM - PAGE ONE R..,i." 11/14/94
PARCEL IDENTIFICATION
II Applicant's Name L:\kft�-A V0 Y00S
—T
II Permit Number SWG9 (0 - ��6� Subdivision
II
II 1
Installer's Name CAS LJIG _ Assessor's Parcel No. va130 rj II
II Designer's Name a 41 Tr n TI'a€i' II
I
II INSTALLER CEECKLIST II
N/A Yes Prior to
I. SEPTIC TANK \\V_ II
Completion
II A) >5 ft from foundation? `TT II
II B) Bldg stubout to septic tank: cleanout if not 1-2t? _ _ II
II C) Baffles intact and clean? _
II D) Dividing wall intact? II
II. D-BOX Leveled with water and/or speed leveler (circle) ?
III. DRAINFIELD 1 II
A) >10 ft from foundation and >5 ft from property lines? Y II
B) Laterals level to ±1 inch & end caps present if not looped? II
II c) System dimensions the same as shown on the design? _
II D) Gravel clean, properly sized, and proper depth?
u E) PRESSIIRE SYSTEM II
1) Sand quality ASTM C-33?
2) Head height uniform and a24 inches? _
3) Cleanou" and observation ports present?
4) Mo : Side slope 3:1?
5) owner informed electrical connections must be made by V
owner or licensed electrician and inspected by DLI? u
IV. POTABLE WATER LINES
A) >10ft from drainfield?
B) Wells >looft from drainfield? II
II V. PDMP/PDNP C8ANBER 1 II
u A) Designed pump used, or specs attached for equivalent pump? 1 II
u B) Screen basket or effluent filter (circle one) installed? `� b
C) Riser installed for access? \1�
D) Alarm installed? „
i
CERTIFICA=ON OF INSTALLA=ON p
H Installer:. Check box from Row •A.' check box from Row RB,• sign and date the certification.
A.� I certify that Z installed the system
u I certify that all deviations Fran p
II without any deviation from the design the design stamped "APPROVED- by MCOHS are b
II stamped -APPROVED" by MCDHS. shown on the reverse side of this form. 'I
II B. u I certify that I contacted the I did not contact the designer prior II
II designer and left the system open for to final cover because the designer If
II inspection up to 48 bra prior to cover. waived the notification requirement. II
II I further certify that all information contained on this form is accurate. , I understand II
II that if the informatio iaed:herein' is not accurate, there will be 3ust:cause, for. I ..
II immediate suspension f my ' taller certification.
IIThe undersigned approves this installation of behalf of Mason County Department of Health II
II Services. 1.
4" �'\
kS-BUILT FORM - PAGE TWO Revised 12/14/94
PARCEL IDENTIFICATION �I
Applicant's Name
uu rF i�
Permit Number SWG° - O�o, _ Subdivision 02.
ame 1Vl5 Lu'll
Assessor r's Parcel No. ��� �1 goluo
installer's Name II
we ve- i er II
Designers Name
AS-BIIILT DRAWING II
16
I II
'I II
I 11
II I
II II
II 10-A II
II 1�CD it
II II
II it
II II
II � II
II II
cWrICN, sneer adjustamu to septic tank locatim sod drainflald orlm"tim rode !a the field by the installer atr ymerallY
oWtable to bath the depatt•ent sad the deigasr, but could In certain ease aomproaise the vdability of she syste- IC is the
iastaller•e reapm lkdlity to obtain prlor critter approval fz either the bealth daps t or the designer before arkiag =Y
darlaeima fzas the design tbat affeet syste vdability. Any devdatices free the approved dmign scut be sbwm above.
If AS-BIIILT CRECI=ST II
II El I—I
Drainfield orientation t_J Observation port location u undisturbed native soil
and layout u between trenches it
Cleanout location r1
U Trench/bed dimensions and r-j U North arrow II
critical distances within u Manifold placement ❑ Scale of drawing shown II
h layout on scale bar II
Orifice placement
ry L^J D-Bolt/"T"/"L" location r_1
U Lateral placement, with Additional Mound Information 'I
II U Septic tank/pump chamber distances to edge of bed U Endslope width I'
II location r�
II u u Location of wells, roads
U overall fill dimensions II
Location of buildings '�