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HomeMy WebLinkAboutSWG2000-00095 - SWG Application / Design / As-Built - 3/16/2000 MASON COUNTY DEPARTMENT OF HEALTH SERvfICES PERMIT NO. SWG - w n m 426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 D Recate y N O eipt No 1 o y PHONE (360) 427-9670 Amount$ oZ z F PROPERTY OWNER: DATE: 3 y� OD CHECK APPLICABLE ITEMS MAILING ADDRESS: / DAYTIM PHONE: NEW SYSTEM e- REPAIR SYSTEM CITY: SATE: ZIP: TABLE 6REPAIR m C F U MAINTENANCE REVIEW PROPERTY ADDRESS: Q ri SINGLE FAMILY c � ) i _ 5 sf1�� /V' I/ f OTHER: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: / PRIVATE WELL m to COMMUNITY WELLIPUBLIC SYSTEM t SYSTEM WFI N L £ c SYSTEM NAMEIV Al / Y • (�' APPLICANT I r 5I 9Jr/U '- NAME - �--- Name of Lot ft.x ft. MAILING ADDRESS E: K Installer / kv Size: 0��•Z acres TELEPHONE (I - � I Name of um er c SIGNATURE Designer �� /fJ/f //� Bedrooms X OFFICIAL USE ONLY BELOW THIS LINE �-- DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS m )3 -3&(1CT ►mod. SoLaq Ld- 17--19 F;/VI-- crl,, ttd Id _A. 1 n Ce, i 6 -y A o c��n�w�zlrnCG rri SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely INS P CTOR(pri name) INS ECT N SIGNATURE DATE PERMIT E PIR TION DATE _3 z -L •All systems require ongoing Operation and Maintenance(O&M)as specified in Mason Co my -Site Standards. •All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer,unless prior approval is granted otherwise •All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted otherwise. In such cases a preliminary on-site meeting between health department staff and the homeowner is required. •On-site sewage system design approval does not imply other building site requirements(i.e. RLC,Water Adequacy)have been met. •Any change from the speclied use of the property or any site alteration affecting the system design may invalidate this permit. •This penult expires 3 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. DESIC�I RE APPROVAL BY: r I�l DATE: INSTA LA N APPROVED BY: On DATE: JMI-'-- TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy MASON COUNTY r - -- -DEPARTMENT OF HEALTH SERVICES Environmental Health Water Quality - Perron!Health PO BOX 1666 SHELTON, WA 98584 LOCAL(206)427-9670 BELFAIR(206)275-4467&4468 FAX(206)427-7798 DATE: S GC TO: FROM: Qt�}lM RE: Design for t=C, ��� '���/1 Parcel# Your design for the above referenced parcel has been reviewed and is APPROVED. Your design for the above referenced parcel has been reviewed and is HOT APPROVED. It does not meet the requirements or needs additional information. DESIGN FORM - PAGE ONE Revised April 24,1998 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 % Scaled layout sketch,Including all applicable items on checklist % Scaled plot plan,including all applicable items on checklist a Cross-section sketch,Including all applicable items on checklist PARCEL IDENTIFICATION Permit Number: SW(',� 0 9� Designer's Name: Designer's Phone#: c"> > 9 C G /� 1147 6r /7 t/ Assessor's Parcel No.: Applicant's Name: G 7 Mailing Address: •MUr-K��� S=�� (rwelve-Digit Number) .S'fi LT/J/VJ/� ��-r),' - Subdivision: 4z 79 �T City State Zip (Name/Division/Block/Lot) DESIGN'PARAMETERS MC H155,6;1% DEPT Treatment Device MAY 1 4 2000 O Glendon Biofilter ❑Sand Filter ❑ Mound asand L � infield ❑ Aerobic Unit-Make/Model: ❑Disinfection Unit - Make/Model: FF'' Drainfield Type Q Pressure Bed ❑Drainrock ❑ Gravity ❑Trench O Gravelles-Chambers Septic Tank/Drainfield Specifications Laterals 0 G Schedule/Class ft Number of Bedrooms Length 4 x 30 = i zc Daily Flow and / _ n Diamete Septic Tank Capacity // - Qal Number It Receiving Soil Type(1-6) d ff Separation y ft Receiving Soil Appl.Rate KP Required Square Footage fr Orifices \ Designed Square Footage % Total Number of Orifices Percent Reduction Taken % Diameter ft t N N LZ in Trench/Bed Width __ Spacing Spacing Trench/Bed Length Elevation Measurements Manifold 20C Schedule/Class Original Drainfield Area Slope < % Length New Slope if Altered n °/° Diameter n Depth of Excavation from I 7- '' Preferred Manifold Configuration Used? ❑Yes No Original Grade (up-slope) / in Transport Pipe (Down-slope) Schedule/Class ACC Designed Vertical Separation 7 in Len°th �-5 ft ' in Diameter -- Gravelless Chambers Required? ❑Yes No ❑Optional Yes ❑No Dosing and Pump Chamber Pump Required? Number of Doses/Day Af Pump/Siphon Specifications Dose Quantity Chamber Ca aci / v gal Difference in Elevation Between Pump Shutoff and Uppermost P tY Orifice: ft Pump.0 Timer(or) Elapse Time Me r(circle if wired) If Timer: Pump On Uppermost Orifice is❑Higher, ❑Lower than Pump Shutoff/ PP ,q, m Check the following components if they drain between doses: Capacity Total Pressure Head: (v �_eo Calculated Total Pressure Head: h Laterals Manifold Transport (Attach Pump Curve) DESIGN FORM - PAGE TWO Revised April 24, 1998 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross -Section Sketch © Test hole locations M Drainfield orientation and layout Referenced depth from original grade: d Property lines ® Trench/bed dimensions and critical M Septic tank lid and drainfield cover ® Existing and proposed wells within distances w':hin layout depth 100 ft of property lines 0 D-BoxP`T•"L"locations Critical distance measurements to cuts, to Septic tank pump chamber location Reference depth from original grade batiks,and surface water 0 Observation,port location and restrictive strata: Laterals,trenchibed top and bottom Location and orientation of curtain � Clean-out location + Curtain drain collector drain and all absorption components 0 Manifold placement ' Sand inaugmentation C1 Location and dimension of primary '91 Orifice placement system and reserve area W Lateral placement,with distances to Buildings edge of bed Other cross-section detail: 10 0 Direction of slope indicator 9 Audible/visual alarm referenced M Observation ports and clean-outs $1 Waterlines (9 Scale of drawing shown on scale bar ,30 Roads/easements/driveways/ 'Cross-section information for mo d parking La out information for moun ySfeem: system• y Critical resource lands(if applicable) O Ove m ns O Settled ca gth at Wren and edge of'. ® North arrow and scale of drawing Q �i _ems downslope, ndslope bed shown on scale bar 51l wtdth O S�� slope�� ` APPROVED _Ey"Up-slope and downslope bed elevation C HEAI T14 DEPT MAY 1 Additional Information 21 Design staked out PSD [J Operation and Maintenance Notice Attached p Waiver(s)Attached DESIGN APPROVAL The undersigned designer 0 does, (]does not,waive the r�quuement to be notified by the installer of the installation and given 48 hours to perform a final inspection prior to cover: c 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 Specialist Date Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: J ealth Service. The design is stamped"Approved"by Mason County Department of H J The On-site Sewage Permit has not expired,the Permit Expiration Date is: ✓ The system is installed by a certified installer,unless prior authorization is obtained from %lason County Department of Health Services. ✓ [o adversz Drainfield site conditions have not been altered ly affect conditions of design aperoval . . � . APpRO �El��£D T . � 442aaa Ep b PSO 2 b / « � � \ \ <� . \� IV, � \ N,, is w �re 1 rr w o CIOD f = - VJ �17 t T i r t L �-! 1! a PAi ROVE® _� = H .ALTH DEPT MAf 1 4 2000 PSD ` Q,- ; 'J r C ern ;�t-l)''� �., 4 j1 6 i n I i r � o 11 IIIIII�II I `l ' \a ' IV) r m V F84C HEALTH DE(7 y MAY a ?oo pso 19 E 1ajo 17 !-J i Performance Data 12 1 1 I L I I I Pump Characteristics I I t I I I I Pump/Motor Unit Submersible 30 D25A1 Automatic Models W25A1 B C ... .. - _._ _. .. .. .._ .. _ _. . .I. ...I Horsepower 1/4 E _ �20 I I I I I I Full load Amps 8.0 Motor Type Shaded Pole(4 pole) 4 1 1 i i I R.P.'A. 1550 10 1 1 Phase 0 1 1 11 1 Voltage 115 0 0 1 I I I 1 1 1 I 1 I Hertz 60 Capocil'USGPl 0 10 20 30 40 SO 60 Temperature 120 F Ambient limos/swond 0.0 1.0 2.0 3.3 — NBU Design A _r— m meterslhr 0 2 4 6 ! 10 12 Insulation Class A Discharge Si.e 1 1/2' NPT(38mm) I Total Head (feat) 4 8 12 16 20 2.1 Sdids Handling -1/2'0!mm) I — d 6KA A 1.) 44 36 29 23 12 0 Unit Weight I 30 Ibs. power Cord 18,'3,S1TW, 10,Sid. �Imen5i4nCI Duta (20'opliaoan 3.112 5-710 _ y 12 2. "'mpcnml i^!wiars alry rYt S lie�s5 Imo<cm�.;vn pwp a a:Lss[Y i(a 11r2 i A 1.12 NPT DISCHARGE o6�er an { r Mclerials of Construction �e \r ~ f � I 6. Nr mz[a:<'yhl la Handle Stainless Steel �f1 g42 y .,r maie ter am ur Lhricoti;,g^..I Dielectric OR r[ Molar Hou,.;Mg Cast Iron Pum Cain Cast Iron iiwft Steel ;dz<I oricul Seal Faces:Carbaa/Ceraadc Shaft Seal Seal Body:Anodized Steel s� Spring:Sightless Steel Bellows:Buna•4 4R lane Impeller Thermoplastic ,�e U PUMP CNaper Bearina Cass Iron Sleeve �C s f ...-_-..I {.•. tej�1 Lower Beating Single Row Ball Beann c t- ���'` i a lees 1 �1a. 1a� PUMPCFF Strainer/Base Fasteners Stainless Steel AURORA/HYDROMATIC PUmps; Inc. �hqy q<r�31� INSTALLAT-ON _1_;L?INTENANCE s Presure 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 treaded clean-outs at the ends of all laterals , ( caps m'_St extend to within 6" of finished grade ) . 6 . Install a_dio/visual high water alarm. 7 . Install 1/0" mesh non-corrosive screen (min . 12 sq . ft . surface area , preferrably in septic tank at outlet port . 8 . Install check valve in pump transfer lire ( and manifold when ,n�eded)tC prevent system drain-back into the pump ChamDer. 9 . Provide a 3/8" NPT ( National Pipe Thread) fitting .between C'neck valve and pump for pressure guage connection. - OSc press-.:re guage at time of pressure test to permanently reccrC t"= . e_ fect System Press' m ''re ' , so a comparison can be made d'-ring T'_'S?a-CLiCns to de:e'_-mine 'Condlt-J- . of S':S:c-' ' . _ _esS'._re gu g- i;�ay be -e.i Cved and repl aced Dy p:pe plug bat,4 n _nspec:ions . a_! laterals w_L, orifices placed at 12 C I Cloc' . L a :Z C C_C c.- _ c.._t Zi •: o = p':ds ce_ crIflces ( excs t �..n . pl_� _ r'c.. u•S_ _ Infiltrators ) a:tc_ pressure t�St and L'^n:• a?:rp•%a_ b'• ::ea'_t:n spar:-tent . _ _ cver Cra:.- rock _ _ _Or LC Ca�''{- ' - t - d___-. rock extents natural grade , Lhe __.,_ _� at _Cast 2" down tie trench wall . _'- p ^B' - e Cr _-3peCt l2 . a'i ne Septic to-'- and put Cis 1 _ _ -- c"Jery 3 L-C 5 ve—S . 1_ . :ns '..: an clean P-. • sz- e .- ever_ 6-1= ncn:'-s as r.ee_ _nS7=C_ _-Cats _nd test h1g.^. wa:eralar'1 eery 6-1Z aS ne3- u'se^pressII_e c'•'age t0 Geter.,._..c CC':da1 Ct Sys:e-. materials and wort{.rnanship must m=et County and Sta v^'rC^ this d83:gI with Cut _ riCr ?_-:royal from 1- des_c-er An uason County Health Departme_ - will make tnis nd C Cos- CC _ :1 CO'+'1 .. Ce '«1__ Dc _nC_i.--.. In Z::'._ inn _-plop S yS _e . ON—SITE SEWAGE INSTALLATION FINAL INSPECTION a. �zxI � F DATE CALLED IN: J y�b0 TIME: INSTALLER: APPLICAN (OWNER: CALLER: R,1 �nnL//\4-C4 1,/ PHONE#OF CALLER: '7'oCL O - SWG#: 7 Jzy /) -- PARCEL NUMBER: JOL Q J'-7 J, lz SUBDIVISION: M-6p LOt: SYSTEM TYPE(CHECK ONE): ❑ PRESSURE GRAVITY INSPECTION SCHEDULE(CHECK ONE): P ❑ APPOINTMENT PLUG IN AS-BUILT ON-SIZE(CHECK ONE): a ❑ YES NO STAFF INITIALS: IISrAFFtIS 0MLY APPOINTMENT DATE: TIME: COMMENTS: Dd tjPa 564✓I���✓IW `Q RiV A ✓rp✓n ON-SITE SEWAGE INSTALLATION STAFF INSPECTION REPORT STAk�' . tsr x Yes No Comments I. SEPTIC TANK A) >5 ft. from foundation? .\ B) >50 ft from wells and surface water? C) Bldg stub-out to septic tank:clean-out if not 1-2%? y D) Baffles intact and clean? _4 E) Dividing wall intact? F) Risers installed for access? _ 11. D-Box Leveled with water and/or speed leveler(circle)? (A) 14 M. DRAMMID A) >10 ft from foundation and>5 ft from perceived property lines? B) >I00 ft from wells and surface water? C) >10 ft from potable water lines? X D) Laterals level to±1 inch&end caps present if not looped? E) Gravelless chambers utilized? F) System dimensions the same as shown on the design? _ G) Gravel clean,properly sized,and proper depth? H) PREssuRE SvsTEms 1) Sand quality ASTM C-337 Y, 2) Head height uniform and z24 inches? 1` 3) Clean-outs and observation ports present? 4) Mound: Side Slope 3:1? yj F 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I? IV. A) Scr ptaskaa�B� A) Screen basket or uent filter circle one)installed? B) Riser installed for access C) Alarm installed? D) Pump on timer o deman circle)? V. As-BuiLTREQunu D? _ VI. OTBm CoNavwNTs/OBSERVATIDNs The undersigned has reviewed this installation and verifies these findings on behalf of Mason County Department of Health Services. Sanitarian Date C:tivtyFilmtfinaldwdcwpd Revised 9/26/97 AS—BUILT FORM yIs.199E Applicant Assessorp 'S 3 a 13 y 13 — 90 1 ► 1 (7Wehle-0I9ftNumber) Permit Number SWG a00t) - lQ�d�/J Sy 9 q ) 9 JA Installer / `� Subdivision (Name/DIWs1orJ81ooWlot) Designer La e a h i a N!A Yes Prior to Completion e I. SEPTICTANK A) >5 ft.From foundation?................... ... ..... .... .. . . .... B) >50 ft from wells and surface water? ... ..... ..... c) Bldg stub-out to septic tank:clean-Out if not 1-20/*? ...... ..................... D) Baffies intact and clean? ...... . ................ . — E)_ Dividing wall intact?.......... — F). Risers installed for access? ..... .......... . .. . .... G) Tank Size: 1150 gal.;ManufacWre k- ' Q II. D-Box -- A) Leveled with water? .. ... ... .... . ... .. ... . . . . .. — B) Speed leveler used? ... .. . .. . . .. . ... .. . .. . . . . . . III. DRAINFIEI.D A) >10 ft from foundation and>5 ft from property lines? . . . . . . • • • .... . . B) >100 ft from wells and surface water? ....... . . . . ... .. .. . . . . C) >10 ft from potable water lines? . . . '' ' ' '' ' '' ' ' v — D) Laterals level to±I inch&end caps present if not looped? ....... .... — 1E) Gravelless chambers utilized? ..... ... .......... .. .. ....... ..... t, > System dimensions the same as shown on the design?.. . . . .. ` G) Gravel clean,properly size4 and proper depth? — H] PRESSURE SYSTEMS _ 6- 1) Sand quality ASTMC-33? .....................•''......... %. 2) Head height uniform and 2,24 inches? Actual head height ..• - 3) Clean-Outs and observation pods pros _ 4) Mound: SideSlope3:1T ..•••............ 5) owner informed electrical connections must be made by owner or licensed electrician and inspected by I.&I? . . . . . . .. . . . . . IV. PUPump mP make A BE t Pump model — A) Pump make B) Chamber size be a gal: Manufacture inches C) Height of pump off bottom of pump chamber Z gallons inch D) Pump chamber draw-down ILL g minute E) Pump capacity �0gallons per F) pump controls:Tuner(or)Elapsed Time Meter (circle if installed) _ if timer is used:Pump On Pump Off V G) Screw basket or e@luentfrlter(circle oae)Installed? ................ H) Riser installed for access? ...... ............. . . .. .. . . . . .. . ... Sao [) Ahum htttal led? ... . .. ... ...... ......... — * . .. .. . . c � � QUECKLIsr ARM 0 Dndnfield&manifold U orientation &layout \ 13 Tr eat h/bed dimensions and critical distances within layout ❑ Septidpump tank placement. Ap ❑ Location of buildings. ❑ Observation port&clean- \ y out location. 1.- ❑ Location of wells& r roads. ❑ Undisturbed native soil �J between trenches. o U rl aie ❑ North arrow CAUTION:Minor adjustments to septic tank location and drainfield orienution made In the field 6y the Installer arc ette y acceptable to both the department and the designer,but could in certain cases compromise the viability of the system. It Is the installer'a responsibility to obtain pnorwntten approval from either the dcpuu�nent or the designer before making any deviations from the design ant Street me system viability. Any deviations from the approved design must be h Installer Check a box from Row"A"and"B',sign and date the certification A. I certify that I installed the system without any ❑ 1 certify that all deviations from the design stamped deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above. MCDHS B. I certify that I contacted the designer and left the ❑ I did not contact the dcsignerprior to final cover because the / system open for inspection up to 48 hrs prior to designer waived the notification requirement. cover. 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 cent i`fation. 0-1k) o signature o er ate The undersigned approves this installation on behalf of Mason County Department of Health Services. V0 Sanitarian _ Date