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HomeMy WebLinkAboutSWG2004-00590 - SWG Application / Design / As-Built - 10/27/2004 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SING ♦ O' W o. N 426 W.CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date 161,4 6m: o PHONE (360) 427-9670 Amount$° z PROPERTY OWNER: DATE: w m i CHECK APPLICABLE ITEMS �/ m m MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM m O - D L-1 9 O`OSAO REPAIR SYSTEM CITY: STATE: ZIP: TABLE 6REPAIR Vt m S €LT)ro aS"$y MAINTENANCE REVIEW PROPERTY ADDRESS: SINGLE FAMILY z OTHER: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL (i m I� `i .- 5 L COMMUNITY WELL/PUBUCSYSTEM 6 SYSTEM WR N C-6-'r p i - SYSTEM NAME APPLICANT rwk.ILN C T =15K f h t GKrr_L soVU lZji). NAME Name of Lot ft.x ft. MAILING ADDRESS Installer Sze: Is acres T u.ra rt o TELEPHONE _2 tl R � 7 Name of _ SIGNA E o Designer Number o 9 / l�.l ICA Y1L4 Bedrooms t X OFFICIAL USE ONLY BELOW THIS LIN DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS m 0 r 0 i RECEIVED ;OIL TEXTURE CODES: =Very G=gravelly S=sand L=loam Si=sift C=day E=Extremely OCT 2 7 20041 VSPE R(print name) IN T N SI TUR,E a DATE PERMIT EXPIRATION 1 /n/ +/ 0 All systems reqvft ongoing Operation and Maintenance(O&M)as dpecified in Mason CountyOn-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 specified use of the property or any site alteration affecting the system design may invalidate this permit. This Permit expires 3 Vears from the date of site review.Denial of this Dermit mav be aDDealed to the Health Officer within 10 days of denial date. DESIGN R APPROyy"Y: DATE: N PPROVED BY: DATE: Y�f.�Ja l/ o L u IN IO Z !`l 6 TOP: Health Dept. Copy MIDDLE: Designer's Cop BOTTOM: Applicants Copy MASON COUNTY ' DEPARTMENT OF HEALTH SERVICES November 04, 2004 PO BOX 1666 5HELTON, WA 98584 5HELTON (360)427-9670 FAX (360)427-7798 Jim Henry ELMA (360)482-5269 PO Box 14531 BELFAIR (360) 275-4467 Tumwater WA 98511 SEATTLE (206) 464-6968 RE: Design for KINNEY Case No: SWG2004-00590 Parcel No: 321343490033 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. 353 if you have any questions. Sincerely, Cindy aite Environmental Health Mason County Health Services COMMENTS: 11/4/2004 1 of 1 SWG2004-00590 DESIGN FORM-PAGE ONE RECEIVED Pxv1sc„&W=Y 4.t9" A design wiv be reviewed when 3 copies of each of the following items are submitta-T 2 7 2004 cothhytltetea deeton totm frutlura been NoIte�.tae a tea • seated gyosA skel k soakd plot pW4 Mttdttd!tw aN thpplleable ms on eheekikt croes.eecnott eketeh.rtcwd : Permit Number. SWG - Designer's Name: 1 rti 1�Ex R� Designer's Phone#: 3 o Ysi� 7.Z ti Z Applicant's Name: 5 41+�u n1 iC+ .�u 4 Assessor's Parcel No.: 3 2 i �(1w3e`rn Nt nth Mailing address: = Sri 0 0 n1LTn^cOtL6 1J2. Subdivision: SA7i R7 07 L ,Y_3 _st-iK.LTcW ._w� `l &St)Y ��/DivisbolBkkk/[at) City State zip A > ES1G s �v Treatment Device Ile O Glendon Biofilter D'Sand Filter [I Moundd Lined DrainSieM O Aerobic Unit-Makc/ModeL• — O Disinfection Unit - MakeJModeL- Drainfield Type ZaVainrork OGmvity 0�ch Q Gravelles Chambers Septic TankfDralydleld Spermcations Laterals � Schedule/Class 7-00 Number of Bedrooms Length Davy Flow ti�� and Diameter l.u� in Septic Tank Capacity i 9 on ¢al Number 3 Receiving Soil Type(1-6) !-A Separation 31 ft Receiving Soil Appl.Rate ! D teod/ft Required Square Footage jfe Orifices O L Designed Square Footage % Total Number of Orifices (/- Percent Reduction Taken ft Diameter Trench/Bed Width Spacing —2-!Y. in Trench/Bed Length lv O ft Elevation Measurements ScheduManifold ZA0 • Length APPROVED .5- ft Original Drainfield Area Slope _ e° Length !>s— m New Slope if Altered �� •m a.�+ �/ Diameter MC HEALTH DEP1 — Depth of Excavation from 2 N " •n Preferred Manifold[eaaifneuratioN00sod? Yes No❑ Original Grade 2 N r (uv-stenre) Transport Pipe (pfw slope, Schednle/elass CEW Z•0'0 ft Length 7— Designed z Designed Vertical Separation 2 Ll in Diameter in Graveness chambers Required? ❑Yes ONNo ❑Options( Dosing and Pump Chamber 45, Ia Yes ❑No Number of Doses/Day a o ial Pump Required? Dose Quantity Pump/Siphon Specifications Chamber Capacity i x nn gal Difference in Elevation Between Pump Shutoff and Up�� �p Controls mien Elapse Time Meter(circle If requireA Orifice: If Time. Pump On S S"3 cc , .Pump.Off uppermost Orifice is d Mgher, ❑Lower than IM Shutoff Check the following components if they drain between doses: Capacity®Total Prrsshae Head: d f xtcrah Manifold Transport CalWlatedT "Pram HZ; !lo.9N ft (Attach Pump Carve) DESIGN FORM-PAGE TWO Re kea�24,IM Scaled Plot Plan Scaled Layout Sketch 7sepfic on Sketch Or Test hole locations �'Drainfield orientation and layout h from Original grade• j� petty lines �Trench/bed dimensions and critical and drainfield cover 4Y Existing and proposed wells within distances within layout depth 100 tt of property lines I O D-Boxt T/"L'locations O Critical distance measurements to cuts, er Septic tank/pump chamber location Reference depth from original grade banks,and surface water P(Observation port location and restrictive strata: O Location and orientation of curtain Clean-out location WLatcrah,trea /bed top and bottom drain and all absorption components Manifold placement O Curtain drain collector [Location and dimension of primary J7( Orifice placement .0"Sand augmentation system and reserve area Lateral placement,with distances to OJ Buildings edge of bed Other cross-section detail• 0'Direction of slope indicator ,0' Audiblelvisual alarm referenced )9r Observation ports and clean-outs 8'Waterlines 0"Scalc of drawing shown on scale bar .O-Roads/easements/driveways/ Ping >�oae �egemAan6rlor�acnunrl� " F system: - .Y �.� , O Critical resource lands(if applicable) a ,. 12'�North arrow and scale of drawing !' 14Wnle:aci :. . qyh shown on scale bar :3"dltvrdtl'i? €� £ > �� l;Y�d�sval�stop�" CJ df�-sTop�atii[stoT t ' Additional Information fil'Design staked out O Operation and Maintenance Notice Attached O Waiver(s)Attached ax ..i�1�Ste_s t,'.i,"S a- -3, 7 m '`3r' 3 v 4,E'mc"M1 �arai#,x .� ;� "s✓�. -,y��`=&nu,�<.Arc'a.T�r�zww.�um��., The undersigned designer Ordoes, ❑does not,waive the requirement to be notified by the installer of the installation and given 48 hours to perform a final inspection prior to cover. Sigfiature 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: EnvironmcnW Health Specialist Da(ee Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: The design is stamped"Approved"by Mason County Department of Health Services. .� The On-site Sewage Permit has not expired,the Permit Expiration Date Is: // y /07 ✓ The system is installed by a certified installer,unless prior authorization is obtained finm Mason County Department of Health Services. d Drainfield site conditions have not been altered to adversely affect conditions of design approval f 1 J'l 'ti JIM HENRY DESIGN SERVICES, INC. MASON COUNTY DEPARTMENT OF HEALTH SERVICES ON-SITE WASTEWATER DISPOSAL SYSTEM DATE: October 14, 2004 APPLICANT: SHAWN & NICOLE KINNEY E. 590 DARTMOORE DR SHELTON, WA 98584 Q T LEGAL: LOT 3OFSP2967 PARCEL#: 321343490033 51000171 _ IIM HENRY PROJECT#: LICENSE D SIGNER '`��x?IaEs: oan�lps DESCRIPTION: NEW CONSTRUCTION PROJECT DETAILS: NUMBER OF BEDROOMS 4 GALLONS PER DAY(GPD) FLOW 480 APPLICATION RATE 1.00 DRAINFIELD -Absorption Area Required 480 SQ.FT -Absorption Area Designed 480 SQ.FT -Trench/Bed Length 60 FT -Trench/Bed Width 8 FT DRAINFIELD CROSS SECTION - Bed Depth 24 INCHES - Rock Depth Below Pipe 6 INCHES -Vertical Separation 24 INCHES - Fill Depth 12 INCHES SEPTIC TANK -Size& Composition 1125 GAL CONCRETE - New/Existing New JIM HENRY DESIGN SERVICES, INC. APPLICANT: SHAWN & NICOLE KINNEY DATE: October 14, 2004 PARCEL #: 321343490033 PRESSURE SYSTEM - 3 LATERALS System Parameters Pressure Calculations Orifice Size 3116 inches Minimum Orifice Discharge Rate 0.62 gpm Residual Head at Last Orifice 2 feet Total Lateral Length 177 feet Orifice Spacing 2 feet Number Orifices Lateral 1 30 Number Orifices Lateral 2 30 Number Laterals 3 Number Orifices Lateral 3 30 Lateral 1 Length 59 feet Total Discharge Rate 55.8 gpm Lateral 2 Length 59 feet Lateral 3 Length 59 feet Friction Loss Pipe Class 200 Tightline Friction Loss 6.10 feel Lateral Line Size 1.5 inches Manifold Friction Loss 0.72 feet Lateral Elevation 98.5 feet Lateral Friction Loss 0.93 feet Friction Loss through System 7.74 feet Manifold Length 6 feet Manifold Size 1.5 inches Dynamic Head Risidual Head at Last Orifice 2 feet Elevation Difference 7 feet Add-on Friction Loss 0.2 feet Elevation Difference 7 feet Tightline Length 150 feet Total Dynamic Head Loss 16.94 feet Tightline Size 2 inches Total Discharge Rate 55.8 gpm Add-on Friction Loss 0.2 feet Total Dynamic Head 16.94 feet PerformtD&JlwP9e: "Said,: `""'°�°� P � Data Data Dated:January 2MI RPM: 1750 9 30 tz tM 6 0 20 SPSO 3 R 10 SP40 0l 0 Capaiiry-U.S.0.P.6L 0 20 40 60 80 100 120 140 i Ulas/Seiond 0 2 4 6 8 . 7M commas relba maAmum verbmiance aum.+eristi s e9thaa erreecing tuN bee(Nameplate)Mrsevnxer.M pumps bare a service factor of 12.OperaEon Is recommended in aie bounded area with operadwal poM walb Use curve amn.Perbmumce curves ere based on actual tests ft dear water M M*F.end 12001eM rile sleva5cr. 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N a C W O w 0'O a -O c om wp y �a c E W - WFW of W o > o c oL 0 SW m _Io fC « y $ 0- n (nnm WL Na O Q d o CD n N .0 LO O c y c ZXOW NO ° o O ° CZ oof ° `� Q O- a) 0 c Z 2 2� O W dk WQQ of LLJ UCDC. m mO fES c2 ` Nc a A 0 Z wQ U0 O o a yvc U o . y2a-a 0o o mm E OQ 00 rtac Z t Q a � R . o c « ja 0 2 ? a c a O W LL < C L P 0 'OO € m m ' & a yc '0 �0) m a) cc ro m oo ¢ V) n W -le 1�1 E c o do Z Z co to W c O O Q U o ~. c O y d 0 w = " E c o Z 0Ca ZN LLJU W LL.0 Z Q > > a v ~E ca , w 4 U O R " 0) .0m ' ` om� 8 0 a n r � mLLJ v wZ0 0 w n 0 W 0 w 0¢W ` Z O v S O nZ Wc w ' .,& Esm E V m m c9 ¢ n U O O W a $ z°m L G m <- w n _`0 S-BUILT FORM Revised February 18, 1998 PARCEL IDENTIFICATION: - j/Applicant Assessor's I � I,LI ►�FuttiluA D03_� —� Parcel # A L-1 4 3 e� � Permit Number SWG �- oor-ei o (Twelve-Digit Number) Installer 14 ti&Iorm L 04 AJ14C Subdivision SP ! &q'7 3 (Name/Division/Block/Lot) Designer RE_(;EIVED INSTALLER CHECKLIST HEALTH SERVICES,QEH Yes Prior to Completion 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%? . . . . . . . . . . . . . . . . . �! D) Baffles intact and clean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E) Dividing wall intact?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F) Risers installed for access? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y� G) Tank Size: IgAyj gal.;Manufacture II. D-Box A) Leveled with water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — B) Speed leveler used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -� — III. DRAINFIELD 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? . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 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) PRESSURESYSTEMS 1) Sand quality ASTM C-33? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2) Head height uniform and z24 inches? Actual head height ;)t�/ . . . �= 3) Clean-outs and observation ports present? . . . . . . . . . . . . . . . . . . . . . �-- 4) Mound: Side Slope3:1? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — 5) Owner informed electrical connections must be made by `Zy- owner or licensed electrician and inspected by L&I? . . . . . . . . . . . . . IV. PUMP/PUMP CHAMBER L A) Pump make�LL. Isse M.t/Ir' ; Pump model yCPSU B) Chamber size 4.1�13 gal; Manufactu C) Height of pump off bottom of pump chamber 4 inches D) Pump chamber draw-down gallons per inch E) Pump capacity gallons per minute F) Pump contro : Timer(o ) Elapsed Time Meter (circl if installed) if timer is use : Pump On/ ,d isfisutdp Off I — G) Screen basket or uent filter c' cle one)installed? . . . . . . . . . . . . . . . . H) Riser installed for access. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — I ) Alarm installed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [C] AS-BUILT DRAWING CHECKLISTPlainfield&manifold orientation & layout Trench bed dimensions and critical distances �� r �� within layout ❑ Septic/pump tank $ we placement. ❑ Location of buildings. ❑ Observation port&clean- N out location. �J e ❑ Location of wells& o roads. ❑ Undisturbed native soil between trenches. ❑ North arrow ro P/L �aapee�,r rJ P"r-IVEQ ate JAN 3 0 2006 HEALTH SERVICES, EN CAUTION:Minor adjustments to septic tank location and drai�eld orientation made in the field by the installer are generally acceptable to both the department and the designer,but mould in artairr cases compmmise the viability of the system. It is the installer's responsibility to obtain poor wnnen approval from either the health department or the designer before making any deviations from the design that affect the system viability. Any deviations from the approved design must be shown above. CERTIFICATION OF INSTALLATION Installer Check a box from Row"A"and"B",sign and date the certification A. ❑ 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 MCDHS are shown above. MCDHS kU.11 2 eP B. $t 1 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 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 fication. ✓ 01. Z, 0f0 ignatur Installer ate The undersigned approves this installation on behalf of Mason County Dep t f H alth Services. Z ( q I Ut anitarian Dait