HomeMy WebLinkAboutSWG96-0196 - SWG Application / Design / As-Built - 3/29/1996 10
MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG4A. — N
iZ� I cl a
426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date y. o
Receipt No. L {
PHONE (360) 427-9670 ?i �
Amount$ 20 I z
A ; _ CHECK APPLICABLE ITEMS
DT 3
MAI ING ADDRESS: DAYTIME PHONE: NEW SYSTEM
3 D /�/j REPAIR SYSTEM
CITY: STATE: ZIP: MAINTENANCE REVIEW m
13 y4o 6,}4 SINGLE FAMILY ✓
PRO ERTY ADDRESSh OTHER z
l o f Spa/ o f /cry SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL
k nz C l T COMMUNITY WELUPUBLIC SYSTEM
/ SYSTEM WFI#
/d t7--wrel e^ol SYSTEM NAME p
APPLICANT
l I�AJ
Crtc.E - C7 / f-m A,— X �"I NAME h b
Name of �oee Lot I6 7- ft. x 3.30. 3 ft. MAILING ADDRESS �/ r
Installer A/o/.Ic CCt r n � / v IO
Size: I 1 acres TELEPHONE 60 �� < }�
Name of //�� Number o SIGNATURE D
Designer�e P," self"CeS' Bedrooms 3 J X
PLOT PLAN /?r&Perfp t`S on R.phf. Lop �s> / �`d, lzex/ty qrz, �- -
Draw a drJensional p , / An./e -Nee P�nfk er ld ke /fCCe SS L
includin� c Mt
❑Preci l tes( r F
holes, owin ,
meas d distarTcas
prolbounNies.
❑Ent d;012 roal
driv 5. A� J
NOTEIO NOT D d
R (J{
YSTEM
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OFFICIAL USE ONLY. DO NOT WRITE BELOW DOU
tf 1� .V Cal
LOGS
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Grade t oRestrictive
!' /r Layer or Water Table: In.
jo,DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One Ar"wo
Soil Type����11L
Vertical Separation
Septic Tank Daily
- in. Capacity: LL
Gal. Flow: 7� GPD
Slope �¢'Jxh% �
Appl. Infilt. �./
Parcel Size /t Ac. �_ Rate 0t ,rGPD/FTC Area 6,� FTC
Distance to Shoreline ,^ ' ft. _ Total r Inspector Date
3 , zz2�
CO MENTS/CONDIT ONS FOR APPR AL
4 c
Y1 ! h
E' -J" r 11 d �i -33
•All septic systems must be designed and installed by contractors certified by-�a��gn CoVil Depart n�of Hea Services unless r' r royal is
granted by the department,or the design is by a professional engineer. F Lf C V� Ix{ ('a been et
•Septic permit approval does not imply other building site requirements (i.e. ater equ ) a Seen met
•Any change from the specified use of the property or any site teration affecting the system design may invalidate t is p
•This permit ires 2 years from the date of site review.Denial AS permit may be appealed to the Health Officer within 10 days of6enial
SI EVI D G IE Approved -i Not rov d INSTALLATION:O Approved ❑Not Approved
BY: DATE: BY. DATE: BY: DATE:
�JlkumilTOP: Health Dept. Copy IDDLE: Designer's Copy BOTTOM: Applicant's Copy
DE&IGT4 FORM : PAGE ONE 1..i.ee 08/24/94
A design will be reviewed when 3 conies of each of the following items are submittedt
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
• Scared layout sketch, including all applicable items on checklist
Cross-section sketch, including all applicable items on checklist
u PARCEL IDENTIFICATION
� u
I Permit Number s W(r 96- Ol y(, Designer's Name
Applicant's Name "Ir- cReror .S Prop. Owner's Name TMttM ►.I, A 1rnolp
Mailing Address _f!j t IDS Mailing Address 4330 xlln�ee eA 09
N
p
Assessor's Parcel No. Subdivision I
p p10
DESIGN PARAMETERS
LTH SEF1�vezticn N
A Mound Subsurface Pressure Gravity Bed Trench /S in
Y
N Septic Tank/Drainfield Specifications n
N No. Bedrooms 3 Pressure Distribution? 1�9 Yes L..J No
N Daily Flow 360 god ........................ (If yes, proceed. . .) ......................
::::....................
::::...........::.....:. ..................::
Septic Tank Capacity /SO gal
u Receiving Soil Type (1-6)Receiving ? II
Soil pl. ate d tSchedul� antYam•RIM "e'V CBS
Trench/Bed BottomArea .5- f ' 0o
p Trench/Bed LWidthength
=____� Length APPRO ED s
p Trench/bed Length
p Diameter Initials /125— in
N Elevation Measurements umber 3
M Orig. Drainfield Area Slope 43 t Separation Date 3 ft
Final Drainfield Area Slope Orifices
p Depth of Bottom of Trench/Bed Total Number of Orifices 4�
h from Original Grade �,6 in Diameter O./8750 in
Q Spacing -qA,l
�I Manifold
n Schedule/Class ZOO
�1 n Length r ft
b Infiltrator Used? u Yea No Diameter �•6 'r in
�:: ................... proceed. . ./ ..........^........ Transport Pipe u
Pump Required? ,�1 Yes v No Schedule/Class Z00
.................
.......••...•... (If yea, ) :::::::::...............:: Length SO ' ft
N Diameter '24 in
Pump/siphon Specifications Dosing and Pump chamber
Difference in Elevation Between Pump hptoff A Doses/Day 6
and Uppermost Orifice ft Dose Quantity X6 gal
Chamber Capacity ;250 gal
Uppermost Orifice is %higher, ❑lower
than Pump Shutoff Check the following co�igponents if ey drain
Capacity Tot. Pree. Head �0. wm between down: Ae;W oiAge" V!60 r.�.I/7i/dg .
Calculated Tot. Pres. Head 1?i, ril ft
(Attach Pump Curve) ❑ Laterals 0 Manifold ❑ Transport
,V)�SIGN•FORM - PAGE TWO ".d 09/24/94
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Reference depth from orig-
Test hole locations Drainfield orientation �l grade: ,
and layout
N Property lines m Septic tank lid and
Trench/bed dimensions and drainfield cover depth
Existing and proposed critical distances within N
wells within 100 ft layout Reference depth from orig- N
of property lines anal grade and restrictive 1pI
4p D-Box/"T"/"L" locations etratar p
Critical distance p
measurements to cuts, Septic tank/pump chamber Laterals, trench/bed
banks, surface water i location �\ top and bottom
Location and orientation Observation port location Curtain drain collector
of curtain drain and all
absorption area fly Cleanout location Sand augmentation
N components U
N Manifold placement No external reference needed:b
Location and dimension rto
A of primary system and I-nL orifice placement Observation ports and
reserve area cleanouts
Lateral placement, with p
Buildings distances to edge of bed Additional mound information:H
Jl� Direction of slope I Audible/visual alarm 0 Upslope and downslope p
indicator I referenced fill width
Waterlines C;tI Scale of drawing shown O Settled cap depth at
on scale bar center and edge of bed
Roads/easements/
N driveways/parking Additional Mound Informations 0 Sidewall slope
6 r-i I r-i r-1 d
I u Critical resource lands r-J Endslope width U Up/downslope bed elevat.
p (if applicable)
0 Overall fill dimensions Colleted Resource Lands andResourc• Lands and N
I �f� North arrow and scale of Critical Areas Checklist h
N drawing shown on bar
R yDDESIGN APPROVAL
�
u The undersigned designer does, -does not, waive the regirement to be notified by the p
I installer of the installation nd ve ee ho a to perform a final inspection prior to
cover.
p a
N N
The undersigned has nevi a an pp ve this design on be if f Mason County of Health
Services.
qHeal
N
C2IONt THIS DESIGN IS ONLY ID It STAMPED •APPROVED• BY MASON CO. DEPT. OF HEALTH
6-29. 1995 '5:0 TPM FROM ' ' ME TITLE CO 360 426 9663 11. 1
RANGE 2 TOWNSHIP 23 SECT
SCALE r• P 400• •,
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46.08 AC. 44.33 AC.
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p.t, J Initials ,
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Mason County Dept. Health Dery ces
APPROVED
Initials
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Mason County Dept, Health Sery ces
APPROVED
Initials
___ —. Date
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Mason County Dept. Heaith Serv;ces
N coAPPROVED
Initials
Date
Pero rm-,i art�eL-P-o Submersiblie Efil - c-,—lpt
Qurves PUMPS
G.=TERS FEET
r 100 -- '
30 SERIES:3885
SIZE:4:SOLIDS
I ! rT, I i _ RPM:VARIES
j r l I j SGPM 7
60 '
C 7� I
20
a 604ca .�__
Z _
-�' - j-
40
1' 10
_
20 -
` I
0 00 20 40 60 80 100 120 140 160 U.S.GPM
® 0 10 20 30 1n3M
FLOW RATE
�7 GOULCS PUMPS.INt
WAT611 TECMNOLOOIEf GROUP
SWW-A Ah"NEW V=OW
METERS FEET
120 I SERIES:3885
35 110 SimVi SOLIDS
RPM:3150
S,y , SGPM30 100 I f._R-P
90 T ;'
i_
1
_ IUJ so
' I —� - '- •• -1 i—'
1
3 20 I _ - -- 1 Healrn Serv.ces
O
vB�
J 15 50 I 1 a 1
0 40
10 30 i
y_
20 I 1
S I 1 — — — '
10 1
® I ---
0 0 14 0 10 20 30 40 .50 60 70 80 90 100 110 120 U.S.GPM f
0 10 20 30 m'th
I
CAPACITY Euw-lko JdY•1114
C IS53 GaA1s Pu pl.I K SPECIFICATIONS ARE SUBJECT TO CHANGE WRHOUr NOTICE PRINTED IN U.S.A.
C3MQ450
S.
PRESSURE DISTRIBUTION
REQUIREMENTS
l.Install trench bottoms level without any slope
2.When trenches are being used on different elevatl on,- ,
check valves are to be used between laterals w3ih:'
manifold to keep manifold primed at all times.
3.Install trenches with the contour of the ground.
4.Install ;locator tape to surface to locate laterals if ever
needed
•5.Install observation ports within 24N of ends of all trenches.
6.Install trenches during dry conditions. it smearing occurs,
contact designer or the health dept. official who signed
the design. This is a must or designer is not responsible
for failure caused by smearing of the trench walls.
7.Install a check valve in the transport line within the pump
chamber.
t 8. Install either a pump chamber screen or an effluent filter
to protect the pump and the drainfield from contaminating
solid matter.
9.Install high level water alarm system to warn owners of
pump failure.
10.Install lateral cleanouts, screw fittings forty five up to
finish grade.
11.Risers are to be installed at the pump tank to the finish
grade level for ease in pump removal. if baffle type filter
is being used risers must also be brought to the surface..
12.Install filter fabric over trenches completely over
trenches.
13.Divert all home and storm drains away from the drainfield.
14.SeptiO system is to be inspected, and or serviced every
three to four years. tank should be pumped at a minimum
of every five years.
15.Any deviation from this design without prior approval with
Designer or Health Dept. official will make this design
void, as well as the responsibility of the Designer.
16. Install audio and visual alarm pump chamber .
Mason County Dept. Heath Services
APPROVED
Initials
Date
f A.f v
I
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
..............................................................« .........................::38^ ..............................................' ,2»e;39;;;e :E ................
I �>v
DATE CALLED IN:
p,
TIME:
��-p77pSS`�I
1✓ � CA L.l.t D INSTALLER: � Qc�tl (aQ 2351 55 ,
"1hs „).CNoeu'pta-X . n
�7T*0 APPLICANT/OWNER: �j3P �1'
CALLER:
PHONE # OF CALLER:
PLLcA� I+rn
SWG #: G�—o(R6
Luc-arts WS�Fx�
ilo� W—I S Ut�—iCerl�-
PARCEL NUMBER: as 301-- 13-Q nofab
C� p(sc) (k�rN ��--na��
SUBDIVISION-
�IfJr DIVISION: LOT:
».........«.«..«...............«........««........«.««............ .«......«. .....««.......««...«...««•........�."•• ....»:« .«" «:
SYSTEM TYPE (CHECK ONE) :
P SURE- - ORAVITSC
]S;PECTION SCHEDULE (CHECK ONE) : Q .
APPOINTMENT PLUG IN
4-BMLT ON-SITE? (CHECK ONE) : a Q
YES NO
..........................................«.««.......«.......«............. :a .....««............««...«.....«................««.«..
STAFF INITIALS: —� - --
h:callin.0
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
SSarr CrgCXLISS
I
I CONPIRlfPD BY INSPECTOR? I
i
I I. SEPTIC SaEE Yes No C�a¢ta
1 A) >5 ft from foundation?
a) Bldg stubout to septic tank: clear t if not 1-2%?
1 C) Baffles intact and clean? — —
1 a) Dividing wall intact?
1 Ex. D-aoz Leveled with water or speed leveler (circle one)? — —
I i
I III. DFAINIZ^_ '
1 3) >10 ft from foundation and >5 ft from property lines?
1 a) laterals level to tl inch t end ups present if not looped?— —
1
1 c) system dimensions the same as shown on the design?
1 D) Gravel clean, properly sized, and proper depth?
1 a) PRESSURE SYSTEM I
1 1) Sand quality ASTH'C-33? _ 1
1 z) Nead height uniform and t24 inches?
1 3) Cleanouts and observation ports present?
1 4) Hound: Side slope 3:1?
1 s) Owner informed electrical corrections aunt be made I
by owner or licensed electrician and inspected by DLI?
I I
1 IV. Pon= KLMM razes 1
A) >tOft from drainfie(d, transport line, and septic tank?
a) Yet to 3-100ft from drainfIaid?
1 1
1 V. PMO >sau
3q Snxem basket or effluent filter (circle am) installed?
1 a) Riser installed for,access?
C) Alarm installed?
I
1 VI. AS avlar REaoanm? — —
1
1 Vxx. 07'e8R ommmitsI
1 I
1 i
I I
1 The undersigned has reviewed this installation and verifies these findings on behalf of Hason County of Health Services-
KeaLth inspector vate
h:callin.w
Revised 02/01/95
iIS-BUILT F0RM - PAGE ONE ".-1"-a 12/14/94
II PARCEL IDENTIFICATION II
II Applicant's Name T nImA3
II Permit Number SWG9 4 -019L Subdivision I)
ame ivis ion/ oc o
Installer's Name �� Assessor's Parcel No. ?30/-( dOS� II
II Designer's Name u eF7 II
II INSTALLER CHECKLIST II
N/A Yes Prior to II
r I. SEPTIC TANK Completion II
A) >5 ft from foundation? II
B) Bldg stubout to septic tank: cleanout if not 1-2t? _ II
C) Baffles intact and clean?
D) Dividing wall intact? II
H II. D-BOX Leveled with water and/or speed leveler (circle) ? II
III. DRAINFIELD II
A) >10 ft from foundation and >5 ft from property lines?
B) Laterals level to t1 inch & end caps present if not looped? II
C) System dimensions the same as shown on the design? II
D) Gravel clean, properly sized, and proper depth? �C
E) PRESSURE SYSTEM
u 1) Sand quality ASTM C-33? II
II 2) Head height uniform and a24 inches? II
3) Cleanouts and observation ports present? Q
4) Mound: Side slope 3:1? II
5) Owner informed electrical connections must be made by II
owner or licensed electrician and inspected by DLI? II
IV. POTABLE WATER LINES II
A) >10ft from drainfield? II
II B) Wells >100ft from drain field? II
II V. PUMP/PUMP CHAMBER II
A) Designed pump use tached for equivalent pump? _ _ II
B) Screen basket o effluent filter (circle one) installed?
C) Riser installed for ac II
D) Alarm installed? ,C
CERTIFICATION OF INSTALLATION II
Installer: Check box from Row "A, " check box from Row "B," sign and date the certification. II
A. I certify that I installed the system u I certify that all deviations from II
without any 'deviation from the design the design stamped "APPROVED" by MCDHS are II
I stamped "APPROVED" by MCDHS. shown on the reverse side of this form.
I B. I certify that I contacted the u I did not contact the designer prior II
designer and left the system open for to final cover because the designer II
inspection up to 48 bra prior to cover. waived the notification requirement. II
I I further certify that all information contained on this form is accurate. I understand II
that if the information contained here' is jot accurate, there will be just cause for II
immediate suspension of my inZsler r 'fi ation. II
1g a ure erUaLeII
The undersigned approves this installation of behalf of Mason County Department of Health �I
Services. mealtn II
�I
inspector uatLsII
�J
AS-BUILT FORM - PAGE TWO Ravisad 12/14/94
II PARCEL IDENTIFICATION I
Applicant's Name A�� "o/ Ali Permit Number SWG9 6 - d( It7 Subdivision
ame Zvi >_on oo
Installer's Name Assessor's Parcel No. h
Designer's Name 'h v �T
'I AS-BIIILT DRAWING
Sole� cn a(le� as per, c s�
u
Now :
II II
�� II
u
CAUTION: minor adjustments to septic tank location and drainfield orientation Made in the field by the Installer are generally ac-
ceptable to both the department and the designer, but could In certain uses 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 making any
deviations from the design that affect system viability. Any deviations from the approved design must be shown above.
N AS-BUILT CHECKLIST
bDrainfield orientation Observation port location Undisturbed native soil
and layout between trenches
154.Cleanout location
Trench/bed dimensions and North arrow
critical distances within 0 Manifold placement
layout Scale of drawing shown
9J orifice placement on scale bar
D-Box/"T"/"L" location r-n
bZ Lateral placement, with Additional Mound Information
•�. Septic tank/pump chamber distances to edge of bed n ��
location U Endslope width
Location of wells, roads r_
�� ��ocation of buildings u Overall fill dimensions