HomeMy WebLinkAboutSWG98-0563 - SWG Application / Design / As-Built - 12/10/1998 MA50N-COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT NO. SWG — m
426'W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date
N O
Receipt No. H
PHONE (360)427-9670 1Amount$ )� z E
m
Via_ 9_99 CHECK APPLICABLE ITEMS m
MAILING ADDRE�: r DAYTI E PHONE: NEW SYSTEM
REPAIR SYSTEM
OITY•� e I STATE: ZIP: MAINTENANCE REVIEW obi
J ZI SINGLE FAMILY
PROPERTY ADDRESS: OTHER z
E S - � SPECIFY: 3#k
S ECIFIC DIRECTI NS FOR L GATING SITE: PRIVATE WELL m
C COMMUNITY WELUPUBLIC SYSTEM II'f
SYSTEM WFI#
G SYSTEM NAME
APPLICANT
NAME la
Name of Lot ft.x ft. MAILING ADDRESS -
Installer G Size: acres TELEPHONE I�
Name of � umbar o SIGNATURE,,, o
Designer�(ah0�T t P_1 Bedrooms X
I PLOT PLAN _ W
Draw a dime t plan, I '
including: 4lj1� 3�9 23 c
❑Precise local9d of test o� "- lO
holes,sh CCC555
measure n W 3
property//g�a4MM� ar
❑Entry ro'ce�;Zllhet't0ads, �S 1 2- 0 i S ICU
drivew T�) / " 7
NOTE: OT DFIA L65 ---
—WE DESI
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
`T41 -�T' SOIL LOGS 3 b-2bti
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DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: Tye One ❑Two
Soil Type �_ T
Soil Depth in. Septic Tank Daily '
P L�1�-"" �S Capacity: ',100 Gal. Flow: o GPD
Slope GI S% 0 Appl. rr� Infilt.
Parcel Size I&Z Ac. 0 Rate Q .N GPD/FT2 Area 6 0 0 FT'
Distance to Shoreline afmft Total Ins actor Date
i i
11 ��+ COMMENTS/CO DITIONS FOR APPR VAL
•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 thgepecifled use of the property or any site alteration affecting the system design may invalidate this permit.
•This lt from Ne dale of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE REVIEW: DESIGN REVIEW:Approved Q Not Appr ved INSTALLATION.,ti Approved ❑Not Approved
BY: DATE: BY d.DATE: Y 9 BY: DATE:5-to-AR
TOP: Health Dept. Cop MIDDLE: Desig is Copy BOTTOM:Applicant's Copy
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SEPTIC TANK
PUMP CNAMSER
ACCESS RISER '
i O
CONTROLPANEL
PRESSURE DISTRIBUTION LATERALS
TRANSPORT PIPE
MANIF41 D PIPE
OLEANOUT I MONTIORINO PORTS
PRESSURE DISTRIBUTION
DRAINFIELD
-30
I)ESI(yN.FORM - PAGE ONE Revises Febmary tt, 1999
A design will be reviewed when 3 conies of each of the following items are submitted:
Completed design form that has been signed and dated %6 Scaled layout sketch.Including as applicable Gems on checklist
SWed plot per,Including all applicable Ramon checklist % Cross-section sketch,Including all applicable Rams on checklist
PARCH,IQENTIPICATIQN
Permit Number: S WG 0, - in t;t 3 Designer's Name:
Designer's Phone k: l00 2.
Applicant's Name: P r rn n c r S ha , ,l Assessor's Parcel No.: .Ye2/_3 S—- 41.3 - 00/3 0
Mailing Address: E ) 88 1 =sinnd Lk. Imo.-, Crwelve-Digit Number)
Shel not utA 48,5-&4 Subdivision:
city State Zip (Name/Division/Block")
DEIGN PARAMETERS
Treatment Device
O Glendon Biofilter 0 Sand Filter 0 Mound O Sand Lined Drainfield
O Aerobic Unit-Make/Model: 0 Disinfection Unit - Mak cdb s
Drainfield Type APR VED
® Pressure O Bed ®Dtainrock Initials
0 Gravity 19 Trench 0 Gravelles Chambers
Septic Tank/Drainfield Specifications Laterals
Length
Number of Bedrooms ,3 Schedule/Class
Length
Daily Flow 32.0 Diameter 11 4 in
Septic Tank Capacity 1.264 gal Number 3
Receiving Soil Type(1-6) 3Separation 9 ft
Receiving Soil Appl.Rau 10. gild/ft'
Required Square Footage Coco fe Orifices
Designed Square Footage L d 3 Its Total Number of Orifices
Percent Reduction Taken % Diameter 9/
TrencbBed Width 3 ft Spacing AG in
Trench/Bed Length .24 ft
Elevation Measurements Manifold
Original Drainfield Area Slope c 30 % Schedule/Class coo
Length 3 it
New Slope if Altered 1a Diameter 12- in
Depth of Excavation from l7 in ❑No
Original Grade (Up-slope) Preferred Manifold Configuration Used? 0 Yes
Designed Vertical Separation q in Transport Pipe
(Down-slope) Schedule/Class �200
in Length d '- it
�'
Gravelless Chambers Required? ❑ Yes ❑No 0 Optional Diameter in
Pump Required? QI Yes ❑No Dosing and Pump Chamber y
Pump/Siphon Specifications Number Quantity
s/Day
Dose Quaantity 94 cal
Difference in Elevation Between Pump Shutoff and Uppermost Chamber Capacity IF00 eal
Orifice: /5" ft Pump Controls: Timer(or) Elapse Time Meter(circle if required)
If Timer: Pump On , Pump Off
Uppermost Orifice is 9Higher, 0 Lower than Pump Shutoff
Capacity @ Total Pressure Head: 4.71 eom Check the following components if they drain between doses:
Calculated Total Pressure Head: ❑ Laterals ❑ Manifold ❑ Transport
(Attach Pump Curve)
DESIGN FORM- PAGE TWO
Revised PeMuwy IS.199,
III&IGN CH.ECKI ISTS
y Cross-Section Sketch
rXProperty
led Plot Plan Scaled Layout Sketch
91 est hole locations W Dtainfield orientation and layout Referenced depth from original grade:
Imes ® Trench/bed dimensions and critical
xisting and proposed wells within (� Septic tank lid and dreinfield cover
distances within layout depth
100 ft of property lines O D-BoxP'T"P"L"locations
a Critical distance measurements to cuts, B Septic WWpump chamber location Reference depth from original grade
banks,and surface water 14 Observation port location and restrictive strata:O Location and orientation of curtain 2 Clean-out location aterels
drain and all absorption components Manifold placement O '�c�d top and bottom
LA Location and dimension of rim Curtain drain collector
primary Orifice placement O Sand augmentation system and reserve area O Lateral placement,with distances to
X Buildings edge of bed Other cross-section detail:
M Direction of slope indicator M Audible/visual alarm referenced Observation
Ports and clean-outs
® Waterlines
P Scale of drawing shown on scale bar
0 Rosdsreasemehtsfdriveways/ _
parkingCICtlon
O Critical resource lands(if applicable) Y+Ayout lafyk W4on l°r mapnd� t jF llysterq. ��`. tttt
e 4q.•0� .�.. i•
Q. Overall fill dimensions Q Bottled ca de
CW North arrow and scale of drawing p Pft!At cwxtter: edgo of
shown on scale bar CI Up slope,dawnslopo,and.oadsiOpo° ; hed
filtwidth • " � Stdotvalis[apa '.� �•
attddt+. �tgt(s(Fvatiou
Additional Information
Rl Design staked out
O Operation and Maintenance Notice
Attached
O Wafver(s)Attached
DESIGN APPROVAt,u5
The undersigned designer does, 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 cov
y-99
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:
t:rfYironmental Health S islist Date
Caution: DESIGN APPROVAL IS VAUD ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Department of Health Servicec�ss
✓ The On-site Sewage Permit has not expired,the Permit Expiration Date is: /1//(p��Otj/
✓ The system is installed by a certified installer, unless prior authorization is obtained from Mason County
Department of Health Services.
✓ Drainfteid site conditions have not been altered to adversely affect conditions of design approval
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Initials �-Pn'' I
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Mason County Dept. Health Services
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Muon County Dept, Health Servlaee
APPROVED
q° Initials a
Date < \ �O
X
c� V1 11
SECURED LID WITH GAS TIGHT SEAL
24"DIAMETER
1 ACCESS RISER
FINISH GRADE
- - - - - TO PUMP
CHAMBER
FROM SEWAGE
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS
SEPTIC TANK
(TYPICAL)
SECURED LID WITH GAS TIGHT SEAL THREADED UNION
24"DIAMETER
ACCESS RISER
SERVICE
FINISH GRADE VALVE*
FROM SEPTIC TO DRAINFIELD
TANK
EMERGENCYSTORAGE ANTI SIPHON
VALVE*
HIGH WATER ALARM LEVEL
INDEPENDENT
WORKING VOLUME - FLOAT STEM
NORMAL TIMER OFF LEVEL FOR FLOAT
MOUNTING
ENCLOSED PUMP
SEDIMENT SHROUD CHECK VALVE
i$ I
SEDIMENTS SUBMERSIBLE
CENTRIFUGAL
PUMP
Meson County Dept. Hea th Setv Cas PUMP CHAMBER
"PR VED (TYPICAL)
`AS NEEDED
Initials
Date
TO DRAINFIELD RISER WITH LOCKING LID
PRESSURE LATERALS
a a
1
FLOW CONTROL VALVE
SLOTS AS
REQUIRED
LONG SWEE90 DEGREEP %/\ PTO0 Ic/\\
ELBOW �— %\\ /ix
SECTION A-A
WASHED ROCK
DRAIN SUMP
TRANSPORT PIPE FROM '
PUMP CHAMBER
DRAINFIELD CONTROL BOX M8Sol1 County Dept. Health Services
AP anifo%l abj�, La' xrolS IntiiaR VED
Date
ENGINEERING DETAILS eD OO
47t
Performance Data
Pump Characteristics
Pon /Motor Unit Subo ersble
Monad Model SO MHl MH2 11111116 1 MIA MHS W 48
Autantmk Models AHl AH2 - 0 1 HP
Horsepower 1 2 z '
Fug land Amps 1 S.0 7.5 4.0 1.8 1.5 cs
Motor Type Capacitor Start Three-Phase a 32
A.P.M. 3450 s
Phase 0 1 1 3 0
Volta 115 230 1 200 1 460 575 c 1B tIZHP
Mamrd Model 100 M112 1 MIHb 11111113 1 111 MHS t-
Autonatk Models AH2
Has w 1
Fail load Aar s 9.5 4.5 Z0 2.5 l.S
M6tor7 Ca Three-Phase 00 24 48 72 96 120 144
R.P.M. 3450 CAPACITY-U.S.G.P.M.
Phase
ou e e 230, 200 230 3 460 1 S7s Total Head (feet) 10 20 30 40 50 60
Hertz 60 1/2 HP 105 77 50 23 0 —
Operation Intwwtten
Tom atwe 140-F Ambient GPM 1 HP 137 120 96 67 31 0
HFMU Dodge B
Insuhdian Class Dimensional Data
Discharge Size 12'NP7 (y t.)
SoWsH 3T 4-1/4 _ _ 7-7/8 1.M dimemiom in Wan
Unit Wai t 1 73 firs. i 5-7/8 2.Cmgomrt Amennae may
PowerCwk SPDSOH I4/3,SJTW-A,Is,IISV-10'stA(2(r \ 2NPT eany±1/8 inchopt.)-14/4,STTW-A,la,11 SV-I sit(20'opt.)-1 6/3,STW-A,lo, 4 3.Net for mmtwpmaion wp
230V=201stA-16/4,STW-A,Is,23OV.2W std. SPI1100X 16/3, unless m#W
STW-A,Ia,230V.20'sd.-16/4,STW-A,to,230V=20' 4.dammiom and swiphn are
stA-18/5,STW-A,3a,200%23OV,460V or MY=20'std. I approsinwh
4-trel ( 5.We rmwe the dNM to male
�_ / revisnm to oar poduds and
Materials of Construction aucifineans view
nape
Han& Sled a NOTE Model SPD100AH2uAms
Imbrkating 09 odork 09 — — v&angle PRnbod
Boot seiah for
Motor Housiog Cast Iran aunmolk opanatim.
Sod Housing Cost Iron
Pump Casing Cast Iran -
Shah Stainless Steel
Mechanical Sod Faces:Carbon/Cerark
Shag Sod Sod Bode Bross 15-3/4
Sprier.Stainless Steel
Begows:Bwto-N 14-7/8 I.. tx-Ire
Impeller Cast Iron
Upper Bearleg Single Row Bag Bowing
Lower Bening Single Row Ball Bea*
Base Cost Iron
Fasteners Stainless Steel
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AURORA/HYDROMATIC Pumps, Ince
1840 Boney Road, Ashland, Ohio 44805
(419) 289.3042
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Mason County Dept. Health Services
"PR VED
I Initials.
Date 4 0 .
IYO JC4�G
MASON COUNTY SEPTIC SYSTEMS
Diana FYeld
P.O. Box 1341
Shelton,WA 98584
(360) 426.8642
1NSTALLATION I MAINTENANCE
Pressure Distribution Systems
1. Install laterals with contour of the ground.
2. Install trench bottoms level.
3. Install locator tape on top of all drainf field laterals.
4. Install observation ports as indicated on the plot plan. (Minimum
two per drainffeld with the bottom extending to the drainrock/
native soil interface. Observation ports shoulds
a.) Have threaded removable caps
b.) Be accessible from tha ground surface
c.) Be void of gravel to the infiltrative surface to allow visual
monitoring of standing water in trench or bed
d.) Be designed with a' r to prevent easy removal
6. Install threaded cleanouts at ends of all laterals with cap
extending to within 6 inches of finished grade and be marked with
locator tape.
6. Install audio/visual high water alarm.
?. Install effluent filter on outlet of septic tank and/or 1/8th inch mesh
non-corrosive pump screen. (Minimum 12 sq.ft. surface area,not to
interfere with controls or floats.
S. Tee to Tee construction Letween laterals and manifold with
orifices oriented at 6 o clock. Install laterals to the manifold with
orifices at 12s00, (do not glue), after pressure test and Health Dept
approval,turn orfices down to 6 o' clock and glue laterals to manifold.
Mason County Dept. Health Services
TiaRVEDls
Date
(Unless design specifies orifices to be left at 12:00, in which case orifice
shields would be required.)
9. Geotextile (filter fabric) required over drainrock prior to backfilling. If
the drainrock extends above natural grade, run the filter fabric at least 2
inches down the trench wall.
10. Install drainfield during dry weather and soil conditions. Any soil
smearing must be eliminated by hand raking.
11. Divert all storm water run-off away from on-site sewage system.
12.No curtain drains allowed within 10 feet of the up-slope edge of
drainfield and reserve area.
13. No curtain drains allowed within 30 feet of the down-slope edge of
drainfield and reserve area.
14.A cover of between 6 and 24 inches of mineral soil containing no greater
than 10%organic content shall be placed over the entire drainfield area and
shall be graded in such a manner as to preclude accumulation of water over
the drainfield. Backfill and grade the site to prevent surface water
accumulation over any component of the on-site septic system.
16. Installation of drainfield on a sloped area should have check valves
installed in the manifold to prevent hydraulic overload of the lowest
elevation lateral and also to enhance rapid pressurization of the system.
16. This system has been designed in accordance with all current state and
county Health Department regulations and this designer assumes no
responsibility for its use or longevity. The owner therefore agrees to
maintain and make all necessary repairs to the system at no cost to MASON
COUNTY SEPTIC SYSTEMS and Diana E5eld.
17. All materials and workmanship must meet County and State regulations.
Mason County Dept. Health Services
APPROVED
initals6Q11--
Date
� . . r
Ir
19.Deviation from this design without prior approval from the
designer and Mason County Heath Department will wake this design
null and void.
The On-site Septic System owner is responsible for properly
operating and maintaining the OSS and shall:
a.) Determine the level of solids and scum in the septic tank once
every three years.
b.) Employ an approved pumper to remove the septage from the
tank when the level of solids and scum indicates that removal is
necessary.
c.) Protect the Oss area and the reserve area frome
1. Cover by str tares or impervious material
2. Surface drainage
3. Soil compaction by vehicular traffic or livestock
4. Damage by soil removal and grade alteration
(L) Keep the flow of sewage to the Oss at or below the approved
design both in quanity and waste strength
-e.) Direct drains,such as footing or roof drains away from the area
where the Oss is located
f.) Inspect and clean pump screen every 6 . 12 months
g.) Inspect floats and test high water alarm every 6 to 12 months
High strength waste win increase the depth of the biomat in a
drainil d,causing a decreased flow through the biomat and possible
ponding or flooding of the drainfield. High strength waste in a
residence is usually related to the "Blestyle"or habits of the home,
generally resulting from one or more of the 1bBowizW
1. Excessive use of a garbage disposal
2. Consecutive loads of laundry done all on one day
3. Excessive bleach or detergents with added whiteners
4. Dishwashing, showering,and laundering all at the same time
5. Medications • antibiotics can kill or impair the biological
process in the septic tank
6. Leaky plumbing ftdraulicoverloading) Mason County Dept. Health $eilf:Gits
"PR ED
Initials
Date 4 q
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
DATE CALLED IN:
TIME:
INSTALLER:
APPLICANT/OWNER:
CALLER: / SC
PHONE#OF CALLER: C /
SWG#:
PARCEL NUMBER:
SUBDIVISION:
Div: Lot:
SYSTEM TYPE(CHECK ONE): ❑
PRESSURE GRAVITY
INSPECTION SCHEDULE(CHECK ONE): ❑
APPOINTMENT PIS
AS-BUILT ON-SITE(CHECK ONE): ❑
YES No
STAFF INITIALS:
y :
APPOINTMENT DATE: WO_ TIME:
COMMENTS: 1i CvvV
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
STAkF' IS4TTST
_..Yes No Comments
rG) Gmvel
IYC Tatatc
>5 ft.from foundation?
>50 ft from wells and surface water? —
Bldg stub-out to septic tank:clean-out if not 1-2%7
Baffles intact and clean?
Dividing wall intact? —�
isers installed for access? X
ox Leveled with water and/or speed leveler(circle)? _
umrEt�
>10 ft from foundation and>5 ft from perceived property lines?
I00 ft from wells and surface watefl vivti-d rck — evP 10 ft from potable water lines? f rc N „�
aterals level to±1 inch&end caps present if not looped? —�--� f0a_�1
ravelless chambers utilized? JC
ystem dimensions the same as shown on the design? K
ravel clean.properly sized,and proper depth? x
H) PRESSURE SYSTEMS
1) Sand quality ASTM C-337
2) Head height uniform and x24 inches? ^36
3) Clean-outs and observation ports present? x
4) Mound: Side Slope 3:17
5) Owner informed electrical connections must be made Y_
by owner or licensed electrician and inspected by L&I?
IV. PUW/PUas CHANMFR
A) Screen basket or effluent filter(circle one)installed? _�� ��.�
B) Riser installed for access?
C) Alarm installed? --
D) Pump on timer o eman (circle)?
V. AS-BUILTREQuiEU?
VI. OTHER COMMMWOSSERVAUONS
The undersigned has reviewed this installation and verifies these findings on behalf of Mason County Department of Health Services.
cry 5-`lo nc�
Sanitarian Date
CAMyFilcd£uuld"Lwpd
Revised 9/26/97
-BUILT FORM Aeviaea Vl8N!
a�r PARt^RT�TDkllltFif/a7�011i,±
Applicant's Name ZCaV— Assessor's Parcel No.
Permit Number Q —_Q.r] Subdivision va
Installer's Name Big
Desigfer's Name Alan
N/A Yes Prior to Completion
L Szr=TAtolr
A >5 ft.From foundation? X
B >50 ft fiom wells and surface water?
C JMBld�st�u�b-out to c tank:clean-out if not 1-2%?
D BetYles intact and elan? �_
E Dividing well inhcll
F Risers installed far mans?
IL D-Box Leveled with water and/or speed leveler(circle)? x
M. A RA 10> from foundation and>5 ft from property lines?
B >100 ft fiom wells and surface water?
C >10 A from potable water lines?
D laterals level to+1 inch&end caps present if not looped? _
E Oravellna chambaa utilized?
S dimensions the name as shown on the desip?
deo.prnagmd aerly sittd.and proper depth? A.
PRzssuRx 2 Head height unlityniiterm� amend i24 inches? Actual head height"30 . �—
3 Clean-outs and observation posts present?
4 Mound Side Slo 3:1?
5 Owner informed ' connections must be made by
owner or licensed electriaan and inspected by W?
IV. Pula/PUbe Ctw
IB
Pump model 5�D S Oone)'f installed?Pump Baltic a �'7 f.
Pump en times d car
1 If timer emer On Timer Off
"Ac-BUIITD1tAWAiG ` a
CHAaaaST
❑ DraioWWsmsoit'oldoriwwiao
&layout
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aritinldinasaawithialayout
❑ Sap WFUW teak plaosmset.
Cl IaaatimofbuUiW
❑ oaavatianport&d..00ut
babas
❑ Laotian of wails&rondo
❑ uadimuhad native sail ben was
trtaoha
❑ Narthatrow •.
llUllON.•Yawr adjumnenu ro etiHa fart loeatlon and dwlnJ7ald wlpuaflon rinds In rho fls/d by fhe IufaWr an generally acrepwble fp aqh the departnunf and the
bngwer,but could innrwin case eon In the vloblHy oJN•ryr lime /f It fhe lnrwl4r r rnponslblHryry w obfaln ya�r11or wNHaw oyProwlfi"either Hr health
teporinenr or tht designer before any dewoHou m fht detlgn that af/eat fhe sysum ablHry. .4ny dMaHdruJrorn fM opptowd Ise n uet be thorn above
cBIiIIFIS A1IA�OF�I�s4I
Installer. Check a box from Row"A"and"B",sign and date the certification
A. I ceRity fit)installei "e term t an deviation I tha�all deviations firm the design stamped
from the deign stamped v M MC
vsD by MCDHS are shown above.
B ® I certify feet I contacted the designer and left the system ❑ I diO not contact the deaf�ta prior to 6ma1 cover because the
open for mspation,up to 48 hrs prior to cover.• designer waived the notaCustson requirement
I further certify that all information comyined on this form is accurate. I understand that if the inLymatic wined herein is not accurate,these
will be just cause for immediate suspension of my installer certification.
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The undersigned approves this installation on behalf of Mason County Department Health Service,
• f 5 -l0 aAA