HomeMy WebLinkAboutSWG98-0227 - SWG Application / Design / As-Built - 5/20/1998 MASON COWNtY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG _ C
426 W.CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date J—c4(J, ;)V y: o
PHONE (360) 427-9670 Receipt No. H
Amount$ Z F
PH� e J,\�L DATE � w_ CHECK APPLICABLE ITEMS $/ m m
M OAD S: 1 DAYTIME PHONE: NEW SYSTEM _o
REPAIR SYSTEM
CITY• �O STATE: ZIPO MAINTENANCE REVIEW m
SINGLE FAMILY m
PROP RTYADDRESS, OTHER Z
E nU SPECIFY: 3
SP CIFIC DIRECTION FOR LO ATING SITE PRIVATE WELL m
W O A aJ 1A� O COMMUNITY WELL/PUBLJCSYSTEM �w
SYSTEM WFI A
Oo IS� P� FfC�C SYSTEM NAME IA
Q J N ��. APP C NT (J
Name o Lot a So ft.x QM MAILING A RESS% t I~
Installer
O� S Size: ,•Z acres NE
T �a
Name of
Designer LI (I um er o IG LI
Bedrooms X
PLOT PLAN
Draw a dimensional plot plan,
including: ,Y I 3 a)-!
❑Precise lops V of test
holes,shooWWjjtt>�ij
measured distanc
propertybWndarie .
(::� 4� f
❑Entry road r row �t
driveways. %=
NOTE: DO NOT DRA6C IN
SYSTEMOESIGN 62
� C t
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS
f B� � I
?at IbLE #2 TETTtlaXCS f-3
0-2411 gR+ aLy w
0-25 ' gravelly 1.oRrvi. o_ Z,&fr%,z�lvL"zc-
24-7-q" TIZM51TlON tK
Z 6-30 ° Tv1w5rumv`f` -I&-30 rr f*19 PAN YU0TTtFP
24-31 1 pes ndiv2gray 50- 35 daCOPAV
4v
d jV4t%moN t "M LS IT "Tit Ic'rrvf
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One )(t Two
Soil Type
Soil Depth 74 in. 15 Septic Tank Daily
d Capacity: 1•z� Gal. Flow: GPD
Slope 5' 1014 % � VEpyBe4btt�
/�
Appl. Infilt.
Parcel Size I• AC. Q Rate GPD/Fr' Area GOO Ff7
Distance to Shoreline? ft 11otal Inspector Date
5 2q y8
COMMENTS/CONDITIONS FOR APPROVAL
•All on-s@e 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 dtenne from the specified use of the property or any site aHeragon atFecting the system design may invalidate this permit.
•This perm ex free 2 ears from the date of site review.Denial of this R me be appealed to the Health Officer within 10 days of denial date.
SITE IEW: DESI N R IEW:I Approved ❑Not Approved p INSTAL LATION:gApproved LI Not Approved
BY: ATE: 5 BY: DATE: I-Zcl Aq BY: ql7lqq
TOP: Health Dept.Copy MIDDLE: Designer's Copy BOTTOM:App icanYs Copy
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
Fsvironmenral Health Water Qualify
Personal Health
PO BOX 1666 SHELTON, WA 98584
LOCAL(206)427-9670
BELFA1R(206)275-4467&4468
FAX(206)427-7798
DATE: � -�� I
TO: �0� L006,A "
FROM: PA"'
RE: Designfor_ KQ- �U F, ParcelH 3 2
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
NOTAPPROVED. Itdoes not meet the requirements or needs additional
information.
I I ✓Er � � � N�er� ��1`� n,�. II c
G'1� ✓u���C1� � Ag� �t
DESIGN FORM - PAGE ONE Revised Feli uary 19,199:
"A design will be reviewed when 3 copies of each of the following Items are submitta
Completed design form that has been signed and dated Scaled layout sketch,lnoluding'af pplloeble Itemsrrrs on ci,
Scaled plot plan,Including all applicable Items on checklist Cross-section sketch,Including all applica jt"p hpgldist
, 4
PARCEL CIENTiFICAVON Us i
Permit Number: SWG q6R, - 0Q99 Designer's Name:
� �/� Designer's Phone#: yo�(o- (00
Applicant's Name: R-�l J(1 C4c Assessor's Parcel No.: `w— 90141
Mailing Address: V D I (Twelve-Digit Number)
ASS Subdivision: I '� I � n
City State Zip (NamdDivision/Blocktt-ot)
DESIGN PARAMETERS
Treatment Device
O Glendon Biofilter ❑Sand Filter ❑ Mound ❑Sand Lined Drainfield
❑Aerobic Unit-Make/Model: n UKWera --- QloO ❑Disinfection Unit - Make/Modeli;e-r, ':_o:ri y uep,. Heath Services
Drainfield Type AID P,, r D V
Pressure O Bed O Drainrock Initials
Gravity ❑Trench ❑Gravelles Chambers. 1_Lq-
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 chedul Class AM
Daily Flow Length Sty ft
Septic Tank Capacity i.AOO Diameter 1'�'/ in
Receiving Soil Type(1-6) y Number �(
Receiving Soil Appl.Rate t o gpd/ft- Separation 9 ft
Required Square Footage (goo it"
Designed Square Footage (00c) ftt Orifices tD?
Percent Reduction Taken n % Total Number of Orifices
Trench/Bed Width 3 It Spacing
3//(o in
TrenchBedLength �C,O ItSpacing 3(O in
Elevation Measurements aZEM ,„Manifold 0
Original Drainfield Area Slope o Length
I lass 2i ft
New Slope if Altered ° Diameter er Z in
Depth of Excavation from in
Original Grade (Up-slope) Preferred Manifold Configuration Used? CzYes ❑No
Designed Vertical Separation\ IZ in Transport Pipe(Down-slope) cl i Class 40
IZ in Length 4z ft
Gravelless Chambers Required? ❑ Yes XNo ❑Optional Diameter 7— in
Pump Required? Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of Doses/Day 'ti
Dose Quantity IWe-) eai
Difference in Elevation Between Pump Shutoff and Uppermost Chamber Capacity /000 aal
Orifice: -7 ft Pump Controls: Timer(or) Elapse Time Meter(circle if required)
If Timer: Pump On , Pump Off
Uppermost Orifice is Higher, ❑Lower than Pump Shutoff
Capacity 8 Total Pressure Head: 40,1 Z. ChFck the following components if they drain between doses:
Calculated Total Pressure Head: Txo'Cf Laterals ❑ Manifold ❑Transport
(Attach Pump Curve)
DESIGN FORM- PAGE TWO Revised February Ia r
RESIGN OFI90KLISTS _
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Test hole locations 'n Drainfield orientation and layout Referenced depth from original grade:
Property lines b Trench/bed dimensions and critical Septic tank lid and drainfield cover
�] Existing and proposed wells within distances within layout depth
100 ft of property lines O D-Box/"T'P`L"locations
'M Critical distance measurements to cuts, �9 Septic tank/pump chamber location Reference depth from original grade
banks,and surface water b7 Observation port location \and restrictive strata:
b) Location and orientation of curtain b Clean-out location O Laterals,trench/bed top and bottom
drain and all absorption components Manifold placement O Curtain drain collector
Location and dimension of primary ail Orifice placement O Sand augmentation
system and reserve area )9 Lateral placement,with distances to
�9 Buildings edge of bed Other cross-section detail:
�J Direction of slope indicator Audible/visual alarm referenced �1 Observation ports and clean-outs
Waterlines b Scale of drawing shown on scale bar
Roads/easements/driveways/ (ros$,gat[oh IafotDlBtIQt1 fill tiltntl
pig Layout Information for mound fyatemt. " system;
O Critical resource lands(if applicable) Overall fill dimensions Soaled rap doptit dt txatt artllxtl a tit
North arrow and scale of drawing Up slope,dawmslope and emdslope ! had
shown an scale bar 77 fill wldth SidgYallsko
Up•stope and darnel Ited�letuaticn
Additional Information
�] Design staked out
Operation and Maintenance Notice
Attached
O Waiver(s)Attached
tvasor your; :;e;
DESIGN APPROVAL
The undersigned designer does, does n waive the requirement to be notified by the installer of the ir�alialion and given 48
hours to perform a final inspection pr: o cover:
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:
✓ 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: _4�- 2421- 200 k
✓ The system is installed by a certified installer,unless prior authorization is obtained from Mason County
Department of Health Services.
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval
Services
Date
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SI
S KH D 150 S P40 SP50
^� MAX. SOLIDS 3/4"SPHERE MAX.SOLIDS 1-1/4"SPHERE MAX.SOLIDSI-1/2"SPHI
1-1/2 HP 4/10 HP 1/2 HP
3450 RPM 1750 RPM 1750 RPM
Mason County Dept- ryea;th Serv;CeS
APP0`QED
Initials_
Grata
e'Y_
t
• Dual shaft seals standard. Seal • Available in automatic and manual • Available in automatic and me
failure sensor capability available • Oil-filled ball bearing motor • Oil-filled, heavy-duty ball bear
(to be wired to an alarm device) incorporates automatic reset motor
• 1-1/2 HP, oil-filled motor thermal overload • Enclosed,two-vane cast iron
• Rugged cast iron construction • Non-clog,two-vane thermoplastic sewage-type impeller
• 1-1/2" NPT discharge sewage-type impeller • Automatics feature oil-isolatec
• Spring loaded mechanical seal • Automatics feature reliable level control diaphragm switch
with carbon and ceramic faces diaphragm switch with piggyback cast iron housing
• Non-clogging semi-open plug-in • Rugged cast iron construction
thermoplastic impeller • 2" NPT discharge • Mechanical shaft seal with cal
• Pump-out vanes on rear shroud of • Rugged cast iron construction and ceramic faces
impeller • Stainless steel shaft • 2"NPT discharge(3"flange
• For high head septic tank effluent • Completely field serviceable optional)
applications • Residential sewage ejector or high • Completely field serviceable
• 1-1/2 HP, 1 o 230V and 3e 200V, capacity sump pump • All bronze model(SP50AB1)it
230V, 460V or 575V • 4/10 HP, 1 e 115V or 230V automatic, 1 e 115V
• 1/2 HP, 1111 115V, 20OV, 230V
3o 200V, 230V,460V or 575V
160 32 —.. 32
120 624 { Q24
rr
j a a
J40 � � 8
Fo' F
00 16 20 30 40 60 60 00 20 / 80 60 100 120 00 32 64 96 128 160
CAPACITY-U.S.G.P.M. ►ACT'-U.S.G.P.M. CAPACITY-U.S.G.P.M.
1871 E Johns Prairie Road
Shelton, WA 98584
360-426-6697
Rob's Excavating
GENERAL NOTES
1. Rob's Excavating has designed this system in accordance with all-current state
and county Health Department requirements and 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 Rob's Excavating.
2. The contractor shall be certified and approved by the county to install septic
systems.
3. The contractor shall field verify all contours, stub out elevators, and trench
depths in drainfield areas before construction.
4. All construction materials and installation shall conform to all applicable state
and county Health Department requirements.
S. It shall be the installer's responsibility to have a copy of this design ogsue at1`'
times during construction. f_
lniii8lg
6. It shall be the owner's and/or installer's responsibility to notify Rob's
Excavating and the county Health Department for the required inspectionite
before backfilling.
7. All required tests shall be successfully run before calling Rob's Excavating for
final inspection. All components, including all tank access lids must be
accessible for inspection.
8. Rob's Excavating and the County Health Department shall first approve any
variations to this design.
9. Owner/Installer shall not remove any topsoil in drainfield area. Removal of
topsoil could render the site unusable.
10. Existing utilities shown on the plans have been plotted from the best information
available to the designer. Accuracy and completeness are not guaranteed.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Have agpo&l Day!
ROB'S EXCAVATING
1871 E JOHNS PRAIRIE RD SHELTON, WA 98584 (360-426-6697)
INSTALLATION/MAINTENANCE
PRESSURE DISTRIBUTION SYSTEMS
1. Install laterals with contour of the ground.
2. Install trench bottoms level and at all times a minimum of six inches into the native
soil.
3. Install locator tape on top of all drainfield laterals.
4. Install observation ports as indicated on the plot plan(minimum two per drainfield
with bottom extending to the drain rock/native soil interface).
5. Install drainfield during dry weather and soil conditions, and soil smearing must be
eliminated by hand raking.
asan ;e ,
6. Install threaded clean-outs at the ends of all laterals (cap must extend to within r.,
inches of finished grade and be marked with locator tape). L J r 4
7. Install audio/visual high water alarm. Initials
Date
8. Install 1/8 inch mesh non-corrosive pump screen(min. 12-sq. ft. surface area, not to
interfere with controls or floats).
9. Install check valve in pump outlet line to prevent system from draining back into the
pump chamber.
10. Filter fabric required over drain rock prior to backfilling. If the drain rock extends
above natural grade, run the filter fabric at least 2 inches down the trench wall.
11. Divert all storm water run-off away on-site sewage system.
12. No curtain drains allowed within 10 ft. or the up-slope edge of the drainfield and
reserve area.
13. No curtain drains allowed within 30 ft. of the down-slope edge of the drainfield and
reserve area.
14. Have the septic tank and pump chamber pumped or inspected every three to five
years.
15. Inspect floats, clean pump screen and test water alarm every 6— 12 months as needed.
16. All materials and workmanship must meet County and State regulations.
17. Septic tank risers to be at or above finish grade.
18. Deviation from this design without prior approval from the Designer and Mason
County Health Department will make this design null and void.
19. Pump chamber lid to be above finish grade.
20. 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 scrum indicates that removal is necessary.
c) Protect the OSS area and the reserve area from:
1. Cover by structures or impervious material
2. Surface drainage
3. Soil compaction by vehicular traffic or livestock
4. Damage by soil removal and grade alteration
d) Keep the flow of sewage to the OSS at or below the approved design
both in quantity and waste strength.
ce
21. High strength waste will increase the depth of the biomat in a drainfield, causin���a y
decreased flow through the biomat and possible ponding or flooding of the drainftdtd-
High strength waste in a residence is usually related to the"lifestyle"or habits of theitials
home, generally resulting from one or more of the following: Date
a) Excessive use of a garbage disposal
b) Consecutive loads of laundry done all on one day
c) Excessive bleach or detergents with added whiteners
d) Dishwashing, showering, and laundering all at the same time
e) Medications—antibiotics can kill or impair the biological process in
the septic tank.
f) Leaky plumbing(hydraulic overloading)
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
CIae�Ic� sw♦.
DATE CALLED IN / I
O TIME:
INSTALLER: I
APPLICANVOWNER:
CALLER:
PHONE#OF CALLER:
PARCEL NUMBER: Sc-;)-13 V— KQ
SUBDIVISION:
Div: Lot:
SYSTEM TYPE(CHECK ONE):
PRE KS GRAvITY
INSPECTION SCHEDULE(CHECK ONE):
APPOWIMENT PLUG IN
AS-BUE,T ON-SITE(CHECK ONE): _1� ❑
YES
/!/'�f No
STAFF IN`NTTTALs: �/ / !
�FTSTA�CISEfl14I.Y
APPOINTMENT DATE: TIME:
COMMENTS:
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
Sa�Al��r�uc�.rsr
Yes No Comments
MD) Baffles
foundation?
m wells and surface water?
stub-out to septic tank:clean
if not 1-2%7 ,���,
act and clean? NA
Dividing wall intact? ��
isers installed for access? _
x Leveled with water and/or speed leveler(circle)?
BVFIELB '
10 ft from foundation and>5 ft from perceived property lines?
100 ft from wells and surface water? ✓
10 ft from potable water lines? _—
aterals level to±1 inch&end caps present if not looped?
ravelless chambers utilized? ape
ystem dimensions the same as shown on the design?
G) Grovel clean,properly sized,and proper depth?
H) PRESSURE SYSTEMS
1) Sand quality ASTM C-33?
2) Head height uniform and 2:24 inches?
3) Clean-outs and observation ports present?
4) Mound Side Slope 3:1?
5) Owner informed electrical connections must be made
by owner or licensed electrician and inspected by L&I7
IV. PUMP ER
A creen basket r etiluent filter(circle one)installed? t/
B) ser ed for access? V,
C) Alarm installed?���, —
D) Pump on timer"circle)? �L
V. AS-BUILT REQumm? V/
VI. OTFIER COMIdENrS/OBSERVATIONS
The undersigned has reviewed this installation and verifies these findings on behalf of Mason County Department of Health Services.
!Vmtnan Date
C:\MyFi1cVina1dwdc.wpd
Revised M&97
AS-BUILT FORM Revised FeMumy 18,1998
�Ait
�1 1 1at_rFt�31►Tia
Applicant s To l �r_IZ Assessor's
Parcel # 3 2-13 0 IV'
Permit Number SWG4- GZ2-7 /(Twelve-0I9aNumber)
Installer t 5 - Subdivision w I T"'O C�
J / (Name lvisionlBlocWLot)
DesignerfJ�7
INSTALLI+#t CHECKLIST
NIA 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%? . . . . . . . . . . . . . . . . . IG
D) Bathes intact and clean? . . . . . . . . . . .. . ... . . . . . . . . . . . . . . . . . . . . . . /
E) Dividing wall intact?.. . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . ✓�
F) Risers installed for access? . . . . . . . . . . . . . . . . . . . .
G) Tank Size: (ZGo gal.;Manufacture v `� D.Q
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) Gmvelless chambers utilized? . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . —
F) System dimensions the same as shown on the design? . . . . . . . . . . . . . . . .
G) Gravel clean,properly sized,and proper depth? . . . . . . . . . . . . . . . . . . . .
H) PRESSURE SYSTEMS
1) Sand quality ASTM C-33? . . . . . . • .• —
2) Head height uniform and 2t24 inches? Actual head height-4R—. . .
3) Clean-outs and observation ports present? . . . . . . . . . . . . . . . . . . .. .
4) Mound: Side Slope 3:1? . . ......... . . . . . . . . . . . . . . . . . .. . . . . —
5) Owner informed electrical connections must be made by
owner or licensed electrician and inspected by L&I? . . . . . . . . . . . . . —
IV. PUMP/PUMP CHAMBER
A) Pump make W ekA4cL ; Pump model D
B) Chamber size 100 0 gal; Manufacture v t
C) Height of pump off bottom of pump chamber inches
D) Pump chamber draw-down 2 Z— gallons per inch
E) Pump capacity t40, rL— gallons per minute
F) Pump controls:Timer(or)Elapsed Time Meter (circle if installed)
If timer is used: Pump On Pump Off
G) Screen basket or effluent filter(circle one)installed? . . ... . . . . . . . . . . . —
H) Riser installed for access? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . —
I) Alarm installed? . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
As-Sulu ClmwIN(
CHECKLIST
❑ Drainfield&manifold
orientation & layout
❑ Trench/beddimensions �5 iOeA
and critical distances f U
within layout
❑ Septic/pump tank
placement.
❑ Location of buildings.
❑ Observation port&clean-
out location.
❑ Location of wells&
roads.
❑ Undisturbed native soil
between trenches.
❑ North arrow
CAUTION:M'mor adjustments to septic tank location and drainfield orientation made in the field by the installer are enerally acceptable to both the department
and the designer,but could in certain cases 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 my deviations from the design that affect the system viability. Any deviations from the approved design must be
shown above.
GBRTIFICATlON OF 1NSTALLAT
Installer heck 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
B. ❑ I certify that I contacted the designer and left the Cefdid 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 forth is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certification.
� 7sy
Signature of installer Date
The undersigned approves this installation on behalf of Mason County Department of Health Services.
J � ( h�,r 9/-1149
S tanan F Date