HomeMy WebLinkAboutSWG94-1948 - SWG Application / Design / As-Built - 12/12/1994 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG — N
426 W. C6AR/P.O. BOX 1666/SHELTON, WA 98584 Date
PHONE (206)427-9670 Receipt No.
Amount$ zFKQRERTY OWNER.
E
m m
CHECK APPLICABLE ITEMS
MA ING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM o
a r Ze_ W143REPAIRING OLD SYSTEM
CITY . STATE: ZIP: EXPANDING SYSTEM
S 2 c SINGLE FAMILY $'
O RTY ADDRESS: OTHER c
70 G>%�r SPECIFY: 3
SP CIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m
/' r LT PUBLIC SYSTEM
Z
SYSTEM ID NUMBER
1 ' % al Ivr <I% 490 �r SYSTEM NAME
y, APPLICANT
- +✓ e J NAME 5 Z 4
Name of---.)
f MAILING ADDRESS
Installer > ft.
SiLotze: X �76�x0?& acres TELEPHONE
Name of---.) um er o SIGNATUR o
Designer Bedrooms
PLOT PLAN to ./
Draw a dimension Ian, /� C
including: -0 m
❑Precise lo*, cc
tes ")
holes,sho # Q
measur s ft.
prope ariess,
❑Ent othe�6ads,� _ en I&t ,y
d ' +y<
NOTE: NOT DRA
SYSTEM D;
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
/ 7- Z SOIL LOGS
77,E#3
333wai �.. a-3�S14UEYnaw Cj_2P�,lG[�LU�94 p�iSo4.1DLtcrH�o cu4r 2 �Q u.,r( )&r2
TitF�tf i -TU G
d -3S'�t�A�DLaartn C3-as�- oxAjDL.cUcrK4
35=- 'T 16,4.4ere LG F4e� ,p sF.
3'4 ft�A-,(e-IQ
0-�/�c
6epffi from Original
Grade to Restrictive
Layer or Water Table: 2 In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REOUIREMENTS
Thdnl Designer Level: ❑One (*fwo
Soil Type t/ 2
Vertical Separation J"�in. S� Septic Tank Daily Slope % t,
Capacity) ZoO Gal. Flow: 3 GPD
'Z � Appl Infilt.
Parcel Size r AC �J Rate r 6 GPD/FT' Area 6 UC,) FT'
Distance to Shoreline l ft. _ Total / InspeoQr 4 0 Date/7— ` /4 v g
COMMENTS/CONDITIONS FOR APPROVAL
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 years from date of she Inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE: Approved (q*n Re#ed ❑Not Approved DESI Approved ❑Not Approved INSTALLATION:O Approved ❑Not Approved
BY: DATE: /V f BY: DATE: dc)010' BY: DATE:
TOP: Health Dept. Copy IDDLE: Designer's Copy BOTTOM:Applicant's Copy
MASON COUNTY
DEPARTMENT of HEALTH SERVICES
Shelton,Washington 98584
(206)427-9670• Belfair:275-4467
ENVIRONMENTAL HEALTH PERSONAL HEALTH WATER QUALITI
P.O. BOX 1666 303 N. FOURTH P.O. BOX 166(
MEMORANDUM
DATE.
TO:
FROM:RE: Design for f«-�-f Parcel # J?a t -7
Your design for the above referenced parcel has been reviewed
and is APPROVED.
® Your design for the above referenced lot is NOT APPROVED. It does not meet
the requirements or needs additional information.
e
DESIGN FORM - PAGE ONE ry7 Re ieed 08/24/94
A design will be reviewed when 3 copies of each of the following items are a itted:
Completed design form that has been signed and .♦&W-q 7135
Completed Resource Lands and Critical Areas Checklist a hed
Scaled plot plan, including all applicable items on checklist
Scaled layout sketch, including all appaKSE �}
Cross-section sketch, including all appli Ran i^(qY,
II PARCEL IDENTIFICATION II
Ii Permit Number cior lCi48 Designer's Name II
a�aaeltry II
II Applicant ' s Name Mtm%J ibQTTLES Prop. Owner's Name salAr- Iti•j Am,
II Mailing Address Fin-'ChDX 31c Mailing Address
I LLYN L)_ . 16. 9S5d�
II
II Limey—Seat�e—zip city — a -e ip II
II Assessor' s Parcel No. .113y- '7S- Oc�l _ Subdivision iS�rk=1�1i, i.. COT Is-- , II
'(Iwe ve- >.gi ummoner�) = (Name/ iv'i7 ision/z I cc o
II VOL .Z nF SVR p6 • qr., I�
DESIGN PARAMETERS
II
II FL, r1, F, II
Designed Vertical
U U u u Separation
II Mound Subsurface Pressure Gravity Bed Trench Ig in II
II Septic Tank/Drainfield Specifications I _
II No. Bedrooms 3 I Pressure Distribution? X Yes U No
(If yes, proceed. . . )
II
Daily Flow 3(,o gpd ���
II Septic Tank Capacity 1 J.00 gal I .....................
No
....................
Receiving Soil Type (1-6) - LI I II
II Receiving Soil Appl. Rate D.(o god/ft2 I Laterals
II Trench/Bed Bottom Area 1511 ft2 I Schedule/Class �O(7
II Trench/Bed Width 3 ft ( Length 51 ft I(
II Trench/Bed Length 51 ft I
II I Diameter 1 V4 in II
II Elevation Measurements I Number 14
II Orig. Drainfield Area Slope n t I Separation % 0 ft
II Final Drainfield Area Slop r.CS r) t I .Orifices II
II Depth of Bottom of Tre;Wed I Total Number of Orifices
II from Original Grad, N in I Diameter 311 , in II
II J��y peP ' 4 Up Pope I spacing 3(.1
II
II o��0 0 ��in I Manifold II
II has ty44�/Pl pe I schedule/Class ,400Length II
Infiltrator►Us a�rUa�s / u Yes L� No I Diameter � in II
II Pump Required? Oe'e GTl u I Transport Pipe
I�1 Yes No I Schedule/Class ptl
II...................... (If yes, Proceed. . .) .......................... Length (.0 ft II
II I Diameter 1.7- in
II Pump/Siphon Specifications I Dosing and Pump Chamber II
II Difference in Elevation Between Pump Shutoff I # Doses/Day 3 II
�I and Uppermost Orifice 9.0 ft I Dose Quantity iac) gal II
II n n - I Chamber Capacity 00 gal
Uppermost Orifice is "higher, U lower
than Pump Shutoff I Check the following components if they drain II
II Capacity O Tot. Pres. Head YQ,1:1 cnp I between doses:
Calculated Tot. Pres. Head 1 .1.5 ft I n
(Attach Pump Curve) I Laterals Manifold U Transport II
L
DESIGN FORM - PAGE TWO
Revised 08/24/94
III C�` DESIGN CHECKLISTS II
II Scaled Plot Plan I Scaled Layout Sketch I Cross-Section Sketch II
II I I II
II f�1 I �I I Reference depth from orig-
II LL Test hole locations 113J Drainfield orientation I inal grade:
II I and layout I II
II Property lines I i� I � Septic tank lid and II
II pt I laJ Trench/bed dimensions and I drainfield cover depth II
II VJ Existing and proposed I critical distances within I II
II wells within 100 ft I layout I Reference depth from orig-
II of property lines 11� I inal grade and restrictive
II I�rl I `�'' D-Box/"T"/"L" locations I strata:
II aJ Critical distance I I II
II measurements to cuts, I rg Septic tank/pump chamber J Laterals, trench/bed
II banks, surface water I location S¢E hvr PL*d I top and bottom II
II L I
II Location and orientation I Observation port location I Curtain drain collector
II
of curtain drain and all I I
II absorption area I Cleanout location I Sand augmentation
II components I I
II I Manifold placement I No external reference needed: ll
II Location and dimension I n I
of primary system and I Orifice placement I Observation ports and II
I reserve area I I cleanouts 11
Lateral placement, with I II
IIXj Buildings I distances to edge of bed I Additional mound in£ormation: ll
II I I r-i II
II Directionof slope Audible/visual alarm u
Upslope and downslope II
II indicator I referenced 3-W &�SIL04615 I fill width II
I r-,
II Waterlines W kLL 5trf I Scale of drawing shown I U Settled cap depth at II
on scale bar I center and edge of bed II
II Roads/easements/ I I r—i II
II driveways/parking I Additional Mound Information: I U Sidewall slope II
II r-1 I r-i
II L_.1 Critical resource lands I u Endslope width I U Up/downslope bed elevat.
II (if applicable) i U I II
Overall fill dimensions I Completed Resource Lands and II
II z North arrow and scale of I I Critical Areas Checklist
I drawing shown on bar I I II
I
w yes
DESIGN APPROVAL II
r,
II The undey 'gner does, t_Jdoes not, waive the reqirement to be notified by the II
II installer of i�n,�gy lati , and given 48 hours to perform a final inspection prior to I
II cover. �n ^
Qa�e SiYI gnaul..}��Puhw.ue�luzer i-Y -4S II
The undersigned has review and apprUethis design on behalff, Sof Mason County of Health II
II Services.
nspec or a e
II CAUTION: THIS DESIGN IS MY LID IF STAMPED "APPROVED" BY MASON CO. DEPT. OF HEALTH II
II
�i i
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-Poor IPLA J FOR 5wC-- 94-190
SGAL E services fF 3213 N-'15-o o/BO
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Performance Data
E* ENGINEERING DETAILS - SP40
Pump Characteristics 32
Pump/Motor Unit Submersible
Manual Models SP40M1 SP40M2 w 24
LL
Automatic Models SP40A1 SP40A2 a ono HP
Horsepower 4/10 s=i
g16
Full load Amps 9.4 4.7 z
Motor Type Split-Phase '
a
R.P.M. 175 0 8
Phase 0 1
Voltage 115 1 230
Hertz 60 0
0 20 40 60 80 100 120
Operation Intermittent CAPACITY.U.S.G.P.M.
Temperature 140aF Ambient
Total Head (feet) 4 8 12 Ib 20 24 28
NFMA Design p
Insulation Class GPM 1 4/10HP 120 108 90 68 42 20 0
Discharge Size 2" NPT
Solids Handling 1.1/4" Dimensional Data
Unit Weight 60lbs.
Power Cord )8/3,S1TW, 115V— 1D std. 3-15/16 6-13/16
5 /8
I All dmenconsininchs
(20'opt.) Y. Component dimensions may
230V=201 std. 2 NPT vary z 1/8 inch
4-5/16 DISCHARGE T Not for mnnmaion purpose
- unless<erited
4. Dimensions and weighs ore
Materials of Construction appmximme
3-3/4 5.We reserve the right a
4-15/16 make revinans to our
Handle Steel �_ products and their
Lubricating Oil Dielectric Oil spedficarans without name
Motor Housing Cast Iron
Pump Casing Cast Iron C.Ps
Shaft Sta' s�t11eE
Mechanical �tiS�e�F mic
Shaft Seal Masot\CD fairs n6
YSr Ilg:Stain) eel 13-1/16
I un0-N / 12 1/4
0 DISCHARGE PUMP
Impeller Ther astic I HEIGHT { ON
angle
Upper Bearing e Raw Ball Bearing -ct
— 4-5/16
Lower Bearing Single Row Ball Bearing PUMP/OFF
Fasteners Stainless Steel
AURORA/HYDROMATIC Pumps, Inc.
1840 Baney Road, Ashland, Ohio 44805
(419) 289-3042
P. O. Box 2003
�a
Shelton, Wash. 98584
Ll;t(,- 75-71
TN4TATT ---/ AiAINT1. A �^
Fressure l)lstrlbution Systems
1 . Install laterals with contour of the ground .
2 . Install trench bottoms level and at all times a minimun of' six
inches into the native soil .
_ . Install locator tape on top of all drainfield laterals .
4 . Install observation ports as indicated on the plot plar:
(minimum - two per drainfield with bottom extending to thedrainrock \ native soil interface) .
S . Install drainfield during dry weather and soil conditions , an%
soil smearing must be eliminated ..by hand raking .
6 . Install threaded clean-out at the ends of all laterals
nrcedut extend to within 6 inches of finished grade and be
a
with locator tape) .
7 . Install audio/visual Thigh water alarm.
c . Install 1/6 inch mesh non-corrosive pump screen .(min . 13
SC surface area , not to interfere with controls or
; roats)
? . instal check valve in pump outlet line to prevent system from
draining back into the pudip chamber .
i0 . Tee to Tee construction between laterals and manifoid with
orifices oriented at 6 o ' clock . Install laterals to the
manifold with the orifices at 12 o ' clock , (do not glue) , afte-
pressure test and Health Dept , approval , turn orifices down (6
o ' clock) and glue laterals to manifold .
11 . rilter fabric required over drain rock prior to backfill '
if the drain rock extends above natural erade , run the filter
fabric at least 3 inches down the. trench` wall .
12 . Divert all storm water run-off away from or,-site sewage
system .
! No curtain drains allowed within 10 ft . of the -slope ecge
of the drainfield and reserve area .
Ld . No curtain drains allowed within 30 ft . of the down-slooe edge
of the drainfield and reserve area .
t _ . _ave the septic tank and puma chamber pumped or inspected
every three to five years .
16 . Inspect and clean pump screen every 6 - 13 months as weeded .
17 . Ins ect f yes
as need�pjaq�{��� and test high water aiara every o - i2 months
Oep�' y
ib • jo4Ty }yaCL��1s aI:d workmanship must ^leer Couniv A -.. Star
� ons .
9 . �ksta ept1 tank and cumn chambers so that insole' ° ;;is l ds
ar h thin inches of 'nish grade . Tf tank tops are se -
dzp�- erh- 1Q inches rpm finish grade . risers till be
rec®aged .
20 . Deviation from this design withou rho;' aPFr ? :a: '
Designer and Mason r9 UIity 7ealt:l :.iepar ;ment xi : , mase" th1 design null and void .
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
::..........................................
................................«..........................33i:e:i;. . ... ..............................................
.......
DATE CALLED IN: 2,4 0 ' q
TIME: L9 0-
INSTALLER: (LVO
/5�II 2 L�
APPLICANT/OWNER: ��VV�,V� [ J l).. .
CALLER: _//
PHONE # OF CALLER: eo_l 'b 7 6(.J `7
SWG
PARCEL NUMBER:
SUBDIVISION:
DIVISION: LOT:
«........
82STSd TYPE (CHECK ONE) :
- PRES GRAVITY
]ISPECTION SCHEDULE (CHECK ONE) :
APFM7MM PLUG IN
di-BUILT ON-SITE? (CHECK ONE) :
I LA
Ts NO
»9»9»......... �::....:a .i»ee» ..»..:'.:�».....;.
�V
STAFF INITIALS: ..
h:callin_u
ON-SITE SEWAGE INSTALLATION
STAFF INSPECTION REPORT
STAFF CESCMIST
I COEPIR?D'.D BY IISSP8CTOR7 I
1 I. SEPTIC TART wo CO is
1 A) >5 ft from foundation? 1
a) Bldg stubout to septic tank: cleanout if not 1-2%? =
I c) Baffles intact and clean? I
1 a) Dividing wall intact? I
1 IT. n-sox Leveled with water or speed leveler (circle one)? _ I
i 1
1 III. ORAIffi48?D I
1 A) >10 ft from foundation and >5 ft from property lines? _
1 s) Laterals level to tt inch i end caps present if not looped? _ 1
1 c) System dimetm:fans the same as shown on the design? _ - I
1 a) Gravel clean, properly sized, and proper depth?
1 a) PRESSORE SYSTEM I
I) sand quality ASD(C-33? 1
1 z) Bead height uniform and 224 inches? 1
I) Cleanouts and observation ports present?
1 a) Mound: Side slope 3:17 _ 1
1 s) owner informed electrical connections aunt be wide 1
1 by owner or licensed electrician and inspected by OL12
I 1
1 Tr. POTABLE XLTER LLaS _ I
1 A) 3-10ft from drainfield, transport line, and septic tank?
a) hells 3400ft from drainfietd?
I 1
Screen be effluent filter(circle one) installed? _ f^
1 a) ser installed for,access?
1 c) Alarm iretalled? 1
I
jvI. as so= REQoaao? _ 1
I I
aI. oTasx C=mxzs
1 I
1
1
1 _ I
1 _ 1
1
1IS, i
1 The undersigned has reviewed this install and findings on behalf of Mason County of Health Services-
1 I
I
Inspector T te-19I I
h:callin.w
Revised 02/01/95
AS-BUILT FORM - PAGE ONE R<vi..d 12/14/94
�-- - -
PARCEL ZD£NTIFICASZON
I� Applicant 's Name S
�I PerniC Nu;-.;er swG9 F - �n7 -- subcivision C1/F-6�
_ ame t�!
jj Installer's Name /9/ eA/ 69-5/ Assessor's Parcel No. z.gauer T2/ OiSP j..
e e- j.
jj Designer's Name �/T 6�r.�
j INSTALLER CHECKLIST j
j N/A Yes Prior to j
I. SEPTIC TANK Completion
jj A) >5 ft from foundation?
jj B) Bldg stubout to septic tank: cleanout if not 1-2&? j
j� C) Baffles intact and clean?
N D) Dividing wall intact?
I1.
D-BOX Leveled with water and/or speed leveler (circle)?
III. DRAINFIELD I
A) >10 ft from foundation and >5 ft from property lines?
�) B) Laterals level to tl inch & end caps present if not looped?
jj *C) system dimensions the same as shown on the design? - ✓ j
D) Gravel clean, properly sized, and proper depth? j
E) PRESSURE SYSTEM I
jj 1) sand quality ASTM C-33? _L j
2) Head height uniform and z24 inches? ✓ j
3) Cleanouts and observation ports present? Z j
4) Mound: side slope 3:1?
j) 5) owner informed electrical connections must be made by j
jj owner or licensed electrician and inspected by DLI? ✓ j
IV. POTABLE WATER LINES
A) >10ft from drainfield?
B) Wells >100ft from drainfield? j
V. PUMP/PUMP CHAMBER j
jj A) d used, or specs attached for equivalent pump? ✓ j
B) Screen basket or effluent filter (circle one) installed? j
C) Ri lnsta led for access?
�j D) Alarm installed? j
-v ` - - -, / Zo V f-Z C7 ? // c A r 5 T --
a CERTIFICATION OF INS'TAT•T AXION
NInstaller: Check box from Raw 'A,• check box from Row •B,` sign and data the certification. j
A. � 1 certify that I installed the system U I certify that all deviations from j
b without any deviation from the design the design stamped 'APPROVED• by MCDHS are j
�j stamped •APPROVED" by MCDHS. shown on the 'reverse side of this form. j
�j B. v I certify that I contacted the I did not contact the designer prior j
�j designer and left the system open for to final cover because the designer j
�j inspection up to 48 hrs prior to cover. waived the notification requirement-
1 further certify that all information contained on this form is- accurate. _ I understand
u that if the informationg cbntained:herein'is n accurat there will-be just-cause.'for- - j
b immediate suspension of' my er ce ifi
/ a r o e -//-97
jj The undersigned approve i 1 tallation o behalf of Mason Co ty Department of Health
j) Services. /�
jj ea pe or �/9
�j
AS-BUILT FORM - PAGE TWO Revised 12/14/94
Ir Ir PARCEL IDENTIFICATION li
I
I� Applicant's Name G / '_ II
Permit Number SWG9 l/ - ,�j Subdivision �'9Sh �� �S � ICI
�(z7rs 1v1 ki, oc oC7—
/ r
Installer's Name �-+ ��A/%' Al Cv.Us y Assessor's Parcel No. 3.Ve t -- �3 y UE eI II
T'PweT�LTig1 u� er II
II Designer's Name �•+t ST.�.�., � —
II �a AS-BIIILT DRAWING II
II Y II
II CY II
II I, raoU t ___ _ -a_ �_--•--� II
II II
II
II � II
II II
II
�ryfz5"^ II
II a II
II i � II
qe
i
r
I�
CAprTON, 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 cases conproulx the Mabillty of the syst®. It is the
installer's responsibility to obtain prior written approval fzum eitber the health department or the designer before making any
deviations fr s the design that affect syst® viability• any deviations from the approved design east be shw above.
NAS-BUILT CHECKLIST �I
r i
Drainfield orientation u Observation port location U undisturbed native soil II
and layout I"'1 between trenches II
u Cleanout location n
U Trench/bed dimensions and r-1 lJ North arrow I'
critical distances within U Manifold placement U Scale of drawing shown II
h layout u
II U Orifice placement on scale bar
D-Box/"T"/"L" location 1—I
II f1 U Lateral placement, with Additional Mound Information
II U Septic tank/pump chamber distances to edge of bed n -
I location n U Endslope width
n U Location of wells, roads n
U Location of buildings U Overall fill dimensions