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HomeMy WebLinkAboutSWG2000-00094 - SWG Application / Design / As-Built - 3/16/2000 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SW cl W QO n m 426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Rea D � y cteeipt No. � y PHONE (360) 427-9670 Amount$ z ' w m PROP OWN DATE: CHECK APPLICABLE ITEMS 3 CP ,Loy NEW SYSTEM MAILING A D DAYTIME PHONE: ro 1� �r REPAIR SYSTEM � CITY: ' `AA STA E: zl TABLE 6REPAIR w MAINTENANCE REVIEW PROPE D)kESS: SINGLE FAMILY z U �` OTHER: 3 SPECIFIC DIRECTIONS FCOR GATING SITE PRIVATE WELL m t✓I LJ �M 3 COMMUNITY WELUPUBLICSYSTEM SYSTEM WFI N �1 SYSTEM NAME Iv APPLICANT NAME Name of Lot ft.x ft. MAILING ADDRESS Install e������ �C Size: acres TELEPHONE o Name of um er o SIGNATURE o Design cL Bedrooms X OFFICIAL USE ONLY BELOW THIS LINE (� DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS f T- j I� �2 P p- V L S 3 u cril sAVi& TH o 0 Lq Q t^1 Sa1pI ru, SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely INSPECTOR(pri t name) IN ECTION SIGNATURE DATE PERMI EXPIRATION DATE �I 00 3 2 03 •All bystems require ongoing Operation and Maintenance(O&M)as specified in Mason CourIty On-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 •Al 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 mirmilt exDires 3 years from the date of site review.Daniel of this permit may be apiqw..o the Health Officer within 10 days of denial date DESIGN EVI PROVAL BY: DATE: I IN ALLATION AP�VE6 BY: DATE: �j (nJ fG r.1lJ�, eU n� TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Water Quality Penonal Health PO BOX 1666 SHELTON.WA 98584 LOCAL MO 427-9670 BEL.FAB2(206)2754467&4468 FAX(206)427-7798 DATE: 5 G C TO: FROM: RE: Desigq for SV-,AA ' Parcel# 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 NOT APPROVED. It does not meet the requirements or needs additional information. DESIGN FORM - PAGE ONE Revised April za,1998 A design will be reviewed when 3 copies of each of the following items are submitted: Completed design form that has been signed and dated a Scaled layout sketch,Including all applicable Items on checklist a Scaled plot plan,including all applicable items on checklist % Cross-section sketch,including all applicable Items on checklist OFAARCE!_ IDENTIFICAT10�1 Permit Number. S—Wc°ado- 0 00 7 T Designer's Name: c Designer's Phone#: 3 9O Assessor's Parcel No.: 2 A t 34 - 13 - 90l!3 Applicant's Name: E Subdivision: (Twelve-D' it Number) Mailing Address: UT 3 S �•if 7 _ £ [ ¢ (Name/Division/Block/Lot) city State Zip DESIGN PARAMETERS Treatment Device O Glendon Bioflter O Sand Filter O Mound O Sand Lined Drainfield O Aerobic Unit-Make/Model: O Disinfection Unit - Make/Model: Drainfield Type Pressure gBed ODrainr p Gravity O Trench O Grav e VED Septic Tank/Drainfield Specifications MAY LPFrals Schedule/Class ST NDVO Number of Bedrooms 3 ' ft Length �� Daily Flow 360 Qp Diameter d P S D 4 in O al 3 Septic Tank Capacity Number Receiving Soil Type(1-6) Separation 3 ft Receiving Soil Appl.Rate �0 P ftz Required Square Footage _ D Orifices Designed Square Footage �� rDiameter�_umber of Orifices Percent Reduction Taken mTrench/Bed Width mTrench/Bed Length Elevation Measurementsold le/Class ft Original Drainfield Area Slope 7 °�0 n i Length �' -- New Slope if Altered 0 % Diameter NO Depth of Excavation from o2 0 Pr ed Mantfold Configuration Used? ❑Yes � . Original Grade - in/12. (Upsi Transport Pipe n fISTF (Down-slope) Schedule/Class Designed Vertical Separation '1R 1 in Length „ n Diameter Gravelless Chambers Required? ❑ Yes ❑No 0 Optional ZQssiing and Pump Chamber Pump Required? ❑ Yes ONO Number ofDoses/Day - �— Pump/Siphon Specificati s Dose Quantity r g gal Difference in a Between Pu utoff and Uppermost Chamber Capacity --- —� Orifice: ft Pump Controls: for) Elapse Time Meter(circle if requir4a im r: Pump On , Pump Off Uppermost Orifice " Higher, ❑Lower than-Zump Shutoff Capacity @ T Pressure Head: Check the following components if they drain between doses: Calculate otal Pressure Head: ft tem s antfold ranspo (Attach Pump Curve) DESIGN FORM - PAGE TWO Revised April 24,1998 DESIGN CHECKLISTS" Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 0 Test hole locations 18 Drainfield orientation and layout Referenced depth from original grade: Property lines O Trench/bes dimensions and critical M Septic tank lid and drainfield cover Existing and proposed wells within distances within layout depth 100 R of property lines t$ D-Boe, PV' locations Critical distance measurements to cuts, Septic tank/pump chamber location Reference depth from original grade banks,and surface water JR Observation port location and restrictive strata: Location and orientation of curtain Clean-out location Laterals,trench/bed top and bottom drain and all absorption components -0--Manifold placement Curtain drain collector fig Location and dimension of primary Orifice placement and augmentation system and reserve area fil Lateral placement,with distances to 0 Buildings edge of bed Other cross-section detail: A Direction of slope indicator -B—Audible/visual alarm referenced JR Observation ports and clean-outs Waterlines l; Scale of drawing shown on scale bar 15 Roads/easements/driveways/ Gross-section information for mound parking L out information for moul�lY stem:r - :system: Critical resource lands(if applicable) 0 Overall I is s h Settled;cap depth at center and edge o£ i) North arrow and scale of drawing 0 Up_• ,down11 slope, slope bed shown on scale bar t 1 width 10 Sidewall slope FD Up•slope and dowps U.bbcd elevation APPR ¢`�" Additional Information Ok Design staked out MAY i Operation and Maintenance Notice Attached PS. D - Waiver(s)Attached DESIGN APPROVAL 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 c over: O Sign ur fDesl net a7ate 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: ? - Z-� , ©3 ✓ 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 z ZC rl8 - ��'Rr yjPPRoxtl a fo 1 sT t d 4A tl , O' � 6r v � f. 7 ICJ /� ��4tl ul Y``✓ W I� -�L/o5 rvIC HEALTH DEP�r11, ' MAY t A 7Gi J r / � P$D < /�d �, �- i; Li. APPROVE MC HEALT14 ►le � O I MAY , PSD li n r J •� c 0 a= ; n4 �E" Ny vJ 71CQ C SI �y io > 1 L41 I I .y atno x �= 1 DO y � (h ON-SITE SEWAGE INSTALLATION FINAL INSPECTION t �zcruss DATE CALLED IN: 1 � �r/`�lY TIME: ' �T W 4 Iy"", S INSTALLER: / l� I ` n APPLICANT/OWNER: "�^f CALLER: PHONE#OF CALLER: S WG#: PARCEL NUMBER: SUBDIVISION: Div: Lot: SYSTEM TYPE(CHECK ONE): ❑ PRESSURE GRAVITY INSPECTION SCHEDULE(CHECK ONE): 4 cl APPOINTMENT PLUG IN AS-BUILT ON-SITE(CHECK ONE): p YES No STAFF INITIALS: 1 VV 1;H STAFP'US�ONLY APPOINTMENT DATE: TIME: COMMENTS: ON-SITE SEWAGE INSTALLATION STAFF INSPECTION REPORT $2'AFJ+ +clursr I. SEPTIC TANx 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%7 ;r - D) Baffles intact and clean? ✓ E) Dividing wall intact? — F) Risers installed for access? 11 D-BOX Leveled with water and/or speed leveler(circle)? M. DRAUMELD A) >10 ft from foundation and>5 ft from perceived 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? ci E) Gravelless chambers utilized? F) System dimensions the same as shown on the design? — G) Gravel clean,properly sized,and proper depth?H) PRESSURE SYSTMgS 1) Sand quality ASTMC-337 2) Head height uniform and x24 inches? _- 3) Clean-outs and observation ports present? 4) Mound: Side Slope 3:17 — 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I7 _ IV. PUMP/PUhW CHAttmER A) Screen basket or effluent filter(circle one)installed? B) Riser installed for access? C) Alarm installed? D) Pump on timer or demand(circle)? V. As-BUILTREQun;im? VL OTBER COMMENrs/OBSERVATIONS The undersigned has reviewed this installation and verifies these findings on behalf of Mason County Department o Health Services. Sean Date C:\MyFi1*SVi alchedcwpd Revised 9l26/97 AS-BUILT FORM �•t�,t�B Applicant e Kit Assessor's Parcel# 3a! '344 — 13 - 76)r1 (1WeWe-0Igk Nwnbar) Permit Number SWGJIbr onnq Zy7Q '44 Z Installer 11 � �� •�✓ Subdivision (Namerolvisionfatockhou Designer �� T ' 8> .. NfA Yes PHortoCompletion I. SEPTICTANK A) >5IL From foundation?............................. .... ...... B) >50 ft from wells and surface water? ............................ — Q 13149 stub-out to septic tank clean-out if not 1-2"/0? .... .. . ...... .. — D) Baffies intact and clean? ....... ... ................ . . .. E) Dividing wall in(act?........... ..... ..... ....... . . . . . ...... . .. F). Risers installed for access? ..... .... .. — G) Tank Size: 1) gal.;Manufacture 1 I II. D-Box v A) Leveled with water? ... ... . . .... . ... .. .... .. . . . . . . . .. . . . . . . ... B) Speed leveler used? .. . ... . . .. .. . ... .. . .. . . . .. . . . . . . . . . . . . . .. . — III. DRAINFIELD A) >10 ft from foundation and>5 ft from property lines? . . .. • • • • • • • •. • • B) >10o ft from wells and surface water? .......... .. . . . . . . . . . . . ..... — y _ C) >10 it from potable water lines? .. .. .... ..... ... . . .. . . . . . .. ' '' ' ' — v D) Laterals level to±1 inch&end caps present if not looped? . .. . . • ••••• — =� 13) Gravelless chambers utilized? ........ ... ....... ...... . .... ... .. J — F) System dimensions the same as shown on the design?...... .......... — G) Gravel clean,properly sized,and proper depth? — IJ) PRESSURE SYSTEMS 1) Sand quality ASTM C-33? ................................. — 2) Head height uniform and z24 inches? Actual head height .• — 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 Pump modes -- A) Pump make _ B) Chamber size gal: Manufacum — C) Height of pump off bottom of pump chamber�—inches D) Pump chamber draw-down gallons per inch E) Pump capacity gallons per minute F) Pump controls:Timer(or)Elapsed Time Meter (circle If Installed) — If timer is us On Pump Off G Strout basket vent fil (ehrle one)LnstaUed? ................ �L Hj Riser installed for ...... .......... .. . .. .. . .. . .. ...... I) Alarm installed? ...... . . . . . . . c � � "Xixfaf� ...YMw : MECRE.Isl 13 Dralnf eld&manifold orientation &layout ❑ Denchrood dimensions 6 and critical distances g /4*' 6 113 Within layout ` ❑ Septic/pump tank — _ c placement. ❑ Location of buildings. ❑ Observation port&clean- out location. ❑ Location of wells& roads. ❑ Undisturbed native soil between trenches. ❑ North arrow SonUKOCAUTION:Minor adjustments to ttpfie tank location and dratnfield orientation made 11 1he field b the htstallu amg III and the ePut er,but wale to certain taus wn P""otse the viability oCthe tystcm It is We Installer's ya Y acceptable W both fhe depanmwt diown above.depanmwt or the designer beCom makmg any deviuions from the duign fhat afrwt the Ponsibil' to too rain Pnor K'nttea approve from either the system viabitity. Any dcviations from the appmved design must be I Installer Check a box from Row A"end B",sign and date the certrficanon s A. EfI 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 ❑ I did not contact the des- system prior to final cover because the system open for inspection up to 48 his 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 accurate,there will be just cause for immediate suspension of my installer certification. is not Il — �p I$raatnit:O ter ate 771e undersigned approves this installation on behalf of Mason County Department of Health Serv' .� G. date