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HomeMy WebLinkAboutSWG93-0989 - SWG Application / Design / As-Built - 7/27/1993 MAiS OI INTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG F y / %€ Date `- 426 W.,CEDAR/P.O. BOX 1666/SHELTO ,WA 9858 "' ° RiptO dr PHONE (206) 427-9670 �1.f Amounts w F PROPERTY ti Srt t Ttt 7ba y3 CHECK APPLICABLE ITEMS ✓ 3, m INSTALLING NEW SYSTEM DAYTIME PHONE: �: MAILING ADDRESS: REPAIRING OLD SYSTEM I.Iz2 flrt-tGlNson) fJ � 206-3`�2 '4439 v CITY: STATE: ZIP: EXPANDING SYSTEM w t H �J a- g5v z SINGLE FAMILY PROPERTY ADDRESS: OTHER 1'tR5'o` t D^ °o* ' uea- ✓Zo. Swa,vu�s9- SPECIFY: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m 60 l4 i 6 tj w A•f 3 To f7 A-SoN 1aC. "� I h 1 . O J 1 PUBLIC SYSTEM i SYSTEM ID NUMBER Lnl Q0. To M�ckgLSo MI}$oU�Arcra � Rb' b� Ovr PIiCJC6lSot) Q� SYSTEM NAME Ec, Srfr-rm I� APPLICANT 5 ave>Qiran owxjvL 5U9j6r_T Qi4eLo61- " PC &t4T NAME S)I>L)erY BecNrot,T Ir NubV - MAILING ADDRESS E 2690 AbaTE Name of Lot 112. ft.x 3ios Q• S -vruN IJA• 985$> Iw Installer 0•SZ acres Fo "r q Size: TELEPHONE �.0 6 426- /7Z y I� Name of 3 XIGNATUR ��rGle'T 0 um Designer Bedrooer o me PLOT PLAN I I W Draw a dimensional plot plan, SEE RT TAGH6o sl�oa r pL HT including: A mt, 'J 1C 4J t7Y m ut_0 Lttc@ 7o B6 gt,0�- Ap' `� I ❑Precise location of test oT�; t7 W N E� W° �gSE NT 3 holes,showing [\1 OT I F 18 D H•KI D P 5° measured distances to D U et N b �� s PG o?r°"S' 90 _ property boundaries. t',o Rn ❑Entry road;other roads, �`SoJ .tor driveways. Y4 H' M`L� 30 LoT 4 Hhs��O � NOTE: SYSTEM DESIGN aS 045'3 MOSCALE OFFI E ONLY. DO NOT WRITE BELOW DOUBLE LINE. -�° y M Lm� a v�f 1 k J KGB rn �� (,yQA1�lu( S `( fy6sk t, u c., ! )AP (�0 S'I"ta0 fat L4 t y Depth from Original 't0 W Grade to Restrictive �fp Layer or Water Table: ` J In. DESIGNER DESIGNATION SCORES MINIMUM SYST REQUIREMENTS Soil Type indin Fg � Designer ❑one Vertical Separation I in. Septic Tank Daily � P Capacity: �� Gal. Flow: l/"�'w-� GPD Slope 2- 56 Appl, Infilt. Parcel Size OZZ'Ac. p 2i Rate Q,�GPD/FT' Area 01 FT' Distance to Shoreline 4 ' fr. d FTO-61-1 20 Inspector Date �}bJ� �1sI3 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 site inspection.Denial of this pqrlpit may be appealed to the Health Officer within 10 days of denial date. SITE:kApr A Design Retired ❑N DESIGN: A 0 Not Approved INSTA TIOiW Approved ❑Not I BY: DATE: BY: DATE: BY: DATE TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Appli6dis Copy rft"Z UNP, P"ISW 09/17/93 A design will be reviewed when 3 copies of each of the following items are submitteds RE '•""Completed design form that, has been signed and dated HE Completed Resource Lands and critical Areas Checklist attached DO Scaled plot plan, including all applicable items on checklist Scaled layout sketch, including all applicable items on checklist OCT Cross-section sketch, including all applicable items on checklist GENERAL SERVICES PARCEL IDENTIFICATION Permit Number ?3 -0 9tq 9 Designer's Name ZeA,/L£ -.4 NTi1 Applicant's Name (f D S mJ T N Prop. Owner's Name E M 7- Mailing Address — A Ile L S&V (address ¢y / ( ^/ RIO, oler �a�C� sly of<r ��rt�s� sly Assessor's Parcel No. 3213+— / 3 90//O Subdivision (TwNly�—D1piC NYmb�s) (N�,n�%Dlvl 10l.//'L'llloOlC%LOC) DESIGN PARAMETERS ` eat, Health Se ez Initials�- data signed vertical LJ (�G( u LLJJ Separ ion Mound Subsurface Pressure Gravity Bed Trench in Septic Tank/Drainfield Specifications No. Bedrooms Pressure Distribution? Yee No Daily Flow gpd ...................... (If yes, proceed. . . ) ....... . Septic Tank Capacity gal Receiving Soil Type (1-6) Receiving Soil Appl. Rate Q, �1 gpd/ft= Laterals Trench/Bed Bottom Area Q'jjJ ft, Schedule/Class aLie Trench/Bed Width ✓w ft Length 90 -70 - g7 1 ft Diameter in Elevation Measurements Number Orig. Drainfield Area Slope 2 8 Separation ft Final Drainfield Area Slope a Orifices Depth of Bottom of Trench/Bed Total Number Of Orifices $�J from Original Grade �p,7� in Diameter 3//G in "y'lyyy Spacing T in Manifold DDwn.1Dy. Schedule/Class �p0 Length / g ft Pump Required? 11;z Yea No Diameter in (If yea, proceed. . . ) ::::i::.:................. Trans rt Pi ` ...............::::::..... po pe Schedule/Class Pump/Siphon Specifications Length ft Difference in Elevation Between Pump Shutoff Diameter in and Uppermost Orifice ft Dosing and Pump Chamber # Doses/Day Uppermost Orifice is ®higher, lower Dose Quantity al than Pump Shutoff Chamber Capacity 10 O gal Capacity @ Tot. Pres. Head SO ,5/ m Calculated Tot. Pres. Head 13 ft (Attach Pump Curve) VE22=11 .. x awimd 09/17/93 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Crone-Section Sketch Reference depth from orig- Test hole locations Drainfield orientation ', inal grade: and layout Property lines VX% Septic tank lid and I r-/LLA7 " Trench/bed dimensions and drainfield cover depth Existing and proposed critical distances within wells within 100 ft layout Reference depth from orig- of property lines r7 inal grade and restrictive D-Box/"T"/"L" locations atratas . Critical distance measurements to cute, Septic tank/pump chamber .� Laterals, trench/bed �bayn(� �- +ks, surface water location .too�pp and bottom L&URion and orientation Observation port location CV+rthin drain collector of curtain drain and all absorption area Cleinout location U-86 augmentation components Manifold placement No external reference needed: Location and dimension of primary system and Orifice placement Observation ports and reserve area cleanouts 1� Lateral placement, with Buildings (� distances to edge of bed Additional mound info7ope ions Direction of elope mAudible/visual alarm elope and down indicator ( referenced fi 1 width Waterlines Y-'� Scale of drawing shown Sett d c depth at on scale bar center d edge of bed ARoads/easements/ �/��d�/ryliveways/parking Add ional Mound Information: Side all lope E �Ctitical resource lands Ends pe width /downslope bed elevat. (if applicable) ❑ Overall fi dimensione Completed Resource Lands and North arrow and scale of Critical Areas Checklist drawing shown on bar .anon County Dept. Hgeaa4h y DESIGN APPROVAL '�' 'e•�� E . --� The undersigned designer does, ❑does not, waive the regiremektto-be_nQtjfied by the installer of the insta*tion v 48 hours to perform a final inspection prior to cover. The undersigned halo reviewed and 8 pr a this design on behalf of Mason County of Health Services. 'i GY; M��1<h 2 �D�o<or nee• ' CAUTION: THIS DESIGN IS ONLY VALID IF STAMPED "APPROVED" BY MASON CO. DEPT. OF HEALTH R -h, r3 A �i c d a son,, s �C C\ �15P o o 7 Pi 4son 64 \ . 4 aj r r � 44 rb \ \ 0\0 00, ZtL r.� set�,�E@Sy d 'TI ` M f p/C ca � c a IlAo V� �ncn Cr �n .- •S q n � T zra .mob A VL n N 047 n i rt + _° A •z fb t ` \,4j1 rp�cPS f� s j OSI ©• 4 .. EFFLUENT PUMPS P3 :.: 1/41i1).10 1/2 Hp. .-.,.. _.... .. «:..;..;...:...:......'..;.. ...i...:......;.; » ..;..:.. . SINGLE PHASE 6 HZ Nov N 0 •`-�' 115/230 VOLT 1991 30 .., S. ..:.: , ZEII♦ 11 Fl : ..i_ ..:..;......6..i... ... ......i...L..:...:. r.:: .. ................:: ::::: ......i.........:.. .. ...i...... .. . ...........t... . ............. . ;..... ...... t..: I .. . �...... ...,... ..,..,...._:._:.. , SS 300:. 10 { : r ..�.. :.. ...;... ...:.. r.. .... ♦ ...-. ..... . 1 ................... j. i L. T. i«. ..:..:.. ...:...... . ;.. ............... .. :-.:.. ...:... . ..:..:..T...:...:... S25.i 5 ..L_ ..t..tx x.l.x{_. _tn .. .u1...{......1..;.. .. .y'..t.. ... .•t..1.. .• .•.1.•..w:..i.. ...{w'... ..:.. .- : I 0 10 20 30 40 50 60 NET DISCHARGE, GPM o • - o R E au if�£N- 2826 Colonial Road Ro•aburg,OR 97470 503/673-0165 4 �K ~ ON-SITE SEWAGE INSTALLATION FINAL INSPECTION DATE CALLED IN: (SIX TIME: INSTALLER: 5,n ( 70 APPLICANT/OWNER: (� SR (--t)4 CALLER: LP .� r LIUIn�U 1� 1 � IPHONE # OF CALLER: `1-)— SWG #: � JL Wik 7Latr� _ PARCEL NUMBER: I'�U SUBDIVISION: DIVISION• LOT: SYSTEM TYPE (CHECK ONE) . _..pRES GRAVITY INSPECTION SCHEDULE (CHECK ONE) : T'r APPOIINTMENT PLUG IN AS-BUILT ON-SITE? (CHECK ONE) : f 1 u S NO ..........«...... .......................«................................... ......w. .«...............................................«...................................... ....... .....« ................«............. STAFF INITIALS: h:caUin.0 Revised 02/01/95 w . ON-SITE SEWAGE INSTALLATION STAFF INSPECTION REPORT I STAFF CHSCR.IST I I I I CORPIRlfCD HY IISSPECIOR7 I 1 I. SEPTIC TAPE Yas No Comments 1 A) >5 ft from foundation? 1 s) Btdg stubout to septic tank: cleanout if not 1-2%? 1 c) Baffles intact and clean? _ 1 a) Dividing watt intact? — zz. D-soE Leveled with water or speed leveler (circle one)? IIx. DRLUWI=M 1 A) >10 it from foundation and >5 ft from property tines? _ 1 s) Laterals level to zt inch t end caps present if not looped? _ 1 c) System dimensions the same as shown on the design? _ 1 D) Gravel clean, properly sized, and proper depth? E) PRESSURE SYSTM I) Sand quality ASTX C-337 — 1 2) Head height uniform and t24 inches? _ 1 3) Cleanouts and observation ports present? _ 1 4) Hand: Side slope 3:1? s) Owner informed electrical connections must be made by owner or licensed electrician and inspected by DL17 _ 1 xv. POTABLE wxTxE LIDES 1 1 A) >10ft from drainfield, transport tine, and septic tank? _ I s) Wells >100ft from drainfield? ! V. Pie@ T= ` - I 1U Screen basket or effluent fitter (circle one) installed? _ I I s) Riser installed for access? I - c9 Alarm installed? I � I Vx. As HUII.T RsgUIREDz 1 jvxx. OTMM Comism" I I I I 1 1 I 1 The undersigned has reviewed this installation and verifies these findings on behalf of Mason Canty of Health Services. 7 3 S I e pec r vale I h:catlin_w Revised 02/01/95 P-10S-BUILT FORM - PAGE ONE Revised 07/12/93 PARCEL IDENTIFICATION ,[ Permit Number SWG9 ,3 - Subdivision Installer's Name 5 Assessor's Parcel No. Designer's Name ........ .. INSTALLER CHECKLIST I. SEPTIC TANK Yes No N/A A) >5 ft from foundation? [/ B) Building stubout to septic tank: cleanout provided if not 1-28 !/ _ C) Baffles intact and clean? D) Dividing wall intact? II. D-BOX A) Water leveled? /✓� !/ B) Speed levelers used? III. DRAINFIELD A) >10 ft from foundation and >5 ft from property lines? B) Laterals level to tl inch? JL _ C) End cape present if not looped? D) System dimensions the same as shown on the design? E) Gravel clean, properly sized, and proper depth? c/ _ F) PRESSURE SYSTEM 1) Sand quality ASTM C-33? 2) Head height uniform and L24 inches? _ 3) Cleanouts and observation ports present? 4) Mound: Side elope 3:1? _ IV. POTABLE WATER LINES A) >lOft from field or double sleeved? B) Wells >100ft from drainfield? V. PDMP T A) Creen basket or effluent filter (circle one) installed? B) Riser installed for access? _ C) Alarm installed? CERTIFICATION OF INSTALLATION Installer: Check box from Row "A,w check box from Row "B,- sign and date the certification. A. I certify that I installed the system EZ I certify that all deviations from without any deviation from the design the design stamped "APPROVED" by MCDHS are stamped "APPROVED" by MCDHS. shown on the reverse side of this form. B. I certify that I contacted the 0 I did notcontact the designer prior designer and left the system open for to final cover because the designer inspection up to 48 bra prior to cover. waived the notification requirement. I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not accurate, there will be just cause for immediate suspension of my etaller certification. 3 9� The undersigned approves this inatallatiop of behalf of Mason County Department of Health Services. l r`l5 Xw_1 h Znapacto nwt_ A"VS-3-BUILT FORM - PAGE TWO Mevlsed 07/12/93 PARCEL IDENTIFICATION 1 ,c Pekmit Number SWGg 'j - (� �] aj Subdivision 4. '� a� �a/ g, r S/0 (N�m�/mivi�lor /Hloolc/LOG) Installer's Name gy .S�GC2 <_�d,,57 /. Assessor's Parcel No. 9d//0 Designer's Name (T"'aly�—miyit H,amb�t) AS-BUILT DRAWING �� 90 CAUTIM: Minor ad]untments to septic tank location and dralnfield orientation made in the field by the installer are generally ac- ceptable to both the department and the designer, but could in certain cases compromise the viability of the system. It is the in- staller's responsibility to obtain prior written approval from either the health department or the designer before making any devi- ations fros the design that affect system viability. Any deviations frca the approved design must be shown above. AS-BUILT CHECKLIST Drainfield orientation a'observation port location u Undisturbed native soil and layout Ejllbetween trenches Cleanout location �% EJ Trench/bed dimensions and / LJ North arrow critical distances within E Manifold placement n 0 5 G04C— layout Scale of drawing shown EY�Orifice placement on scale bar D-Hox/"T"/"L" location ❑ Lateral placement, with Additional Mound Information Septic tank/pump chamber distances to edge of bed location �� � Endslope width '-`� Location of wells, roads Location of buildings 4 overall fill dimensions