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HomeMy WebLinkAboutSWG94-1344 - SWG Application / Design - 10/5/1994 MASON COUNTY DEPARTMENT OF HEALTH SERVICES ' PERMIT NO. SWG 426 W.CEDAR/P.O. BOX 1666/SHELTON,WA 98584 DateRece <. y N PHONE (206) 427-9670 Amoulnt pt$o z -� m m Z N /n- .- «f CHECK APPLICABLE ITEMS m m MAILING ADDRESS: . DAYTIME PHONE: INSTALLING NEW SYSTEM o � Ti57 %� /� AVE '50f)r. 8_5�yt=_s96, REPAIRING OLD SYSTEM CITY: STATE: ZIP: EXPANDING SYSTEM y KEnn WA A C)5-2- SINGLE FAMILY '$ PROPER[Y ADDRESS: OTHER c t U M l L` FN R%� SPECIFY: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL 2 m OR�V{ / U ZlVfrv^!� C� MIKlLSC1� 1 , PUBLIC SYSTEM _ SYSTEM ID NUMBER I(P; F ) J2SJI t-F CT C"F --T14- -RCAO , SYSTEM NAME I1 APPLICANT NAME LE7 4)/a CA) (— Name of Lot ft.x ft. MAILING ADDRESS. Installer A JiEw/ Cxr��<>�c�tS E' L ul e�z W Size: acres TELEPHONE ( Name of Designer J Number o SIGNATURE —^ r ) �� � ct4��IOf Bedrooms S 1 CA X to PLOT PLA Draw a dims plan _ I [ including:,AQ\V tij ro ❑Precis tion3est I K�LSE holes ing: me dist@goes TFe� prgpQ LLAearies r NOTE: D N RAW IN SYSTE DESIGN \�� '— OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. I M SOIL LOGS -7 f 3 �'/ logmyWYl(f3 T� O LofdAt' fff4iqP —Z3 / Zs -Go ICI- Depth from Original Grade to Restrictive Layer or Water Table: In. DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS Finding Score Designer Level: ADne ❑Two Soil Type Vertical Separation in. K Septic Tank Daily ,�qq -tom Capacity: f ZUV Gal. Flow: 3 6U GPD Slope fit✓ % _� Appl. r� Infilt. Parcel Size J nc. '.5J Rate - O GPD/FTC Area `J L FTC Distance to Shoreline U fl• �_ Total �- Inspector Date 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 expirps 3 years from date of site inspection.Denial of this permit may be appealed to the Health Aker within 10 days of denial date. Srl-E: - n Required ❑Not Approved I DESIGN Approved ❑Not Approved j INSTALLATION:❑Approved ❑Not Approved BY: DATE://-2g-j Y: DATE: _;U-q 5 I BY: DATE: TOP: Health Dept.Copy DLE: 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 QUALITY P.O. BOX 1666 303 N. FOURTH P.O. BOX 166E MEMORANDUM DATE: TO: 2c-(4 �C/ua.�La.i�yt FROM:-J�-9J �0 c�'-7 &/ eJ Parcel # I )? C�l`77G GGlO RE: Design for � 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. .DESIGN FORM - PAGE ONE Re.1.a 12/28/93 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 • Completed Resource Lands and Critical Areas Checklist attached • Scaled plot plan, including all applicable items on checklist • Scaled layout sketch, including all applicable items on checklist • Cross-section sketch, including all applicable items on checklist C� PARCEL IDENTIFICATION Permit Number - {3�f-I Designer's Name ��Q21 Applicant's Name IeAry -II'2,� Prop. Owner's Name GLry Mailing Address a�733 I n -" So _ Mailing Address WS K�O 0 P Q C icy ''//Sas<� Zip CL<y 3<sca Sip Assessor's Parcel No. 13�' /`/- 00o)Q Subdivision " Ay+\ I �-- ('Tv�lva-Digit Nomb�c) (Nsm�/O1vl�lon/BloOk/LO<) DESIGN PARAMETERS J J J J Designed Vertical �f Separationn � Mound Subsurface Pressure Gravity Bed Trench �J in .Septic Tank/Drainfield Specifications No. Bedrooms Pressure Di No Daily Flow ' I� 4Pd ................... s41 •�' Septic Tank Capacity JZoo gal . • . . . Receiving Soil Type (1-6) �A�� 4 •� Receiving Soil Appl. Rate d/ft' LA"al 995 Trench/Bed Bottom Area LtSo ft2 Schedule/class Trench/Bed Width 1(� ft Length ft Diameter HEALTH SE R in Elevation Measurements Number Orig. Drainfield Area Slope 0 8 Separation ft Final Drainfield Area Slope O 8 Orifices Depth of Bottom of Trench/Bed ^-/ Total Number of Orifices from Original Grade in Diameter in Spacing in Manifold Schedule/Class �pUU\y O r� Length ft Pump RequiAhe Yg �� ,Yes (� No Diameter in .................. 2 (If pr\Qacyc"• • • Transport Pipe .• \pd�a '• Schedule/Class •••.•.•.•.•...•Pump/siphon,�t4@c fications .. 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 cal than Pump Shutoff Chamber Capacity gal Capacity @ Tot. Pres. Head qpm Calculated Tot. Pres. Head ft (Attach Pumn Curve) DESIGN FORM - PAGE TWO ae ieed 12/28/93 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Reference depth from orig- Test hole locations Drainfield orientation al grade: m and layout \LJ Property lines r� Septic tank lid and m u Trench/bed dimensions and drainfield cover depth LI Existing and proposed critical distances within wells within 100 ft layout Reference depth from orig- of property lines inal grade and restrictive D-Box/"T"/"L" locations strata: Critical distance measurements to cuts, Septic tank/pump chamber Laterals, trench/bed banks, surface water location top and bottom Location and orientation Observation port location ""' Curtain drain collector of curtain drain and all absorption area � Cleanout location ® Sand augmentation components Manifold placement o external reference needed: Location and dimension of primary system and Orifice placement Observation ports and reserve area cleanouts Lateral placement, with Buildings distances to edge of bed Additional mound information: Direction of slope Audible/visual alarm Upslope and downslope .� indicator referenced fill width \� Waterlines Scale of drawing shown Settled cap depth at m on scale bar center and edge of bed LJ Roads/easements/ driveways/parking Additional Mound Information: Sidewall slope Critical resource lands © Endslope width Up/downslope bed elevat. (if applicable) - ® Overall fill dimensions Completed Resource Lands and North arrow and scale of Critical Areas Checklist drawing shown on bar 35 e5 eP� Nea\ DESIGN APPROVAL MaSo\N 4 The undersigned desire does not, waive the regirement to be notified by the installer of the instal pdn and n 48 hours to perform a final inspection prior to cover. 61gn�cvr� 01 ��19n�r D�c� The undersigned has reviewed and apprq ed his design on behalf of Mason County of Health Services_ J /� z 0 _ <:l 5 Fi 1<h Snrpr or OscJa J CAUTION: THIS DESIGN IS ONLY VALID IF STAMPED "APPROVED" BY MASON CO_ DEPT. OF HEALTH 3 'Si �P i H 1 c 330' e� j I jcl C'J �0 NUvJ� �Jon,ConafY t Nk Q T C c c o P S o G v - G ` c b / � 0 � h L C �c MaSpP C � G C c i i z � . _ z _ D W A 'V Z V "v woads G I i