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HomeMy WebLinkAboutSWG96-0297 - SWG Application / Design / As-Built - 5/10/1996 !' IBM M'o MASON COUNTY DEPARTMENT OF HEALTH SERVICES7A - RaceGG / - — w n (r"426•W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 yo PHONE (360) 427-9670 ' Z £ L v c 1 e S q(p CHECK APPLICABLE ITEMS 3 MAILING ADDRESS: DA I E P NE: NEW SYSTEM V R 2 . 39 I �u Cfeek uq-�p83� REPAIR SYSTEM - CI STATE: ZIP: 'I MAINTENANCE REVIEW I W ci� `1' SINGLE FAMILY PROPERTY ADDRESS: OTHER Z Ow+1R SPECIFY: 3 SPECIFIPDIRECTIONS FOR LOCATING SITE: PRIVATE WELL 1/ a m COMMUNITY WELUPUBLIC SYSTEM SYSTEM WFI# S _39 I _ ri VE w 1 e t p 1 1 SYSTEM NAME �+ + O NAME Name of Lot 330 7 ft. x ft. MAI IN ADDRESS S�- ; Installer VjMn kA UJO r^ Size: S acres TELEPHONE (eb ^0 0 Name of c Number o SIGNATURE Designer )� or\ Bedrooms 3 X n ` PLOT PLAN Draw a dimensional plot plan, including: r,* 00 :1 Precise location of test f� 10% "r 0 holes,showing t3 35t Sot s �1 measured distances to property boundaries. A /t dbt ❑ I� 2 ❑Entry road;other roads, r- I� driveways. o NOTE: DO NOT DRAW IN f✓rm^6 x cr. a SYSTEM DESIGN OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. I SOIL LOGS .Y�J Z� y (Z�y i /1_3�/ " Gaq►.., D-'C Fh S.ANo ti G497>t Depth from Original Grade to Restrictive / Layer or Water Table: ` In. DESIGNER DESIGNATION SCORES MINIMbM SYSTEM.REQUIREMENTS Finding Score Designer Lev ❑One / Two Soil Type Vertical Separation {o In. Septic Tank Daily Capacity: /� Gal. Flow: GPD Slope � � Appl D Parcel Size -OAC. Rate GPD/FT2 Area 600 FT2 Distance to Shoreline,'4-'Q h. --Cr- Total Inspector Date Q A41561 <-/ (- 16 COMMENTS/CONDITIONS FO P VAL U; � N6- 2 3 e �6-ass 6sS C6) . WAC 244 -117'4100, ) 6V;;r w lff- sr f I b •All septic systems must be designed and installed by contractors certified by Mason County Department of Health Services,unless prior approval is granted by the department,or the design is by a professional engineer. •Septic permit approval does not imply other building site requirements (i.e. RLC,Water Adequacy) have been met. •Any change from t ecified use of the property or any site alteration affecting the system design may invalidate this permit. This Permit e i s years from date of site inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. SITE REVIEW: //� DES N REVI Approved -j Not Approved INSTALLATION pro d ❑Not Approved BY: DATEq�3-R6 BY: DATE: BY: DATE://4f56 TOP: Health Dept. Copy MIDDLE: De ' ner's Copy BO OM: Applic s Copy DESIGN FORM - P R,�!&.d /28/95 n i ed when 3 conies of each of the following items are submitted: A desig f� � eted design form that has been signed and dated \\A Com�7��d Resource Lands and Critical Areas Checklist attached 1 S lot n, including all applicable items on checklist V- filed la.y�ketch, including all applicable items on checklist Cross-�=,�v4� sketch, including all applicable items on checklist II PARCEL IDENTIFICATION III II p II Permit Number SwG- 1�O" b�97 Designer's Name 7`�+ ���So I II Applicant' s Name y0n Vx(442�'ALA Prop. Owner's Name II Mailing Address « z i7 A t, 9 Mailing Address E ( I ^I II i II Assessor' s Parcel No. L1 Oo0 e,T Subdivision ii I e si o II I L_ I II DESIGN PARAMETERS II ' II ✓ ✓ ✓ ✓ 11 y Designed II Vertical II u jYjj u Separ tion II Mound Subsurface Pressure Gravity Bed Trench in 4 Septic Tank/Drainfield Specifications II No. Bedrooms Pressure Distribution? Yes U No { II Daily Flow 310o gnd (If yes, Proceed. . . ) ..................... c:. E'E[ieEE' II Septic Tank Capacity alI I I I) Receiving Soil Type (1-6) I II Receiving Soil Appl. Rate .2. god/fC' I Laterals II - II 4:w�a /Bed Bottom Area 300 ft' I Schedule Cla s Z� II II /Bed Width _ to - ft I Length _ O ft i' I II gxanCh/Bed Length 30 ft ( in I) I) I Diameter II Elevation Measurements I Number 3 II i II Original Drainfield Area slope e 3 Separation aration 3 ft II Drainfi eld Area SloPeifAltered 3 Orifices II n �I II Number of Orifices $ II Total II II Depth of Bottom of in I Diameter (I from Original C; d09 tj� g ope I Spacing 3ta C0 sooksztl r r in I Manifold II i i N,asO O s ope ScheduleQ ILength lg ftInfiltrator UseYes "5' No Diameter Z in Transport Pige Pump Required? Yes u No I Schedule/ as S ft II (If yes, proceed. . . ) .......................... I Length IG :iEi:eccEE:c6i9iiiiE I I, Diameter 2 in Pump/Siphon Specifications Dosing and Pump chamber 3 II Difference in Elevation Between Pump Shutoff I # Doses/Day ILO II and Uppermost orifice ft I Dose Quantity II r, i chamber Capacity inn gal II Uppermost orifice is Z3 higher, u lower than Pump Shutoff I Check the following components if they drain m II Capacity @ Tot. Pres. Head between doses: I II Calculated Tot. Pres. Head ft I II (Attach Pump Curve) I ix Laterals Manifold Transport J Rwi--d 07/28/95 DESIGN FORM - PAGE TWO , DESIGN CHECKLISTS III II Scaled Layout Sketch I Cross-Section Sketch II Scaled Plot Plan i�'1 Test hole locations I Reference depth from orig- II �j d orientation j ina grade: II I Drainfiel or l II II and layout I u Septic tank lid and II Property lines II � I L_J gj=Z=� /bed dimensions and j drainfield cover depth F U Existing and proposed I critical distances within ro wells within ro ft I layout i Reference depth from orig- II o£ property lines inal grade and restrictive II 2%D-Box/"T"/"L" locations strata: �I II W Xritical distance i lv— SEA ?uCrr ?Llw measurements to cuts, U septic tank/pump chamber i U Laterals, trench/bed j location banks, surface water top and bottom I IIIU Location and orientation I U, observation port location I. '-tT curtain drain collector of ."`-;" „ and all I �--] Cleanout location I �--� Sand augmentation absorption area , I II IIcomponents i � I No external reference II '� Manifold placement needed:Il11 LJ Location and dimension II orifice placement u observation ports and II of primary system and � 1 p I cleanouts I t II reserve area I u III, Lateral placement, with I u Buildings I distances to edge of bed I Additional mound information: SrE ceps 4Ecn r/ I p III, Direction of slope LJ AudiblevisuaQ alarm IUpslope and downslope II II I fill width indicator referenced I i III Scale of drawing shown I Settled cap de S pth at II t-J Waterlines i I center and edge of bed on scale bar I Roads/easements/ I I tion: Sidewall slope driveways/parking I Additional Mound Informa I IIU I 'A Up/downslope bed elevat. Endslo Critical resource lands I j (if applicable) Overall fill dimensions I Completed Resource Lands an I II � N I I Critical Areas Checklist North arrow and scale of II drawing shown on bar J II DESIGN APPROVAL II II The undedesi er v does, does not, waive the regirement to be notified by the II insta a to latio'^ and given_48 hours to perform a final inspection prior to II co, O II The undersigned has reviewed and a ro ed this design on behalf of Mason county of Health II Services. b � 1 II e CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIONS: t/ THE DESIGN IS STAMPED -APPROVED" BY MASON COUNTY DEPTARTMENT OF HEALTH SERVICES ✓ THE ON-SITE SEWAGE PERMIT HAS NOT EXPIRED; EXPIRATION OF SAID PERMIT IS BASED ON THE DATE OF INITIAL SITE INSPECTION, NOT ON THE DATE OF DESIGN APPROVAL ✓ THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS 1 I OBTAINED FROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES i t i i i r I f F Wn :Lar 512E O!J VEK"Y t STATEs 330xGGC�,LortS N0� bbO X66o i r boo i i PR�PoSk,D`1=ouSE ww-rcc.T in�E ,...._. 30o SOS SI OhIVewWo � _ j ,*Vr r TR�:KiPvmp CN• So _- TRwn:l$, i I oX 90 KE Si..k_vESwpE; .z I zoo1 Ex1i?I�IC, I �0loOs Maso���atY DePti �. ��- 6 i }1 i 1 �p CONTI NIOJS AP.faV)nID 'PiE'D o F v oB5!`'2 41loN Po4T(TYP) Fk ll -33 SAND 1°PVC 1.�97�;.�HS.S 13" f i III i �s�+ G,eFauE i la 10 ou.i piCES 9 3(�' 0-r— ._ J t \\ MRNIFOLD 1 'MREPD n CAP 1"�uc RISE-Q -M r*-NT>c t� 4S EL i ' C71tLV-_CS LAyovT 1 solos 1 aOO�ty QOP,' Mom° �Q 00 LPATL-RAL\oV, FIclz _-Up ynttt PC,* Z 1 i i f • ti -I I,� 1.30o Gqt�, tAfAc�-ry ' Z. pG[&fS RISER.TO 62 DS I 170o GrNL- 3,1Vr 144 BASKET SCAEO) sync, TANK I 4. REDVNDAWT OPf FWATS ! I 5.w ►t LEV0. f14AV 4.�rv¢o..rRTit. Sw Ls, Fvvl I I I _pumP._ cAvNrAD Rl5EP7rjC Nk CRbSS �St;tT7s�L�- _ .5 1e_nKil�- - I � ail 1 1L1 ItAAt p 4A i 1>g 1 " • j low-Al �R�CK OUC2 • • 'q11 v ec ASTrA G-3'5 MGDIuw\ SANG Z�M I >24" sit >Z4 08Pt ,D '"agoll�,pY p Y' WOO Date --.__.. _ . D2►�tNWELi'� BED_ �_4stSS-��.cTlaF� Cf�T.,��j �logkll�ta_�84T') .. . _. .__.__, _ . P6,j,`3 or-3 __.nl u S c,W L E 1 I ] . ] . ' ) « WJ �j uj ( ` ] cc $ § m § � ) \ ■ ■ � � � � ) , ■ � cc §§ In co |� q ■ 5 . ) % )¢ � | ) ` | � � � - § ~ $ n 40 co , Q R Nq ■ CD a m222 . � , - q ■ ■ w � � | w ! k � m o - (| a $ � U.ui ) # [ OR) ` ° _ , o � � [ �� CL F ( � ON SEW...:__ . ffrl FF ,:.. . DATE CALLED,INt.. TIME. •• INSTALLER: ►-uskan APPLICANT/OWNER: r "H CALLER. •��'�� r: \ � YEON$.# OF CALLER: 4: sWa #: PARCELN BR: " i 3 c. � o o o 4 o SUBDIVISION: D ry IsIoN. LOT: - �$!�����:}S�.N'•�'•iii.:d«•SS�:S� � '�•'L`••SSgSSS '• «SS«••.•.iS57i�S 5•••••: BYSTHRt €L'EECK ONE) � a�►vlTr INB (CwCK ONE) : Y nF APYOINTR PLUG IN A8—EL1 -$L1S4 (CHECK ONE) : 0 us no STAFF INITIALS:. 4,as ReViNd e�: g R TAI Y' d I Sy ^ ba 4 1 S �et } Y afwdetiant a 1 ' " trr'saptiC tam C(wweflolit if wlot / %f _ 1 -"' 'Old L`Iy�lwf ,i iw Yith water or spoor"irmter (Cftigil ")? tion ah4 ft qa}1�' rout V to #i 11 k .pf iwpst ioopedT�� ' _.. the sw ee ice►a" w _. r l a .grid tie spur ' 1, k yx 1AYY 1W0 4-At e lRn44tfanle �lf ►arde _.. i woo �" l iae, wM1d Jwe teNci' Y, _ , J,,rIed . Fe Nttaint f((tet is#weie wra) fnehiiad) _ "KESv<-F�365 E •. ' ITIT N 5' tits WAW*WW Me w>e1 inKnt(etlan and wrifiee thaae f(ndtnp an b44f wff' $antY of Oeelew 1 1 1 hrasii lto"aW OW", F AS-BUILT FORM - PAGE ONE Revised 12/14/94 PARCEL IDENTIFICATION II Applicant' s Name uc.,, ��e �DQ• cr . (I Permit Number SWG9 (D - OZ9 ] Subdivision __. ame Ml,,a :lonl=eR-71 t -_ II Installer's Name ELy�J�n EJ�A Assessor's Parcel No. �L Designer's Name } _�lo` ���n`�M `I wB€P7 II INSTALLER CHECKLIST II ¢ N/A Yes Prior to I. SEPTIC TANK Completion II A) >5 ft from foundation? B) Bldg stubout to septic tank: cleanout if not 1-2t? C) Baffles intact and clean? D) Dividing wall intact? II. D-BOX Leveled with water and/or speed leveler (circle) ? t III. DRAINFIELD A) >10 ft from foundation and >5 ft from property lines? .� 4 II B) Laterals level to tl inch & end caps present if not looped? _ II C) System dimensions the same as shown on the design? D) Gravel clean, properly sized, and proper depth? II E) PRESSURE SYSTEM I 1) Sand quality ASTM C-33? 2) Head height uniform and z24 inches? _ II 3) Cleanouts and observation ports present? _ t a 4) Mound: Side slope 3:1? ._ I 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by DLI? IV. POTABLE WATER LINES A) >10ft from drainfield? _ B) wells >100ft from drainfield? I H V. PUXP/PUMP CHAMBER A) Designed ump used, or specs attached for equivalent pump? B) en has or effluent filter (circle one) installed? C) R ser installed for access? 1! N D)-Alarm installed? q CERTIFICATION OF INSTALLATION i Installer: Check box from Row •A,• check box from Row •B,• sign and data the certification. A. El I certify that I installed the system I certify that all deviations from M 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. II � j I SA I certify that I contacted the r- r I did not contact the designer prior i designer and left the system open for to final cover because the designer u inspection up to 48 lire prior to cover. waived the notification requirement. NI further certify that all information contained on this form is accurate. I understand that if the informatiol4, contained:herein' is not accurate,' there will be just. cause - U immediate suspension of my installer certification. II The undersigned approves this insta lation of behalf of Mason County Department of Health II services. 1l IIR67IN lnspecco��,) e t AS=BUILT FORM - PAGE TWO RseSaed 12/14/94 PARCEL IDENTIFICATION II Applicant's NameLjZtjj4 II I II Permit Number SWG9 to Subdivision ame 1v15ion oc II Installer's Name -t�� C- f1 tG Assessor's Parcel No. 3Z.1� 4i2, �O'pIgoe r7 II Designer's Name 1'1•���'�-il"_51m $oe� �I I AS-BUILT DRAWING I� tltl I 4 II II II II II I II II II i it II II --731 II j 14 ' II fl II II T. II II © 6 II fl j II 1 � I CW7zav, Minor adjwtsents to septic tank location and drainfleld orientation made In the field by the installer are generally sc- oeptable to both the departeent and the designer, but could In certain cases coepxoeise the viability of the system. It is the i Lutaller•s responsibility to obtain prior written approval from either the health department or the designer before asking any deeistiens frog the design that effect ayatem viability. Any devietiom from the approved design must be show above. I� AS-BUILT CHECKLIST II �I n ^ H Drainfield orientation ❑ Observation port location U Undisturbed native soil N and layout n between trenches II M u u Cleanout location r1 {I N Trench/bed dimensions and f-j U North arrow N critical distances within U Manifold placement r1 u h layout n U Scale of drawing shown Q h U Orifice placement on scale bar II II D-Box/eTa/eLe location n II U U Lateral placement, with Additional Mound Information II II . Septic tank/pump chamber distances to edge of bed n II I I{ location r-1 Ll Endslope width II I II r-i U Location of wells, roads r__1 II 1 U Location of buildings U Overall fill dimensions {I 1 � i i i