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HomeMy WebLinkAboutSWG94-1273 - SWG Application / Design / As-Built - 9/23/1994 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG - C/) H N 426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date N. o PHONE (206) 427-9670 Receipt No. H Amount$ Z F 3 m 7 s CHECK APPLICABLE ITEMS ✓ m CP MAI A RESS: v J DAYTIME P ONE: INSTALLING NEW SYSTEM 0 /)C REPAIRING OLD SYSTEM - CITY" STATE: ZIP; EXPANDING SYSTEM m heitnNSINGLE FAMILY P PER ADDRESS• OTHER Z e SPECIFY: a prnfjSPECIFIC DIRECTI NS FOR LOCATING ITE: PRIVATE WELL g 41J(4PUBLIC SYSTEM SYSTEM ID NUMBER Olre& CYPCk ro SYSTEM NAME S} APPLICANT I� NAME t Na Ye of Lot ft.x ft. MAILING ADDRESS r- Installer U 1 Size: ONE acres o. Name of TELEPHONE HONE - R 9 Number o SIG N Designer T h Bedrooms X L PLOT PLAN -_ 50' ' P Drawer onal plot�, �j 5 I-F includ� LIJ \ 1° m ❑Preration of testU g p hol win �I I� me�dis sto� proper oun cries. WI o M ❑Entm;othw roads driv ys. 4 -N — _ I© f� r. NOT : NONrbRA IN STEM DESIt� DSO N OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. F SOIL LOGS S9 v>,3fi 4 "Cod's, .lido g l*p— 'lam-6a a b I 12ev-1S !a -1 0 ' e'eq /� Zo ZLF h Depth from 4 Grade to Restrictive Layer or Water Table: In. DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS Finding Score esigner Leve TWO Soil Type —�t_ Vertical Separation in. Septic Tank Daily Capacity: 1� Gal. Flow: 360 GPD Slope -�� Appl Infilt. / Parcel Size - Ac. Rate 0,,6 GPD/FT' Area b 0D FTF Distance to Shoreline +O ft. Inspector Date �-4-4 Esau f/' /z -,q V � � 1 MASON COUNTY DEPARTMENT OF HEALTH SERVICES MASON COUNTY RLD0. 111, 426 W. CEDAR P.O. ROX 1664 SNELTOK WASNINOTON 99594 (206) 427-9670, FAX 427-9425 x DATE: F ` x TO: T,4t1:TA- { x FROM: - - - Guy Grayson - - - x DESIGN FOR.- PARCEL #: 321 6- ?,y 0 4 D »> < YOUR DESIGN FOR THE ABOVE REFERENCED PARCEL HAS BEEN REVIEWED AND IS HEREBY APPBOVLA „.. ❑ YOUR DES GN FOR THE ABOVE REFERENCED f7 PARCEL H BEEN REVIEWED AND CANN07' B6 PPROV .THE REASON(S) ARE: . lC[ uA S4 Avt! n1 £iv7A01 ly , m DESIGN FORM - PAGE ONE xWWLW r lam/93 A design ri311 be rsviewOd when 3 copies of each of the following items acesubmittedz • Completed design form that has been signed and dated • Completed Resource Lands and Critical Areas Checklist ,attached LEI j • Scaled plot plan, including all applicable items on checklist i"•�•� }J • Scaled layout sketch, including all applicable items on checklist • Cross-section sketch, including all applicable items on checklist r• LLJ PARCBZ IDZMTIFICATION Pa.192Aft Nul3orf6-- 901 7_ Designer's Name .9�A/d�d /Q ` CDr ABn,,,• n i s N �' jl L. SI7YC(O/I Prop. Owner's Name s .Stern do%/ Ma�Addree Mailing Address ea•ay _ _ �<-<a eta G�t7 Assessor's Parcel No. ��/36 .Zy QL/O6� Subdivision f Swr-ly--aLVL< ;W;4. ) (M-.w- OlvL�len/else Yl Le<) DESIGN PARAMETERS 7FP DataDesigned Vortical ressure Gravity Bed Trench Separation: n ld Specifications �/.3 Pressure Distribution? L.J Ye8 No �Sd apd ........ If yes, :::,::::................ :::::::::::::::::::::::: ( Y proceed.. .) Septic Tank Capacity /20d c_al "" Receiving Soil Type (1-6) Z, Receiving Soil Appl. Rate _/.2. and/ftI wv(.b Laterals Trench/Bed Bottom Area >O O fts Schedule/Class z 6 Trench/Bed Width / O ft Length yX30 _ /ZO ft Slevatioa Measurements Diameter inNumber Orig. Drainfield Area Slope /fin • Separation 3p a Final Drainfield Area Slope LAW ft Depth of Bottom of Trench/Bed GT-- Orifices ` Total Number of Orifices from Original Grade // in Diameter Z!-7//4 n Spacing 3li7 { in Manifold oern-'-w Schedule/Class d (� Pump Required? 2/ Length ft zee No Diameter:••:::::UM: (If yes, proceed. . ) in • iiii.......eiiEiiiiiiiieE Transport Pipe Schedule/Class C Q Pump/Siphon Specifications Length Difference in Elevation Between Pump Shutoff Diameter !t and Uppermost Orifice 2, f ft in --�_ Dosing and Pump Chamber ♦ Doses/Day Al Uppermost Orifice is higher, lower Dose Quantity than Pump Shutoff cal Capacity Z3, G Chamber Capacity _TO d cal P y d Tot. Free. Head ` Calculated Tot. Pres. Head �y ft (Attach Pump Curve) DESIGN FORM — PAGE TWO RAWLS" IMS/93 DESIGM CHzczLrSTS Scaled Plot Plan Scaled Layout Sketch Cross—Section Sketch Reference depth from orig— �Jfest hole locations Drainfield orientation iaal grade: u,( and layout _. Property lines �� ��Septic tank lid and � Trench/bed dimensions and drainfield cover depth '--' 8xisting and proposed critical distances within wells within 100 ft layout Reference depth from orig— property lines ✓ final grade and restrictive- �ox/"T"/"L" locations strata . Critical distance ,�—,(/ �..,(/ measurements to cuts, Septic tank/pump chamber Laterals, trench/bed banks, surface water /location �ltop and bottom "EyLocation and orientation —�y vation port location Car in drain collector of curtain drain and •11 absorption area gyeanout location Sand augmentation ponentsr�J/ Manifold placement No external reference needs, Location and dimension Ln rimary system and Or Tice placement Observation ports and rve area cleanouts Lateral placement, with dings distances to edge of bed Additional mound information' ction o! slope 9-Au/dible/visual alarm slope and downslope cator refer nced fi width rlines Yam+ Scale of drawing shown Settle cap depth aton scale bar center d edge of beds/easements/eways/puking ional Mound Information: Sidewall s peical resource lands 0 Endslo idth Up/downslope evat. applicable) Overall 1111 neione Completed Resource Lands and arrow and scale of critical Areas Checklist ng shown on bar M DESIGN APPROVAL Initials— ate The undersigned designer does, does not, waive the regirement to be notified by the installer of the installation and given 48 hours perform a final inspection prior to cover. C .n...�_.o The undersigned has reviewed and ap ro this design on behalf of Mason County of Health Services. rq CAUTION: THIS DESIGN IS ONLY VALID IF STAMPED "APPROVED" By MASON CO. DEPT. OF HEALTH , o ' a <,r � Mason Co , CeOtNe>alth Se i 0 lnitiiaalS YP I ces M � Cata It 0 w � h INy a , IV CL jo O �w O r�e o j W . �/�ss.8✓ipp y c/Za, �pd �. K All- r �JSG n�04971y oB W �A pt, nit��O*yB'e/th Sejv/� Lp ^\ 10, F ti b y 4 I c I v'C � q d. �a�son�cjOUQy DeA' 4 A a/fh o (�@ initja��V rj� Sery/ee� y, Oat � � M o , I o (0's a ly yl °` 8 o - j 1 3 r I r w N LTS 8 S - LU e9 N p D _ . .�.— -�- .._ . ...... .-.......-.. I .......y. -........ ... .-Q -...... _......_.._ l i I ..... M s(n Co my ep . exit Sirvlce _ — c� v 1 Itlal . . /- " a m I O -� -_ 7-1 8 A Z r _ . a r M t--�- owl I M er p OR ul- ac u w . , • �df00 C 4AAye® y ' '��ta,�0�1�sBry,�,• preiiure f N On., Yi. far . __..... ........_,. 1. e Install laterals with contoua• of the ground. 2. Install trench bottoms level'* 3. Install locator tape on top of all drainfield laterals. 44. Install observation ports as indicated on the plot plan ((minimum one or draisfield with bottom extending to the drainsock nat ve soil i terface) . 3. Install dr infield during� da�yy weather and soileondltions, any soiill smearing must be siiainated by band raking. t 6. Install threaded clean-outs at the ands gt,all laterals aca arJcsdm withh looccator wtay) . 6 inches of linishad grade and be 7• Install audio/visual high water alarm. S. nsit1reeofrie Pump screensg surface area, not nt B1goats) . ewtcopts i 12 or 90 Install check valve in pump outlet line to prevent system from draining back into the pump chamber. 10. Ts4 to Tao construction between laterals and manifold with orifices oriented at 6 o'clock. Install laterals to the manifold with the orifices at 12 o'clock, (do not lug) after pressure o'clock) rest and glue latlth erralspto manifold: turn orit cas down (6 11. Filter fabric required over drain rock prior to backlilling. If the drain rock extends above natural grade run the filter fabric at least 2 inches down the trench wait. 12. Divert all storm Water run-off away from on-site sewage - system. 13• No curtain drains allowed within 10 ft. of the up-slops edge Of the dsaintisid and reserve area. 14. No curtain draains allowed within 30 tt. of the down-slope efts of the drainfiold and reserve area. 13. Have' the as i tan% and pump chamber pump" or inspected every three years. 3-6• Inspect and clean Pump screen every 6 - 12 months as needed* -- 17. inspect�� floats and ted. est high water alarm wary 6 - 12 months IS- All materials and workmanship regulations. must "at County and State 19. DevIgn ation from this design without prior a pr44vval from the Desgner and Mason County Health Departaen will mars this des null and void. • 4-DA f2� �gv � i��o � ON-SITE SE LLAT ON FINAL INSPECTION ........................................ ...........::::::...... ..................::::::::::::: :: :::::::::::::::: ... : :: :..::: ..::::::... .......... DATE CALLED IN: TIME: INSTALLER: APPLICANT/OWNER: CALLER: PHONE # OF CALLER: SWG #: (_ PARCEL NUMBER: SUBDIVISION: DIVISION: LOT: SYSTEM TYPE (CHECK ONE) : PRESS RE GRAVITY INSPECTION SCHEDULE (CHECK ONE) : - APPOI ENT PLUG IN STAFF INITIALS: 1 _ .� h:callin.w ��..11 Revised 06/17/94 ON—SIZ;"E SEWAGE INSTALLATION , STAFF INSPECTION REPOI2,T srAFP �cMG.IST CONFIRMED BY INSPSC10R7 I_ SEPTIC TANK YAeAe A) >5 ft from foundation? /` "iNN:x-'h B) Bldg stubout to septic tank: cleanout if not 1-2%7 n C) Baffles intact and clean? D) Dividing wall intact? ^ II. D-BOX Leveled with water or speed leveler (circle one)? III. DRAINFIELD -w A) >10 ft from foundation and >5 ft from property lines? B) Laterals level to 21 inch c and caps present if not looped? C) System dimensions the same as shown on the design? X D) Gravel cleans properly sizede and proper depth? ^ _ E) PRESSURE SYSTEM ,( 1) Sand quality AM C-33? 2) Head height uniform and a26 inches? 3) Cleanouts and observation ports present? !) Mound: Side slope 3:1? I�j 5) Owner informed electrical connections east be made by licensed electrician? IV. POTABLE WATBR Lms . A) >10ft from field or double sleeved? e) Wells >100ft from drainfield? — V. A r;;; basket effluent filter (circle one) Installed? I� _ B) Riser s lled for access? _ C) Alarm installed? VI. AS BUILT REQUIIW? — VII. oTOER C!Y@DaP15 I I (JJ-- ,', � I a� sCll The undersigned has reviewed this installation and verif h findings on behalf of Mean, County of Realth Services. hecallin. Revised 06/17/9 AS-BUILT FORM - PAGE ONE r PARCEL, IDENTIFICATION �y III Applicant's Name Il yy)pC��l d : Ini/QI 2 .3 1.TJ'I II Permit Number SWG9 - �01 7� Subdivision no II S II II Installer's Name Assessor's Parcel No.� ve- 1 1 er II Designer's Name 'I INSTALLER CHECKLIST I N/A Yes Prior to II I. SEPTIC TANK Completion II A) >5 ft from foundation? II B) Bldg stubout to septic tank: cleanout if not 1-2a? C) Baffles intact and clean? I D) Dividing wall intact? II II. D-BOX Leveled with water and/or speed leveler (circle) ? II II III. DRAINFZELD II A) >10 ft from foundation and >5 ft from property lines? X B) Laterals level to ±1 inch & end caps present if not looped? C) System dimensions the same as shown on the design? D) Gravel clean, properly sized, and proper depth? II E) PRESSURE SYSTEM II 1) Sand quality ASTM C-33? II 2) Head height uniform and a24 inches? II 3) Cleanouts and observation ports present? II 4) Mound: Side slope 3:1? by X II 5) Owner informed electrical connections must be made'a II II owner or licensed electrician and inspected by DLI? II IV. POTABLE WATER LINES II II X A) >10ft from field or double sleeved? II II B)" Wells >100ft from drainfield? II V. PUMP/PUMP CHAMBER A) Desi ned um used, or specs attached for equivalent pump? _ _X_ II B) Green basket r effluent filter (circle one) installed? II II C) Riser in­sUa—fl7ed for access? _ 1L ,I II D) Alarm installed? — — II CERTIFICATION OF INSTALLATION I II Installer: Check box from Row "A," check box from Row "B," sign and date the certification. II II r-1 gyp( II A. u I certify that I installed the system ld I certify that all deviations from Q without any deviation from the design the design stamped "APPROVED" by MCDHS are II stamped "APPROVED" by MCDHS. shown on the reverse side of this form. II r, II B. u I certify that I contacted the RN II designer prior I did not contact the d II I) designer and left the system open for to final cover because the designer II II inspection up to 48 hrs prior to cover. waived the notification requirement. II II I further certify that all information contained on this form is accurate. I understand II II that if the information contained herein is not a curate, there will be just cause for II II immediate suspension of my installer ceetific 3aegnarure II The undersigned approves this ins T11 of behalf of Mason County Department of HealthServices. ea r a e 40 AS-BUILT FORM - PAGE TWO ' Aeviaed 08/24/94 I' PARCEL IDENTIFICATION II Applicant's Name 1 �J �.1 Permit Number SWG9 —7 - is 73 Subdivision �Xf/ II ii A ame lvlsion oc o II Installer's Name ) 1 Assessor's Parcel No.,4Rp4 oZ ��numoe 0II II Designer's Name n I� I AS-BUILT DRAWING II I 021 II II I Reserve — ese - 39� I� II Enlargfd Aeia1L bra urea Punp CAemhrl II r ilnK S II QO 30' r,° II I � II _ 3/i a II IIv 3 O/d Noso, 11 GIUMON: 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 compromise the viability of the system. rt is the in- staller'. responsibility to obtain prior written approval from either the health department or the designer before making any devi- ations from the design that affect system viability. Any deviations from the apptnved design must be shown above. II AS-BUILT CHECKLIST Drainfield orientation Observation port location Sa Undisturbed native soil II II and layout between trenches II Cleanout location I) Trench/bed dimensions and tq1 North arrow II critical distances within Manifold placement II II layout Scale of drawing shown II Orifice placement on scale bar II U D-Box/"T"/"L" location II II Lateral placement, with Additional Mound Information II II Septic tank/pump chamber distances to edge of bed U II II location Endslope width II Location of wells, roads n II IIVu Location of buildings I--I Overall fill dimensions II J'