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Home My WebLink AboutSWG2002-00160 - SWG Application / Design / As-Built - 5/2/2001 $' . MOON COUAW DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG H Date G iy 426 W. CEDAR/P.O. BOX 1666/ SHELTON, WA 98584 Receip No. y PHONE (360) 427-9670 lAmount$ — z f PRO ERTY OWNE ^ DATE: m PF�Q�� J�� -5- 2_0y CHECK APPLICABLE ITEMS J� NEW SYSTEM MAILIf13G2�DDRE$_K� / - s.t DA�Cfy1Fr PHO �o UW.1 W 310(� _ ?( /(o 40 REPAIR SYSTEM � CITY:f� � ,$S ATE: / IP' TABLE 6REPAIR m ro F� &cl¢i�21� W� GIcg30 MAINTENANCE REVIEW SINGLE PROPERTY ADDRES `(S: OT ER:FAMILY 9 Mkk'�l E Aa1016� S ECIFI DIRECTIO R TING SIT PR S FO IVATE WELL m CV r\) COMMUNITY WELLIPUBLIC SYSTEM I1C),I SYSTEM WFIN SYSTEM NAME APPLICA T NAME Name f Lot ft.x ft. MAILING ADDRESS I� Installer Size: acres TELEPHONE < Name of um er o SIGNATUR F.Designer drooms X ' I FFICIAL USE ONLY BELOW THIS LINE DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS F I 2 SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely INSR(print na e) CCl IN EC I SIGN�TI(RE DATE PERMIT EXPIRATION DATE GL� v/ 'E°�f+ !do Z •All systems r uire ongoing Operation and Maintenance(O&M)as sp cified in Mason County 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 •All 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 permit expires 3 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. DES N RE IEW AP? BY: DATE: INSTALLATION PPROVED BY: D TE: s TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy • MASON COUNTY DEPARTMENT OF HEALTH SERVICES Al / om May 20, 2002 PO BOX 1666 SHELTON, WA 98584 SHELTON (360)427-9670 FAX (360) 427-7798 Huston Excavating ELMA (360) 482-5269 1320 SE Arcadia Road BELFAIR (360) 275-4467 Shelton WA 98584 SEATTLE (206)464-6968 RE: Design for TORMANEN Case No: SWG2002-00160 Parcel No: 321347590082 Your design for the above referenced parcel has been review and is APPROVED. Please refer to the comments section of this letter for any additional information. Please call me at (360) 427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services COMMENTS: 5/20/2002 1 of 1 SWG2002-00160 DESIGN FORM - PAGE ONE �A RWIT,4rfl 99a A design will be reviewed when 3 copies of each of the following items are submitted: r y ' / Completed design form that has been signed and dated % Scaled layout sketch,including all applicable items on cklist Scaled pbt plan,Including all applicable Items on checklist % Cross-section sketch,Ineludlgg PI( plicable Items on checklist PAR �DENWF(CMQIV Permit Number: CPU Designer's Name: I1 Designer's Phone#: 6 42te-OS5c FI Applicant's Name: P r,O To f Ma b Assessor's Parcel No.: Bz 1-14-1 S- otoo 81 Mailing Address: 4�2�1 �ti�ure,rs ln_ Sn.1. (Twelve-Digit Number) P1.Orcho.�ri w>. ei$3tc'1 Subdivision: City State Zip (Name/Division/Block/Lot) DESIGN PARAMETMS Treatment Device O Glendon Biofilter O Sand Filter O Mound Sand Lined Drainfield O Aerobic Unit-Make/Model: O Disinfection Unit - Make/Model: Drainfield Type Pressure Aged 0 Drainrock O Gravity O Trench O Gravel les Chambers Septic Tank/Drainfield Speecificatigns Laterals Number of Bedrooms �� Schedule/Class d Daily Flow r}gp ad: Length Septic Tank Capacity I Lo a gal Diameter in Receiving Soil Type(1-6) 1-4 Number Receiving Soil Appl.Rate d/ Separation fr Required Square Footage A v R ov Designed Square Footage A TH Percent Reduction Taken % Total ter we ds Diameter � Trench/Bed width �`_-- —ft Spacing MAY 2 0 2002 t in Trench/Bed Length -t� ��ww�t Elevation Measurements CE�nanifold Schedul6ULD ° Original Drainfield Area Slope °a Length (v ft New Slope if Altered '^ °° Diameter L in Depth of Excavation from ❑No Original Grade Q Qj in Preferred Manifold Configuration Used? ®Yes M t (up-slope) �}$ - in Transport Pipe (Down-slope) Schedule40W. o Designed Vertical Separation 2'� in Length ft Z- Gravelless Chambers Required? ❑Yes I2,No ❑Optional Diameter in Pump Required? MYes ❑No Dosing and Pump Chamber Pump/Siphon Specifications Number n Doses/Day 4 a Dose Quantity BO gal Difference in Elevation Between Pump Shutoff and Uppermost Chamber Capacity Joao Orifice: to ft Pump Controls: Timer(or) Elapse Time Meter(circle if required) If Timer: Pump On Zmn 40Se4 Pump Off Sun ti'7m , Uppermost Orifice is 0 Higher, ❑Lower than Pump Shu Capacity rQ Total Pressure Head: 3U Check the following components if they drain between doses: Calculated Total Pressure Head: Laterals ® Manifold ❑ Transport (Attach Pump Curve) S� DESIGN FORM - PAGE TWO Revised April 24,I991 DESIGN C.IiEC#C LIST'S ' Scaled Plot Plan Scaled Layout Sketch Cross -Section Sketch ® Test hole locations 19 Drainfield orientation and layout Referenced depth from original grade: IN Property lines 0 TiwieHlbed dimensions and critical 1M Septic tank lid and drainfi6ld cover IN/,.,Existing and proposed wells within 1 distances within layout depth 100 ft of property lines X4 D-Box/-'7/ ' locations ® Critical distance measurements to cuts, 0 Septic tank/pump chamber location Reference depth from original grade banks, and surface water m Observation port location and restrictive strata: qb Location and orientation of-ex+4ain 04 Clean-out location 0 Laterals,trench/bed top and bottom -dfai;i4ad all absorption components 0 Manifold placement " Curtain drain collector ® Location and dimension of primary M Orifice placement ® Sand augmentation system and reserve area W Lateral placement,with distances to B Buildings edge of bed Other cross-section detail: 0 Direction of slope indicator (H Audible/visual alarm referenced 0 Observation ports and clean-outs fA Waterlines El Scale of drawing shown on scale bar (9 Roads/easements/driveways/ Cross sewn tnforutatron 3or:mound parking Layout ii�formationlfor)mound system: (system: O Critical resource lands (if applicable) Overali fill dimensions I� fit ttletl eap deptltat eztater and edge of Q North arrow and scale of drawing shown on scale bar (3p-slOpe,downslope,and endslope I bed fill width Sidetiyall slope �f7 Tfp slUpc and ddtinslape.bededevatrou Additional Information Rl Design staked out O Operation and Maintenance Notice Attached 6A! 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 cover: Signa re of Designer Date 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 uZ . Environment 1 Health Specialist Date Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved" by Mason County Department of Health Sery es. ✓ The On-site Sewage Permit has not expired,the Permit Expiration Date is: ✓ The system is installed by a certified installer, unless prior authorization is obtained from Macon County Department of Health Services. ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval t!i - 'NIAk'YAkrJ PLAc-'� / LI r16 A I ! � N � � N � berAcua� ¢REok,�aM f,A ACC S1 r-- ClEAr1-o�i # o00 6Rl Zoo C +kL- pj—p TArlIC' O 5EpnC TANK IH'! rp'z 'lo\ LEVEL 9xw,wb js 5 C�OVED Z!'L0 2W SdiE.° — TN �Z DEPT MAY 2 0 2002 to"-tco'+ �S.Q�+I 6'i OF ? • EpGE v� �E� . SM.P�1SnRR1ER � Ig"�) ! PVC LATE4.AL 3tn 85E'RJRTIuti Rf r�Yy' PVC MRiJIWLD R LRTE'R. LF \o Ru r-Acu LAyour !t. {sEb. };�(Lc�� I" = 10± _. t;bsEP_vrmonl Twat 4 PVC Rt mov WRLC CAP y y`� g PVC PCR G.W 'TFD 11J FA13RI4 21-2'� +,L� � �N UTf)LRE QV!iL�Dl 1-ltJ RaYOrn GM4VEL (a T �'' 1-To itolrq rn ;WD 4 ovca r'LRTE YA�� v*0pw A14oUC UNACiL i MEv!Um SWAID APPROVED MC HEALTH CEPT MAY 2 0 2002 RE ST-RICTI t/F` CEW h t --___. SYSTEM__l!4Ynur_.q-,��--�„I pSS;SES��Q±',( No�3"7J'— C.LEP,K-OUT TV UfI.AU� RCCf Ss k15Ek5 TO GCq'D��TY� T-1LTb-R f If �f N 6 E �_� _ ACCESS RISCR (r, N� I'�k� UR.rYDE --- I '� ♦,lor'e5� ' 1}YDI A�f�viSuh-C HIGH l£UEL RLA-Rr., TI LfL PAi,ICL %EQl)IRCD Wr FpR U DpSf S\OAy Vt L;" 49M ® I4STPLLATiot4, OnIE DAYS II s�KCOMP, APPROVED SNC.n frC � A'� !�� it MC HEALTH ®PT Ric, L1=OFL- +' 1 MAY 2 0 2002 A ARw I I CEW � • � FJYD 20-N`ATI(i '�I I g' a wuc 'EV'nL TP43YI MID Ll7h^P �uPwB�R 4G� 3 oF ? _- �n�uoiiii�■iii� - - ■��■��■■■�■■■emu■ iii■�■iiiiiiiiii ■�niiiimiss ion■iii�iiii�iiiiiuii ON-SITE SEWAGE INSTALLATION FINAL INSPECTION DATE CAu.ED IN: —_ 6 — INSTALLER: - 00 . APPLICANVOWNER: CALLER: PHONE#OF CAIIER: . SWG#: PARCELNUMBER SUBDIVISION: Div: Lot SYSTEM TYPE(CHECK ONE): Qr-� ❑ PRESSURE GRAVITY INSPECTION SCHEDULE(CHECK ONE): ❑ APPOINTMENT PLUG IN AS-BUILT ON-SITE(CHECK ONE): /YES NO STAFFINITIAIS: 14)"�u� : hxF,<u •�r q wT`C`�'➢aC5 vTd f:tfr <�>JGNL \ k >.£ cN:.` :CS'S S:T:''u:4Yk";�L�>w" ,^`;">b'.. P:n>:>..`n APPoINTTENT DATE: 0- TIME: COMMENTS: ON-STYE SEWAGE INSTALLATION STAFF INSPECTION REPORT <p..<.y,..u:'..: p �gbqq�"n .� ":"2`Y��. �:`h�'i)R.�..`: .."yA`,.'�>`.": kY�Y.::w•"$M�SN:.xi:Y•5... .:✓Y,:. ..':S:Z"' `..y. gc v&i�.;� :.. iFa: "..•. c ors,<x'>.ZF��.��>. ?7" .�y,. w 15.._.':i..:<n...T:.,S'....L.`5:ti....\'YC'^N..:...�<:(<Y....-v.. `<s LP:.:..S<:.�:.a' ..::.��'"`: .:... •y ` :.,..:..$..:a �,!<.�.. � •aAQ;fis:gC' � .:is{:?:3'ti�:..•:ff..:.: ...)..::.�1:�. 5':..:Yi9C. Yes No .:,_:Comments: L S1rrTTc TANK A) >5 I from foundation? B) >50 ft from wells and surface water? D) BBema Intact and Ilea tank:clean-out if.no[ 1-2%? 4- E) Dividing wall intact? F) Risers installed for access? - IL D-Box Leveled with water and/or speed leveler(circle)? BL DxAMFMtn TC els#vb tiG A) >10 ft from foundation and>5 ft from Perceived property lines? B) >100 ft from wells and surface water? C) >10 R from potable water lines? D)"Laterals level to±I inch&end caps present if not looped? E) Graveness chambers utilized? F) SYstem dimensions the same as shown on the design? G) Gravel dean,property sized,and proper depth? H) PxEss[mESvsrrars 1) Sand quali(YASTMC-33? 2) Head height uniform and 2:24 inches? 3) Clean-outs and observation ports present? x 4) Mound SideSlope3d? non 5) Owner informed electrical connections must be made x' by owner or licensed electrician and inspected by L&1? W. PUNPIPEW ClrAnmElz _ A) Screen basket effluent file c le one)installed? X B) Riser installed s?-- C) Alarm in timer 0 D) Pump on timer circle)? x V. As-Bim.TREQomID? VL GT'EMCOatMF WOBSIItVATIONS The undersigned has reviewed this installation and verifies these findings on behalf of Mason County Department of Health Services. Sanitarian Date C:1t tyFdaVia,ldw Lmpd Revised 9l2W7 R AS-BUILT FORM a"ised Febmary 19,1998 Applicant Lc1� — Assessor's I Parcel # � 1 -54 ——) 7 - Permit Number SW7G?�' ��I�"� (Twelve-Digit Number) Installer CZ l��.� iC� 5 1\- �'Subdivision (Name/DlvlslontalooWLot) Designer :: IIt4>3"t'A�.L�Iw3kIE�[4L1�'t' t x. NIA Yes Prior to Completion I. SEPTICTANK 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°/u? . . . . . . . . . . . . . . . . . — D) Baffles intact and clean? . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — E) Dividing wall intact?. . . . . . . . .. . . .. ...... . . .. . . . . .. . . . . . . . . . . . . F) Risers installed for access? . ... . . . . . . . . . .. . . . . . . . . . . . . . G) Tank Size: \ZW gal.;Manufacture V � I I. Box A) J/ A) Leveled with water? . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . B) Speed leveler used? . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . — III. DRAINFIELD A) >10 ft from foundation and>5 ft from property lines? . . . . . . . . . . . . . . . — — B) >100 ft from wells and surface water? . . . . .. . . . . . . . . . . . . . . . . . . . . . . — C) >Io ft from potable water lines? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D) Laterals level to± 1 inch&end caps present if not looped? . . . . . . . .. . . E) Graveness chambers utilized? . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . F) system dimensions the same as shown on the design? . . . . . . . . . . . . . . . . G) Gravel clean,properly sized,and proper depth? — H)' S and SvsrFus I) : 1) $and gpalitY ASTTvI C-337 .^r.. k j 2) Head height uniform and 2:24 inches? Actual head height. . . 3) Clean-outs and observation ports present? . . . .. . . . .. . . . . ... .. . . — 4) Mound: Side Slope3:1? . . . .......... .. .. . . ... .. . . .... . . . . 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I? . . . . . . . . . . . . . IV. PUMPIPUMP q4AMBER CC J A) Pump make 1loMA 1 Pump model J B) Chamber size gal; Manufacture S C) Height of pump off bottom of pump chamber inches D) Pump chamber draw-down t�--_gallons per inch - �) I E) Pump capacity gallons per minute' F) Pump controls:'timer(or)Elapsed Time Meter (circle If Installed) J If timer is used: On Pump Off — G) Screen basket ffluent filter le one)installed?. . . .. . . . . . ... . . . . H) Riser installed for access? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1) Alarm installed? . . .. . . . . . .. . . . ........ . . . . . . . . . . . . . . . . . . . . . . . ' AS-SUII�T 13RAW1NS� CHECKLIST ❑ Drainfield&manifold orientation & layout ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank placement. ❑ Location of buildings. (Q� ❑ Observation port&clean- out location. 111� ❑ Location of wells& roads. ❑ Undisturbed native soil between trenches. ❑ North arrow CAUTION:Minor adjustments to septic tank location and drainfield orientation made In the field by the installer ate generally acceptable to both the departmrnt and the designer,but could in certain cases compromise the viability of the system. It Is the installer's responsibility to oMam prior written approval from either the health department or the designer before making any deviations from the design that affect the system viability. Any deviations from the approved design must be shown above. 'rRtTFIbIAIti3t+�t�F Ih�1TILA � Installer Check a box from Row A"and`B",sign and date the certification A. I 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 designer prior to final cover because the / \ system open for inspection up to 48 tars prior to designer waived the notification requirement. cover. I further certify that all information contained on this form is accurst*ature that if the information contained herein is not accurate,there will be just cause for immediate suspension of my inson nsta er ate The undersigned approves this installation on behalf of Mason County Department of Health Services. Sanitarian P Uate