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HomeMy WebLinkAboutSWG2006-00138 - SWG Application / Design / As-Built - 2/28/2006 WItt$4$• rktie A rpatSa' =. ' jiliy & alx8 &$&�# #gsA MASON COUNTY DEPARTMENT Official use '' o� n�llyyy� ll C 0 OF HEALTH SERVICES PERMIT NUMBER: SWG s�zo(o -LJ-�I J fr� //^^ a M 426 PO BOXR16 6REET DATE RECEIVED: °A SHELTON,WA 98584 RECEIPT NUMBER: S 2�-L`%�O ^C4�5 .1 Z (360)427-9670, Ext. 352 M M APPLICANT DATE CHECK APPLICABLE ITEMS m m t?{S Sfj7� Z- Z /-7—OL D-NEWSYSTEM f0 MAILING ADDRESS ' I DAYTIME PHONE O REPAIR SYSTEM /4ya_DAzt V� 0TABLE6 REPAIR m CITY Y t ' STATE ZIP 111,5MGLE FAMILY n �O P_cbA>20 (.t)A 0 OTHER Please describe m SITE ADDRESS A Z DRINKING WATER SOURCE W 3 NAME OF DESIGNER r PHONE NUMBER 0 PRIVATE INDIVIDUAL WELL O ��vf us�la �XC 3Gb�ZG y3G 0 PRIVATE TWO-PARTY WELL 0 NAME INSTALLER H'COMMUNITY/PUBLIC WATER t 6-A) �� 11 e SYSTEM t >S/)I�S V '^ �L SYSTEM WFI#: G NUMBER OF LOT SIZE: ACRES "r FT X FT BEDROOMS 3 SRR6Gul�� Z60 K t-70 1 SYSTEM NAME: SPECIFIC DIRECTIONS FOR LOCATING SITE ` � 1,_ S� LA7j6_ Psntu`e �o jai or► M- u,4n�N da T 7vx�✓ �cGNy 0 x This application is for design approval only. An installation permit will be required to install the system. • All systems require ongoing Operation and Maintenance as specified in Mason County Onsite Standards. -' • All onsite sewage systems must be designed by a Licensed Onsite Wastewater Designer or Professional Engineer,unless prior r approval is granted. • A Mason County Certified Installer must install all onsite sewage systems,unless prior approval is granted. • Onsite sewage system design approval does not imply other building site approvals. x • Any change from the specked 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. Official use only below this line SOIL LOGGSn COMMENTS/CONDITIONS SOIL TEXTURE CODES: V =very G=gravelly S=sand L-loam Si=silt C=clay E=extremely I T R IGNATURE DATE D G PP VED BY DATE DESIGN EXPIRATION DATE 3 i r► 06 G.-�o i b al Revised 2/23/2005 White Copy—Health Department Yellow Copy—Designer Pink Copy-Applicant MASON COUNTY DEPARTMENT OF HEALTH SERVICES March 16, 2006 PO BOX 1666 SHELTON, WA 98584 SHELTON (360)427-9670 FAX (360)427-7798 Peninsula Excavating ELMA (360)482-5269 2380 W Highland Road BELFAIR (360) 275-4467 Shelton WA 98584 SEATTLE (206)464-6968 RE: Design for CHRISTENSEN Case No: SWG2006-00138 Parcel No: 321347590084 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, r W C.v�i�t Cindy Waite Environmental Health Mason County Health Services COMMENTS: 3/16/2006 1 of 1 SWG2006-00138 DESIGN FORM'- PAGE ONE Pe bcd January a,1999 A design will be reviewed when 3 conies of each of the following Items are submitted: Oompkted design form that has been signed and dated Sealed layout sketch,Includlnp aq applicableacme on checklist Sealed plat plan.kwhreli tg all applicable Items on checklist % cross-se6tkm sketch.lnokoding all applicable No on checklist �� .xy...: ✓n -<4;`'C�43 � t Y ; 3 .. . y, a ' :'�u'��"4 [4x°? 4w�� �.yGf Permit Number: SWp�C' - 001—?y Designer's Name: df71/!Nf✓�i4 L. s Designer's Phone#: b GO 7-161 34 Applicant's Name: Ck� o 5t Assessor's Parcel No.: 4 2/3 4/-7S- 5W Y Mailing Address: 6 I & 10..O A , (rwelve-Digit Number) 1 yn7-Q94,hA20, WA 344 Subdivision: City state Zip (NsmcUvhiaNSlock4-*Q g 8n DE+�#lt'aN t�AIIAit :.:.. a .:' '< 4 a i 1 Ie Treatment Device O Glendon Biofilter 0 Sand Filter O Mound CI Sand Lined Drainfield 0 Aerobic Unit-Make/Model: O Disinfection Unit - Make/Model: Drainfield Type bess3fed �rainrock try O Trench O Gravelles Chambers Septic Tank/Drainfield Specifications Laterals L7Z� Number of Bedrooms 3 / Schad lass Dail Length y Flow 3 b O sect Diameter � in Septic Tank Capacity W l?:- cal Number Receiving Soil Type(1-6) Separation A ft Receiving Soil Appl.Rate L 0 gpd/ft' Required Square Footage 3(00 it- Orifices Designed Square Footage Total Number of Orifices A I Percent Reduction Taken a Diameter Trench/Bed Width 3L 8 Spacing in Trench/Bed Length Elevation Measurements L�Ne-R-e-rLl' Manifold Schedule/Class _ -(30 Original Drainfield Area Slope �_% Length pX ft New Slope if Altered V�/ % Diameter `J vl 5 in Depth of Excavation from Z l in Preferred Manifold[Coonfiiguurraation Used? aYes ❑No Original Grade Ly Np Mope) r-'ib�tisLt# e 7 (Dews-nape) Schedul��IEALTH DE a Length MAR 1 7 It Designed Vertical Separation 3(, in Diameter ��� T Gravelless Chambers Required? ❑Yes ,�Jo ❑Optional Dos r� vump Chamber ¢a1 Pump Required? ❑Yes ZKo Number of Doses/Day Pump/Siphon Specifications Dose Quantity Chamber Capacity ¢al Difference in Elevation Between Pump Shutoff and Uppermost Pump Controls: Timer(or)Elapse Time Meter(circle if required) Orifice: ft If Timer: Pump On I / Pump Off Uppermost Orifice is 0 Higher, 0 Lower than Pump S �g'tt��oo�ff�f�,,``� Check the following components if they drain between doses: Opacity®Total Pressure Head: v T� 0 Laterals ❑ Manifold ❑Transport Calculated Total Pressure Head: (Attach Pump Curve) DESIGN FORM - PAGE TWO Ie,ind A01 24 I998 Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch est hole locations Winfield orientation and layout Referenced depth from original grade: 0-Property lines GP-franch/bed dimensions and critical 6"S-eptic tank lid and drainfield cover 0-Existing and proposed wells within distances within layout depth 100 ft of property lines ja-iTBox/"T'/"L"locations I?Critical distance measurements to cuts, tic p chamber location Reference depth from original grade banks,and surface water O-Observatiop,jort location and restrictive strata: cation and orientation of curtain O Cleap.e{vw6tion 0-'i curls,trench/bed top and bottom drain and all absorption components Q�TOfanifold placement A-Q px '3 Cuodor 8�lrocation and dimension of primary O Orifice placement O San augur talfdn system and preserve area .6 -- ateral placement,with distances to rLoWldings l nIar O S'M edge of bed ,/ Other cross-section detail: .0-Direction of slope indicator O Audible/visual6&Aerenced S?'6S; ;;t on ports d clean-outs M-waterlines 1 R o p o SAC D A-S ale of drawing shown on scale bar 5--Roads/easements/driveways/ tirtiotr laormtifta n far moupd PCB Iwo uat in[arm atfaR far inavad ayatemx of atemg O Criticalresonf applicable) tsCaadad `ttf d�rth arrow and scale of drawing � 1�p•x�a� ettdsiupe shown on scale bar #ill width 4*._ L3 L3rpaiape attd dflwnatiipn bed elevattflri eW Additional Information O Design staked out Q ORFO 'p„ aR O Operation and Maintenance Notice Attached EXPIRES ovmb O Waiver(s)Attached - 13ESICN APPA VAL 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:: f `, ',�` �-r AAA ji=A z— Z-7 —0 6 Sign re f igner 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: / Envirmuneffil Health Specialist Date Caution: DESIGN APPROVAL IS VAWD ONLY TINDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Department of Health Services. ✓ The On-site Sewage Permit has not expired,the Permit Expiration Date Is: 3/ l 0 41) ✓ The system is installed by a certified installer,unless prior authorization is obtained n County Department of Health Services. ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval 7 v� VL ol G a Im 3 c a 'APPROVED 2 MC HEALTH DEPT MAR 17 2006 r � S � CEW W s � Gl,CAL_ xA, >lE SECURED LID WITH OAS TIGHT SEAL DIAMETER AC E88 RISER fl�GRADE FROM SEWAGE FLOATING MAT SOURCE APPROVED EFFLUENT FILTER SEDIMENTS 8EPTIC TANK APPROVED MC HEALTH DEPT MAR 17 2006 CE Pure Performance The OSI BiotuW Effluent Filter is the most advanced in the indus"y, engineered to provide maximum ExtcjlAll�!c PVC protection for your septic system. Features and Benefits Air VEOt • Improves effluent quality. Average Total Suspended Solids (TSS)is less than 30 PPM, nearly 2-1/2 times lower tnan a non- screened system! • Allows for smaller diameter drainfield pipe. Lowers drainfield material cols • Superior patented design. Extends drainfield life. Reliabie, corrosion-proof construction. • Easy installation. Installs in minutes in new or existing tanks. . • Simple,hassle-free maintenance. • Available alarm. Indicates when maintenance is needed. • Ideal for variable-grade'sewer"s. Allows reduction of the trlris'poit FVC line size and associated costs • Custom sizes. ' Call for�YPOIAOVED MC HEALTH DEPT MAR 17 2006 CE - IIV`�•f�Ll. model 0 4 6 Y p I � N N i ' I i M i � i b t � I � n J � 7 'V 1 a APPROVED D HEALYH DEPT Ile n MAR 17 2006._ It ° © CE 0 .d c1l 9 � i � � P ♦ g c � J CA cA 3— v see lip: t- Q d' OJoa! P O� •o .o �Op9 O p �3 APPA �9 N d a PgO i/ E® z d Q C HEALTH DEPT u. to ,? MAR 1. 7 2006 'a p CEO .0 Construction Notes 1. If the site Is too wet to prepare, do not proceed until it is properly dry. The soil MUST be properly dry before installation can proceed. Do no install the drain field white the soils are wet 2. Use EXTREME care in site preparation. Remove"NO"top soils. Use ore in tree and stump removal 3. Trench bottoms must be level. Follow contours of the slopes. 4. If a"D"box is used,speed levelers are required. S. Brush piles and debris are not to be bumed on top of the proposed drain fields sites. 6. Do not use the drain field areas for storage of excavated dirt, parking areas, lumber packages,or anything that will disturb or destroy the areas. 7. Do not deviate from this design without permission from the designer. 8. Drain fields sites are to be roped off,for the protection of the sly, prior to and during the construction of the home. No traffic of any type Is allowed on top of the drain field sites. Soils can be damaged easily and the infiltration rate can be lost, making the proposed sites unusable for a drain field. 9. Once the trenches are excavated, the sidewalls and bottoms are to be raked to open the Infiltration surfaces. 10. Cleanable effluent screens are to be used. 11. Construction and materials for this system shall conform to the latest regulations and requirements of the County Health Department 12. Topography, benchmark, stub-out and Invert elevations are based on assumed data. 13. Ascertain location of underground utilities before digging. 14. Edge of drain field trenches to be a minimum of 5 feet from any property and/or easement. 15. Encroachment of house and/or driveway into drain field or reserve area may render the site unusable, requiring a redesign at additional costs,or even totally unusable. 16. All roof drains and surface water run off shall be directed away form the drain field. 17. Sewer lines under roadways shall be encased in pipe rated at 1000 lb. crush strength. 18. This system is not designed for use of a garbage disposal. Use of such may cause system failure. 19. Where sewer and water lines cross, water lines must be a minimum of 18 inches above sewer lines and encased in another pipe for a minimum of 20 feet. Crossing must be at center of encasement pipe. 20. Where a good off site sandy cover is placed over an Installed drain field, the sandy soil shall extend ten feet beyond drain field and be feathered to match existing terrain. 21. Installation and use of this septic system without a tee filter located in the outlet side of the septic tank may cancel any warranty, expressed or implied. 22. This system requires a proper degree of maintenance. Certification of the design and installation does not insure trouble free service. 23. Keep septic components a minimum of 10 feet from any water line under pressure, unless sleeving of water line is provided, per codes. 24. A curtain drain (if required by designer or health department) is to be installed a gan€tilMW& 8 inches into compaction and tight lined to daylight, meeting all county codes. PM- "flopf ' side is to be lined with black plastic. r APPIgOV d 41C HEALTH LIAR 17 2006 PfEW ONSITE SOV"15 SYS11`15111114N MASON COUNTY DEPARTMENT OF HEALTH SERVICES D 426 W. CEDAR ♦ PO BOX 1666 ♦ SHELTON,WA 98584 CD 427-9670, Ext. 352 N ❑ SYSTEM INSTALLATION CD ❑TANK REPLACEMENT ONLY(Attach Supplemental Tank Replacement Form) N N kCERTIFIED INSTALLER Official use only ❑ HOMEOWNER PERMIT NO SWG CII% APPLICANT NAME C ✓Ll. �g e-'v ISSUE DATE _1116 APPLICANT ADDRESS • N V _5�. 14,CL DA k 'et RECEIPT NUMBER � CIT^ O yt STM?' ZIP ?bb v ��((,,JJ .J FINAL INSPECTION an INSTA ER NAME AND BUSIN NAME CALL-IN DATE B�/VfSI)�1, = �t M MINN DDRF�SS - 1 I� ne 3 DAYTIME�PHOON� INSPECTION APPOINTMENT Z (�J �( ICa Y t� DATE/TIME / CITY STATE � 9(ff�.y ASBUILT ON SITE? O YES O NO PROPERTYADDRESS / t F. iu A*A1 c✓ _ I[ts1.7rnL✓ CD I hereby agree to comply with all requirements of the Mason County Department of Health luq Services Onsite Regulations and Standards. Upon completion of the work, the Health Department and the Designer shall be notified. All work shall be left open and uncovered until I N inspected. A completed asbuilt from the installer or designer must be provided at the time of I� final inspection. The applicant has the right to appeal decisions of the Health Department. lv' This permit is valid for one year from the issue date or the r, expiration date of the septic design, which ever occurs first. I'' SIGNATURE OF C�2TIFI D INST LL OR HO EOWNER INSTALLER DATE I I� I� Official use only below this line 1p0 FINAL INSPECTION COMMENTS I 1' INSTAL 2PPR ED BY DATE Revision Date:6/2/2005 White Copy—Health Department YellowCopy—Installer Pink Copy—Applicant 6/2/2005 ASBUILT FORM G Mason Cou=Public Health Assessor's Parcel# 32 r S q- 7s- r^aoF y Permit Number SWG oZ (Twelve-Digit Number) Subdivision ew Applicant's Name <5*" Ck 2r rrtnu sa dH u ,/ (Name/Division/Block/I,ot) Applicant Address 64N ( J �1 i t t n a�e �d .Installer's Name ('�CFW,,i/f t)/d City, State,Zip f o 4 OX c kr.� WA -F F Yr& Designer's Name 6�G L�1Qv�t`leyCL N/A Yes Prior to Completion i I. SEPTIC TANK >5 ft. From foundation?............................................................. ❑ 3- ❑ >50 ft from wells? ................................................................... ❑ E_ ❑ t >50 ft surface water? ................................................................ ❑ 91-- ❑ Building stubout to septic tank: cleanout if not 1-2%? ................... ❑ p- ❑ Baffles intact and clean?............................................................ ❑ Q_ ❑ Dividing wall intact?................................................................. ❑ 0- ❑ Risers installed for access?........................................................ ❑ [EF ❑ Screen basket o uent fi stalled?(circle one) ..........._......._ ❑ $ ❑ Tank size: t2sQ gal.; Manufacture: H. D-BOX Leveled with water? ........................................................... ❑ ❑ Speed leveler used? ........:................................................... ❑ 2- ❑ III. Drainlield r >10 ft from foundation?....................................................... ❑ 1 ❑ >5 ft from property lines and easement lines? ............................. ❑ Ea- ❑ > 100 ft from wells?............................................................ ❑ Q­ ❑ > 100 ft from surface water? ................................................. ❑ 2- ❑ >10 ft from potable water lines? ............................................. ❑ 2 ❑ Laterals level to+1 inch&end caps present if not looped? .............. ❑ a ❑ I Gravelless chambers utilized? ................................................ B' ❑ ❑ Gravel clean,properly SYSTEMS and proper depth?........................... ❑ ❑ PRESSUR Sand quality ASTM C-33? ................................................. ❑ ❑ Head height uniform >24 inches? Actual head height 4 - ❑ ❑ Clean-outs servation ports r nt?......................... ❑ Q__ ❑ Mound: Side Slope 3:1? ............................................. 42, ❑ ❑ Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I?............... Z- ❑ ❑ IV. PUMP/PUMP CHAMBER A } Pump make ; Pump model 0- ❑ ❑ [L] hz- Chamber size gal; Manufacture y ❑ ❑ 1f��1 � Height of pump off bottom of pump chamber inches �v O Pump chamber draw-down gallons per inch per minute U Pump capacity gallons per minute �*� OZ Pump controls: Timer, Elapsed Time Meter,Counter? (Circle all that a- ❑ ❑ s ^Y Q apply). If timer:Pump On Pump Off Riser installed for access?......................................................... g- ❑ ❑ 9 Alarm installed?........................................................................ B� 0 0 CHECKLIST $—Drainfield& manifold orientation & layout $'-Trench/bed dimensions and critical distances within layout U�Septic/pump tank placement 8'Location of •: 4''c eM e� . oit 4+av V.niu buildings ""te gain servation c ean-out location toy � I- B'Location of wells& w roads EY-Undisturbednative soil between t k paai trenches North arrow I0R36, 1 a e--Y AS +X N•'f>i (vuove wk,ta. eor) CAUTION.Minor adjustments to septic tank location and drainfield orientation made in the field by the installer re generally acceptable to both the department and the designers but could in certain cases com romise the viability ofthe system. It is the installer's responsibility to obtain prior written approval from either the health de artment or ar, designer before making any deviations from the design that affect the system viability. Any devianans from the approved deesign must be shown above. Installer: Check a box from Row"A"and`B", sign and date the certification A. ❑ I certify that I installed the system without any certify that all deviations from the design stamped deviation from the design stamped"APPROVED"by "APPROVED"by MCPH are shown above. B. certify that I contacted the designer and left the ❑ I did not contact the designer prior to final cover because the '`4oystem open for inspection up to 48 his prior to cover. designer 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 installer certification Z 'Installer L-o� Si ah ller Date The undersigned approves this installation on behalf of Mason County Public Health. /lam—zi► L -� -y-t U Si na a of Sanitarian Date Revised January 2007