HomeMy WebLinkAboutSWG2004-00408 - SWG Application / Design / As-Built - 7/30/2004 AiTo
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MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG ) c y
♦ Q N
/, d N
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date -c -(� y o
PHONE (360) 427-9670 Receipt No. _ n In
Amount$ Z -t
PROPERTY OWNER: DATE: W m
Toth /3/ewr/ 7-,Z6-o / CHECK APPLICABLE ITEMS 3
MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM o
/301// miry,g Ae-// Lrf 5f; 7,o/-7y9 REPAIR SYSTEM
CITY: STATE: ZIP: TABLE 6 REPAIR ux
Ina lti/4 BSB9 MAINTENANCE REVIEW
PROPERTY ADDRESS: SINGLE FAMILY Z
OTHER: 3
ON SPECIFIC DIRECTIS FOR LOCATIN SITE: iJ/. PRIVATE WELL
®r�{i orf 1;14r19n 46- Idd COMMUNITY WELL/PUBLIC SYSTEM N
SYSTEM WFI# q W
LK. .ed �Gff on la fi5/� L,� Ln — �PLfOH SYSTEM NAME IN
�JiJr� o/it �h S� D� /tom APPLICANT
NAME iiS Ow er �
Name
of Lot 2 Zo ft.x /W—/90 ft. MAILING ADDRESS
n oi
Size: ti/.3 acres TELEPHONE 60 7P/- ?Y 9 7 o
Name of um er o SIGNAT o I`�
Designer e'k f/S E�s hv& Bedrooms 3 X 0
OFFICIAL USE ONLY BELOW THIS LINE I�
DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS
co
o �n
x Iv
\ ' , CAA
SOIL TEXTURE CODES:
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INSPECTOR(print n e) IN CTION SIGNATI}�iE-dkkA gD3A� 11
4 3PERMIT EXPIRA-ION DATE
O
il
•All systems require ongoing Op ration and Maintenance('O&M)as specified in Ma-son Cou ty 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 pembit expires 3 vears from the date of site review.Denial of this permit mav be antealed to the Health Officer within 10 days of denial date.
DE N R IEW AP V BY' DATE: I ALLAT N 'ED,BY: DATE:
2 U �(.� o L b
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy
r
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
August 11, 2004 PO BOX 1666 SHELTON, WA 98584
SHELTON (360)427-9670
FAX (360)427-7798
Advanced Engineering ELMA (360) 482-5269
3427 Mud Bay Rd SW BELFAIR (360) 275-4467
y SEATTLE (206)464-6968
Olympia WA 98502
RE: Design for BROWN
Case No: SWG2004-00408
Parcel No: 321347590093
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:
8/11/2004 1 of 1 SWG2004-00408
' - REC- L
I-ZSIGN FORM— PAGE ONt JUL 30 20041 uevis<dr.auuya.1999
A design will be reviewed when 3 col2les of each of the following Items are subnaTRV. CEDAR STl
,ft Completed design form that has been signed and dated w, Scaled layout aketch,Including all appgeable items on checklist
Scaled pbt pkn,Including all applicable items on checklist Cross-section sketch,kteluding all applicable Items on checklist
.....- ,.uy
Permit Number: SWG C 2" Designer's Name:
_ Designer's Phone#: 352— 3!6
Applicant's Name: Qiowh Assessor's Parcel No.: 32 13517 M 093
Mailing Address: /3oY/ Cr...•r�/ir//Cr+ SZ (rweive-Digit Number)
T y ini 1Z4 yPfB9 Subdivision: S/° 41� ?6.s6 4271 %G
g city state, Zip (Neme/Division/Block/Lot)`
J� Treatment Device ��
O Glendon Biofilter O Sand Filter O Mound L7 Sand Lined Drainfield
O Aerobic Unit-Make/Model: O Disinfection Unit - Make/Model:
/ Drainfield Type
Lti'Pressure p Bed LWDramrock
O Gravity I1 O Trench O Gravelles Chambers
Septic Tank/Drainfield Specification Laterals
Number of Bedrooms 3 Schedule/Class 200
Daily Flow 3La gPd Length / ft
Septic Tank Capacity /boo gal Diameter 6 n
Receiving Soil Type(1-6) Number y
Receiving Soil Appl.Rate o gpd/fO Separation
Required Square Footage 36o ftz
Orifices
Designed Square Footage 3L '
o ft
o ,o Total Number of Orifices (Jl
Percent R uct(on Taken 3
Trenc Width p Diameterin
Trene Length 34 ft Spacing 2.33 in
Eleva'3onMeasureP &Ms-- _ _ } = _ -- tvianifold —
Schedule/Class zao
Original Drainfield Area Slope °o Length 7 S ft
New Slope if Altered % Diameter �z �gTes
Depth of Excavation from Y/S Z/—A4/,s42An Preferred Manifold Configuration Used? 0 ovo
Original Grade „ ,,(U"lope) 'e, "
in f4Y'�r fiipgrt Pipe
(Downalope) Schedule/Class /Y.,^;
Length ( <'-I' /1� S 8
Designed Vertical Separal ion 2Y >` in Diameter 4001 � 2 n
Gravelless Chambers Required? ❑Yes M<o Cl Optional Dosing Pump�Ohamber
L7 Pump Required? Yes ❑No Number of Doses/Day `l�yr s
Pump/Siphon Specifications Dose Quantity 72 gal
Chamber Capacity /zoo gal
Difference in Elevation Between Pump Shutoff and Uppermost Pump Controls: Timer(or)Elapse Time Meter(circle It required)
Orifice: S'•3 It If Timer. Pump On Se'r- J
Uppermost Orifice is L7 Higher, 0 Lower than F aloft Check the following components if they n doses:
Capacity Q Total Pressure Head: 911eeals ❑Manifold ❑Tnmspoe
,df Calculated Total Pressure Head: °• !1. -
` (Attach Pump Curve) t
DESIGN FORM— PAGE TWO Revised April 2<,,9st
"�`• ' ` .n : r3a om• Itl n
Scaled Plot Plan Scaled Layout Sketch Cross -Section Sketch
U Test hole locations 0'Dg*171 Id orientation and layout Referee ced depth from original grade:
®M"Property lines rench/bed dimensions and critical ®/Septic tank lid and drainfield cover
Oe Existing and proposed wells within distances within layout depth
t'/" 100 ft of property lines *D-BoxPT'/"L"locations
CL&Critical distance measurements to cuts, I�ptic tank/pump chamber location Reference depth from original grade
banks,and surface water f?1%O�'nervation port location and restrictive strata:
0 Location and orientation of curtain 9--C an-out location Grtaterals,trench/bed top and bottom
M drain and all absorption components 0,34anifold placement , 49urtain drain collector
G'�Location and dimension of primary Ir O ' r' ce placement . Sand augmentation
system and reserve area CYLateml placement,with distances to
Or Buildings edpe of bed Other cross-section detail:
����AAA��wection of slope indicator A blelvisual alarm referenced �servation ports and clean-outs
terlines : cale of drawing shown on scale bar
oadsteasements/driveways/ NMI
.irtfQrMatinn f4rmolrbd'.�kg;parkin : ,Oynut " a �r� rheal resource IaKIrLs(if applicable) ° ,f Cnop depth at centerand edgy a£C'YNorth arrow and stile of drawing ,shown on scale bar 'fill3vdth
Tope.nd doWnslape bed elevafro
Additional information
O Design staked out
O Operation and Maintenance Notice
Attached
O Waiver(s)Attached
:. .. C);ESIGN A..'pPR1�UALxSEMI
The undersigned designer 0 does, 9�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:
SrgnatureofDesigner 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 add local on-site regulations
C �Gu to 1 Z 10 J-1
Environmental Vlealth Specialist Date
Cautian: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDII'ION:
./ 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: f7
✓ The system is installed by a certified installer,unless prior authorization is obtained from NAon County
Department of Health Services.
^i ./ Drainfreld site conditions have not been altered to adversely affect conditions of design approval
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AS-BUILT FORMRuyh"F4rawy 14 1992
Applicant �ry
y ro w rJ Assessor's
Parce 3,R ) 3 `/m�aw�.o truest q 3
IPerniftNumber Swt3 - OUr/6a'
Installer P c r+{tr a . .� NG Subdivision (Namwotwwere iookrt ot)
Designer
N/A Yes Prior to Completion
I. SEPTIC TANK
A) >5&From foundation?..... ............... ... v�
B) - >50 R from wells and surface water? —��
Q Bldg stub-ontto septic tonic clean-out if not 1-2%? .................
D) BatHes intact and clean? . ............................
.........
I) Dividing wallinlect?...... . ... ........ ................ ........
[) Risers installed r access? ..... ......... —
/�i ., ..:.....
G) Tank Sim: v V gal.;Manufacture
It. D-Box
A) Leveled with water? ......................... ............. .... — —
B) Speadlevelerused?
III. DRAINFIELD
A) >10 ft ftom foundation and>5 ft it m property lines? ....... . .....
B) >100 it from wells and surface water? ..................... .. .....
C) >10 it from potable water limes? .............. ..................
D) Laterals level to±1 lnFh do end caps present if not looped? .......... .
E) Graveness chambers utilized? .......................... ........
F) System dimensions the some as shown on the design?................
(3) Gravel clean,properly sized,and proper depth? .................... —
H) PRESSURE 8vstmss /
1) Ssad quality ASTM C-M .................................
2) Headheigitrmfform and x24fnchms? Actual head helght ... � . -
3) Clean-outs and observation portsptaseno ..................... y;
4) Mound: Side Slope 3:17 .......
...........:..............:.
5) Owner fnformed electrical connections must be made by L/
owner or licensed electrician and inspected by Lai? .. ........... .
IV. Pumpipump C B
A) Pump make f i! S ; Pump model E 3 —
B) Chamber size i voo gal; Manufacture 'C�cj —
Q Height of pump o$bottom of pump chamber Y inches —
D) Pump chamber draw-down gallons per inch
E) Pump any �U gallons permmute
1F) �t�K a' n� Is N Installed) �-
.�R Psmp�
G) Screm basket a unit filter ohole one)installed? ... ....... —. ... . -
H) Riser installed for access?....... ......... _.................... . —
cc^^ I) Alarn installed? ........;..... ............ ............... .....
bid £SEZ-Lib-09E assRvd Rl%wd 7 9oti d92:60 So bZ jdy
Apr 30 05 10: 00a Bob t6 Patty Pausse 360-427-2353 p. 1
wwmw7
cazcxtxr
Cl DtaioSeld&manifold
orientation tit layout
❑ 1lrencMed dimensions
and critical distances
within layout
❑ Septidpumptank
Placement
❑ Location of Wildings.
O Observation past tit clew.
out location.
Cl Location of wells do
rands.
❑ Uodimubed native soil
between trenches.
❑ North arrow
CAUTK tk Mhw W whoeoW e,wpOc Wk red a6saappnmtle la me fleid ty em lsmtlersre aep��. b boa the dap amtbsdm1mg- crew maarsmaasosoampeomiscupThtill+a•aftingymem inertia Wf«•s ton ob eta riap wr °apgmalPome7abrtbe
• dam ��'�aawbdke=+oydevLdossAimmedeslanGtafflado smuv�, Apy'devie�naBemPoaapptowdas(gpmstbe
ln$UH r C heoh s box ftom Row"A"and"Sn,alp and date do omdStadon
A. I certify that I installed the system without any ❑ I certify dot all deviations$om the design stamped
Md��i2wn the design stamped"APexoV$o"by "A"ROVtip"by MCDHS are shown above. .
B. ❑ I certify that I contacted the designer and left the �' I did not contact the desigoprior W final Dove;because the
system open for inspectiMyer. onnp to46 Ina prior to . designer waived the n�ottiiSScc on requirement.
I Sunhtx eautify that all information contained oa thls fame is aoanate. I mrdaastend ffiat if the mtotmation contained herein is not
accurde,them will be jest cause far immediate sv�e�ort of my installer
eta
11a undersigned approves this installation on behalf of Mum County Depat f alb