HomeMy WebLinkAboutSWG2005-00106 - SWG Application / Design / As-Built - 2/25/2005 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Official use onlyD
426 W. CEDAR ♦ PO BOX 1666 ♦ SHELTON, WA 98584 PERMIT i NUMBER ter/ y
(360)427-9670, Ext. 352 SWG -OCUQ`7 —� li J(i� Ch
���
APPLICANT DATE r-1�—o. ' y
ISSUE DATE n/ `7
2 -os y
MAULING ADDRESS DAYTIME PHONE RECEIPT NUMBER �]/� O
14J &4b
CITY STATE ZIP (n
a����-TDAf (ff/F � NEW SYSTEM
PROPERTYADDRESS REPAIR SYSTEM
I �- UYL (E L/V_ TABLE 6 REPAIR
SIGNATURE SINGLE FAMILY
'r--wz- OTHER Please describe
NAME OF DESIGNER PHONE NUMBER
ct:1 s 3b0•y2G -160
NUMBER OF BEDROOMS PRIVATE WELL v
1 )=l= PUBLIC WATER SYSTEM ,,^^
LOT SIZE: ACRES FT % FT SYSTEM WFI# W
' x i 7s SYSTEM NAME
SPECIFIC DIRECTIONS FOR LOCATING SITE FLof pj S1f�L� 41 OM yV Y 3 Lcf=Y e.a/
Iylaso.� Lakes ,mac, I+T- aN CAr istt LAKE- oIh , z-EF7 onl Z
G 4TP�3 �arut t�E . Lsr^r oAt m't9j0ArE- e�KE pG�O�S-r U� LEFT C
SrDE• !�K rCUk- Phi S't�.N o .v Ti�E .
Official use only below this line Q
DEPARTMENTAL SOILS LOGS/COMMENTS/CONDITIONS
0
3
SOIL TEXTURE CODES ty
V =very G=gravelly S=sand L-Loam Si=silt C=clay E=eMremely
e
This application is for design pp g approval only.
An installation permit will be required to install the system. N
• All systems require ongoing Operation and Maintenance as specified in Mason County Onsite Standards. I tf'I
• All onsite sewage systems must be designed by Licensed Onsite Wastewater Designer or Professional Engineer,unless prior
approval is granted.
• All onsite sewage systems must be installed by a Mason County Certified Installer, unless prior approval is granted.
• Onsite sewage system design approval does not imply other building site approvals. PIN
• Any change from the specked use of the property or any site alteration affecting the system design may invalidate this permit. I C5
• 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.
SP CTOR GNATURE DATE D G P BY DATE DESIGN EXPIRATION DATE ISl
cwfr 3 o� j�, �1 21,2 ' 31 n.1 aF
White Copy-Health Department Yellow Copy-Designer Pink Copy-A plicant ��
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
March 25, 2005 PO BOX 1666 5HELTON, WA 98584
5HELTON (360) 427-9670
FAX (360)427-7798
Pioneer Digging ELMA (360)482-5269
3083 E Mason Benson Rd BELFAIR (360) 275-4467
Grapeview WA 98546 5EATTLE (206) 464-6968
RE: Design for FARR
Case No: SWG2005-00106
Parcel No: 321347590094
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, ^
W d"
Cindy Waite
Environmental Health
Mason County Health Services
COMMENTS:
3/25/2005 1 of 1 SWG2005-00106
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
March 18, 2005 PO BOX 1666 SHELTON, WA 98584
SHELTON (360) 427-9670
FAX (360)427-7798
Pioneer Digging ELMA (360) 482-5269
3083 E Mason Benson Rd BELFAIR (360) 275-4467
Grapeview WA 98546 SEATTLE (206)464-6968
RE: Design for FARR
Case No: SWG2005-00106
Parcel No: 321347590094
Your design for the above referenced parcel has been reviewed and is NOT APPROVED. It
does not meet the requirements or needs additional information. Please see the comments
section of this letter for more information.
Please call me at (360) 427-9670, ext. 353 if you have any questions.
Sincerely,
L"I
Cindy Waite
Environmental Health
Mason County Health Services
COMMENTS: Need recorded O&M notice to title.
3/18/2005 1 of 1 SWG2005-00106
DWGN FORM-PAGE ONE as av .1999
A design will be reviewed when$.copies of each of the following Items are submitted:awlicable ,n„Z�pq°�P�Q A
*a Soalbd plot I�an�Includin form ngg all aWicab Rom been alipted and on checklist ft Scaled
� f on sk�ettcch; f9ip 80Pt�ble U(TU/\1�d�
,., ;'ouy;Z
fit'£,y...:. w•3.
r�r •.zs
r• 'fin ?i,��'�3i c �>.."� _,� x�3. :.�'1a14R,+�'+.`.����.' . ...���>�..e�.. �J:�»'�� x>. �::.,� � x. i2ag'
Permit Nil her: SW0a0O: .:.- OOId Designer's Name: T4 jn :QW Se—e
Designer's Phone#: mrn -1l Z6-16031
Applicant's Name: DA-M PAU, Assessor's Parcel No.: ?jZ134-75-4009 /
Mailing Address: /4.37 "CAD111 04YE O'welve-Digit Number)
98.%54 Subdivision:
city Stare Zip (Nane/DivisionBlock/l.ot)
DESIGN PAiRAME ff2S
/`f Treatment Device
❑ Glendon Biofilter ❑Sand Filter ❑ Mound ❑Sand Lined Drainfield
erobic Unit-Make/Model: ka.S T -S ❑Disinfection Unit - Make/Model:
Drainfield Type
Cl Bed AsBrainrock
O rR ty rench ❑Gravelles Chambers
Septic Tank/Drainfield Specifications Laterals
Schedule/Class
Number of Bedrooms 3 Length
Daily Flow 3_fs D gpd
Septic Tank Capacity ZOO al Diameter z in
Receiving Soil Type(1-6) Number /d ft
Separation
Receiving Soil Appl-Rate d/ n
Required Square Footage (ot ft M rssE
DcO
Designed Square Footage (D O C) ft s 8
Percent Reduction Taken o Total ter feces
Trench/Bed Width ft Diameter 3 in
Trench/Bed Length 2Cn ft Spacing 3(e in
Elevation Measurements Manifold
Schedule/Class scH• 40
Original Drainfield Area Slope l % Length ( ft
New Slope if Altered / % Diameter in
Depth of Excavation from 9 ' in Preferred M iLal "ii_ g®5sp�ed? Yes ❑No
Original Grade `/„ (Up-slope)
Sin) MC HFA1f ;�Isot4 Pipe
(Do" lope) Schedule/Class MAR 2 5 2005
Length
Designed Vertical Separation in Diameter Z in
Gravelless Chambers Required? ❑Yes No ❑Optional CEw
Req OP Dosing and Pump Chamber
Pump Required? es ❑No Number of Doses/Day
Pump/Siphon Spec ifi o s Dose Quantity gal
Chamber Capacity gal
Difference in Elevation Between Pump Shutoff and Uppermost Pump Controls: Timer(or)Elapse Time Meter(circle If required)
Orifice: ► ft If Time Ptlmp On .Pump Off
Uppermost Orifice is❑Higher, ❑Lowe than Pump Check Check the following components if they drain between doses:
Capacity®Total Pressure Head: . Dy Z/oS R ❑Laterals ❑Manifold ❑Transport
Cgloulated Taal Pressure Head. y Z/oS R
(Attach Pump Curve)
DESIGN FORM - PAGE TWO Rmlwd Apfft 24.1999
........
SAW
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Test.hole locations rainfield orientation and layout Referenced depth from original grade:
9 — lines :�OTrench/bed dimensions and critical 11 Septic tank lid and drainfield cover Existing and proposed wells within Aistances within layout depth
0",ft of property lines 6 -Bov,r'/"L"locations
0 Critical distance measurements to cuts, O��Plic tank/pump chamber location Reference depth from original grade
b!pk,%.and surface water nervation port location and restrictive strata:
ff�Location and orientation of curtain -out location Cl Laterals,trench/bed top and bottom
EJ4drain and all absorption components ifold placement 13 Curtain drain collector
1LAocation and dimension of primary placement [I Sand augmentation
Ystem and reserve area Lateral placement,with distances to
P �Qb
rlr��
Gr _'
f�LE
(2r- Buildings ,,-41ge of bed Other cross-section detail:
(7-15" ion of slope indicator "Udible/visual alarm referenced Cl Observation ports and clean-outs
'j"t
0,'WAserflues [6 Scale of drawing shown on scale bar
Roads/easements/driveways/ L`rbss Section infarmattan for n
Layopt.inforniationformou sys4twn.".: System.....
g
od
resource lands(if applicable)
0 Overall fill dimensions cam'dopdtt Censor aad edge of
.
SNorth arrow and scale of drawing 0 Up-slope,downslopc,and ondstope",
shown on scale bar
fill width PC:
10 Up7slopeand do wris lope bed elevation)
Additional Information
• Design staked out
• Operation and Maintenance Notice
Attached
C3 Waiver(s)Attached
�.DESIGN APPROVAL ..... ... .......
The undersigned designe does, 0 does not,waive the requirement to be notified by the installer of the installation and given 48
hours to perform a finaZectction prior to cover:
§TinatureofDesigner 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: -,_
L4j L" 31 Q'j ur
Envirommentaf Health Specialist Date
Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved*by Mason County Department of Health Services.
✓ The On-site Sewage Permit has not expired,the Permtt Expiration Date is, '? I 1—7 1 Ok
V The system is installed by a certified installer,unless prior authorization is obtained from Mason County
Department of Health Services.
✓ Dminfield site conditions have not been alteted to adversely affect conditions of design approval
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LOCATION
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28"+ G,f.
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26"-+- G.T.
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360-426-1803
cu5fo&fF NW:
PAN FPS
F CEO #:3 134-1"0094
IAYOUr R G)r PLM
n�O 5C&F: 111-50,
lEPTIC DEDGrLf
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10' 10' 10' 0
6'-10" - -- _ '� CLEANOUf
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360-426-1605
I-7 O\FIC55 pSp LATSp& CU5TOAfFNAW:
-12'' FROM SNP5 (L, PARaL �:32�a-�a a
36" O.C. 20 e`0�' 1,Arour WANFIN U MC nr
0' 10'
IEATIC DEIIGrLJ
O65FPVATON POPT W/6" ICV 6OX
17 9-Op5 FINI5HF17 6M
5AN12Y FIL I, 5AN12Y FII,�
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L25"x 50' LATEM
r 11,T V FAMIC PPAINpOCK
O06INAI OM
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ST�ICI1VF �AYEi? _ = 1
DEPT
MAR 2 5 2005
+SEW
Pa A
5 GAVSSE
EXPIRES �V 60U PAYS
Q\ 560-426-1805
C15TOMU NAAAF:
rm FPS
A� FVC L #:!,X,4-75-90099
I. aY f:CK055-kCJJON
n. 5C&LiN,A
IEATIC DEIIGflf
5112E VIEW OK
VALVE 60X 1,25" MI VALVE (TYP)
I 1.25" FLEX PIPE
C7;
ES I
-f I, F :
I
1,25" CHECK VALVE (TYP)
1,25" CHECK VALV�5(TT)
1,25" MI VALVE (TYP)
® 2" 5CH 40 rL,
ATOP VIEW of
v4v: PDX
L25" EEE12EPLINES<11PJ NJC, P1, _
MAR 2 5 7.00r
CEI I'AYS�E
360-426-1603
CU51 R NAW
PAN FAM
O t'A aL 4: 32134-75-90094
SCPLE:N/A
JEATIC DEJIGQJ
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E PIRES
1
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(ram ry
MAR 2 5 7.005 N
' br7 `�wV 360-426Y 180�
nOV CU5,FOAV IyAME:
PAN FAT
pApaL 0 . ANK OFF IL�90094
IEPTIC DEIIGQf
AOUAWOtX CONTROL PANEL W/TIMERo�N1pShy Sl`
R I Yss
EXPIRES
MIDI WATER ALARM FLOAT TREE V/QUICK
DISCO NECT
TRANSPORT LINE
ELECTRICAL CONDUIT
4•PVC INLET.
IE�VAL.VENEC
FROM OUTLET NIGH WATER
OF SEPTIC TANK ALARM SCONT UNION
TO INLET OF
PUMP TANK 1000 GAL, PUMP
TANK
LOW WATER
ALARM
PUMP
PUMP BUCKET
PUP EF3�--
41AR
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I'AY56�
360-426-1803
QISTOM R NAME:
PAN FAW
O PARCEL #: 52154-75-90094
n` LAY :PUMP TANK TAIL
5C&. .N/A
IEPTIC DEAGnl
GRUNDFOS EFFLUENT PUMPS
E F 3 3 E E F�� SPECIFICATIONS
•Capacity to 120 GPM
• Heads to 90 feet
• Discharge size
2"female NPT
• Power cord 10'or 20'
•Solids 3/4" maximum
MATERIALS OF MATERIALS OF
CONSTRUCTION CONSTRUCTION
•Stainless Steel • Stainless Steel
• Engineered Composite • Engineered Composite
FEATURES & BENEFITS APPLICATIONS FEATURES & BENEFITS
APPLICATIONS • Lightweight •Graywater pumping • Lightweight
• Graywater pumping •Corrosion resistant •Septic Tanks Effluent •Corrosion resistant
•Septic Tanks Effluent •Manual or automatic •STEP Systems •Manual or
•STEP Systems operation •Water transfer automatic operation
•Water transfer • Field replaceable power PUMP MODELS • Field replaceable power,
cords cords
1-phase SPECIFICATIONS •Continuous duty when fully EF •1/3 hp,115 or 230 volt, •Continuous duty when fully
•1/3 hp,115 or 230 volt, submerged submerged
EF50•1/2 hp,115 or 230 volt,
1-phase • Fluid Temp.Range: • Fluid Temp.Range:
•Capacity to 64 GPM 32°F(0°C) min. 1-phase 32°F(0°C) min.
104°F(40°C) max. EF75 • 3/4 hp, 230 volt, 104°F(40°C) max.
• Heads to 27 feet 1-phase
-Discharge size 1-1/2" AGENCY LISTINGS EF100 .1 hp,230 volt AGENCY LISTINGS
female NPT ® UL Listed 1-phase (S),UL Listed
• Power Cord 10'or 20' ® UL Listed to Canadian EF1S0•1-1/ 2iQ vpt �( Listed to Canadian
• Solids 3/4" maximum safety standards 1-phase a` � Listed
standards
MAR 2 5 2005
30 00
Rim"'
1-1EFi 80 T 33i 530
a
20
so
15 ' J4 1.
10 30
3 203t 28'`42 60
10
0 0
26 82
0 10 20 30 CO SO 60 30 0 10 20 30 40 30 60 70 80 90 lOD 110 VA 6(1 . :-]P 34
U.S.GRLIONS PER MINUTE U.S.WElONS PER MINUTE
Pioneer Digging Inc.
Bob Paysse, President
Washington State Onsite Wastewater Designer
INSTALLATION / MAINTENENCE
SHALLOW PRESSURE SYSTEM
1. Install Aquaworx control panel. 3P
pq SE
2. This system requires a .05 FAST ATU. t
rx PtRES
3. Install risers to surface on septic tank and pump tank as per drawing
4. Install check valve in transport line.
5. Divert all storm water runoff away from drainfield and septic and pump
tank area.
6. No curtain drains allowed within 10 ft. of the upslope edge of the
drainfield or reserve area.
7. No curtain drains allowed within 30 ft. of the 4pw7slop�, edge of the
drainfield or reserve area. a�:
8. This system IS required to have operation and maintenance 5 2i30
9. All materials and workmanship must meet County and State regulations.
10. Deviation from this design without prior written approval from the
designer and Mason County health dept. will make this design null and void.
11. The prepared plot plan is not a survey, it is the owner's responsibility to
verify property line locations prior to installation. Any discrepancies must be
reported to the designer immediately.
12. This design is intended to meet state and local health dept. requirements
that are related to the system being proposed. Any placement of proposed
bldgs. or other non related items on this drawing may or MAY NOT meet
MASON COUNTY DEPARTMENT OF HEALTH SERVICES
426 W. CEDAR ♦ PO BOX 1666 ♦ SHELTON, WA 98584 N
(360)427-9670, Ext. 352 N
.{SYSTEM INSTALLATION CD
❑TANK REPLACEMENT ONLY(Attach Supplemental Tank Replacement Form) N
,CERTIFIED INSTALLER CD
Official use only C
❑ HOMEOWNER
WypPLICANT NAIAEE PERMIT NO SWG aC )Cl
r-�CL f'tlYi#1kW
APPLICANT ADDRESS iT7�-M ISSUE DATE
L/J 769 sL OCA0111 RD RECEIPT NUMBER
CITY STATE ZIP G ZIP 0
5 HCG ToN `-,J / Y 7 I/ FINAL INSPECTION
INSTALLER NAME AND BUSINESS NAME CALL-IN DATE �Q
pKILO (SOOW-tf' S-CPZ/c •=-F
MAILING ADDRESS /� DAYTIME PHONE INSPECTION APPOINTMENT Z
IF0 CKAArBF y (2D Sb(&7o,J 4126- 7P20 DATE/TIME /
CITY STATE ZIP
571/ L, Cr �^ ClyS"�lcJ ASBUILT ON SITE? OYES ONO
PROPERTY ADDRESS / Cr
76 sc. OL A26 Or.f SNELTO!d CD
I hereby agree to comply with all requirements of the Mason County Department of Health 1(�j
Services Onsite Regulations and Standards. Upon completion of the work, the Health 1(�
Department and the Designer shall be notified. All work shall be left open and uncovered until
inspected. A completed asbuilt from the installer or designer must be provided at the time of
final inspection. The applicant has the right to appeal decisions of the Health Department.
This permit is valid for one year from the issue date or the
expiration date of the septic design, which ever occurs first.
SIGNATURE CERTIFIED INSTALLER OR HOMEOWNER INSTALLER DATE
1
10
Official use only below this line
FINAL INSPECTION COMMENTS
INSTALLATION APPROVED BY DATE
Revision Date:6/2/2005
White Copy-Health Department Yellow Copy-Installer Pink Copy-Applicant 6/2/2005
ON-SITE SEWAGE INSTALLATION
FINAL INSPECTION
PYNa
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AS-BUII:T FORM lr la ls�
Applicant Assessor's
Ptlrcet# j 3 �/ -75.-;1 DD
PemtitNutnber SWO�� {J D I D la f tw pltle umber)
7 `�
n I
« r 0 1N �i Subdivision (NaMi
Dmigner a b Igo.t�s s•e
NIA Yes Prior to Oompletton
1. :SEPTIC TANK
A) >5 R.From hundation?......... .... ...........
B) . >50 R from wells and surface water? ........... ......... .. .
C) Bldg sorb oatto ... —
sede t?Nc..moat if not I-2%? ........•........
D) BalTlesiDmctaurd c.an7 ........ .................... ..........
B) Dividing wall intact?..................................... . .. ..
F) Risers instilled for saws? ....:............
0) Tank Size: 1100 gal•;Manufachue r ( _ u r s
II. D-BOX
A) Leveled with water? .. . .. . .. ........ ...... ...
B) Speed leveler used? ...:. . . ..... .............................. —
Ill. ORAINFlELD
A) >10 R from foundation and>5 R from property lines? .............
B) >100 ff from webs and surface water? ............ . ............... _
C) >10 R from potable water limes? .... ................... .........
D) Laterals krve!to±1 irph dt and CW P+erent if not looped? .... ...... .
B) (havelleea chambers utilized?
F) System dimensions the some as shown on the desip?................
.0) Gravel clean,Properly sized,and proper depth? ....................
H) PREBSUM Warsaw
1) Sand q=WASTM C-337 .................................
2) Head height uniform and 224 inches? Achtai head height Z
3) Cleso-outs and observation ports present? ......................
4) Moand: Sidefllope3:17 ..................:.............. —�
5) Owner informed electrical conne.tione must be made by
owner or licensed electrician and impacted by Lan ............. —
IV. Pumpipump C R
'A) Pump make CL f'• >�model ri•�� � —
B) Chamber size I gal; Mmufscture i —
C) Height of pump off bottom of pump dumber 1 b itches —
D) Pomp chamber draw-down ;2 tHOW per inch
B) Pump capacity, _ SO gallons per minme
F) Pump controls:Toner(or)Elapsed(elrele If Installed)
Iftimer Pump off
o) Screen basket or e8luuent filter(circle one)installed? ...............
H) Riser installed for accoss?......... .... .................. . .... .. —
1) Ahem installed? . ....... ...............'.......... .
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■ ■
orientation &layout
and critical distancesdimensions
wiffik layout
■
■
■
out location.
■ Undisturbed native soil
between trewhes.Nodharruw
1 I.
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CheckWataftr
MCDHf
A. U I certify that I installed do z ystam willrout Any * 4-1 carW*4 all dovistious firmn dw design staniped I certify did I contacted the designer and left the -�-+d did not comact the dos4nor prior to finsli cover because the
sydem open for inspection up to 48 hrs prior to asigner waived the notification re"immleff"
I Anther oertify that all information contained on this form is acmujft. I underotand the if the Information con4med hervin 13 not
w;curwA,them will be just cwjw fi)r immediate suspension of my iastallarsertificatim— I
'r6GS YT'�11t?' t
�-
lu understped sppmves this installation an bchff of Mason Counly ofibalth Services.
a (,DLP /
Sanitarian I LW