HomeMy WebLinkAboutSWG2002-00497 - SWG Application / Design / As-Built - 12/9/2002 dw
PERMIT NO. SWG
MASON COUNTY DEPARTMENT OF HEALTH SERVICES o y
< m
426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Date O� N
PHONE (360) 427-9670 Receipt o.
Amount$ z f
PROPERTY OWNER: DATE:
Arr&1 12_6_ CHECK APPLICABLE ITEMS ✓ m
MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM 4
/7&3 /o/O 6 REPAIR SYSTEM
CITY: �� /� STATE: �� Z'p: S TABLE
INTENA CER m
n t MAINTENANCE REVIEW m
SINGLE FAMILY
PROPERTY ADDRESS: �rYy1�_� / �
1i•u/ 6'/'i L,,. OTHER: 3
SPECIFIC DIRECTIONS FOR LOCATIN SITE: PRIVATE WELL
4 L G COMMUNITY WELUPUBLIC SYSTEM Id
SYSTEM WFI N OS-1 78
/_ L� SYSTEM NAME C"t Lk T IN
r �/ APPLICANT
t O/ • / 141cr NAME /
Name of Lot 7o ft.x GSZ ft. MAILING ADDRESS 210�. u. • f
Installer p Iw
Size: /. !3 acres TELEPHONE
Name of IN um er o SIGNATU o
Designer �. �/ Bedrooms X
OFFICIAL USE ONLY BELOW THIS LINE
DEPARTMENTAL SOIL LOGS { hL 1 DEPARTMENTAL COMMENTS/CONDITIONS I�
t/ VIp�eS Co
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SOIL TEXTURE CODES: ts..0'9+�.r + ! ��. VKZA
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INS TOq(print na e) IN ECTI SIGN DATE PERMIT EXPIRATION DATE
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•All systems ire ongoing Operation and Maintenance(O&M)ass cified in Mason County On-Site Stan ards.
•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 Detfinit 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.
DESI N REV W APPR BYi�--1_C0 ! DATE: IN ALLAT N APED�BY: J 3� 0 DATE:
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TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy
MASON 'COUNTY
DEPARTMENT OF HEALTH SERVICES
January 02, 2003 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
Olympia WA 98502 SEATTLE (206)464-6968
RE: Design for DAYTON
Case No: SWG2002-00497
Parcel No: 321347590103
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:
1/2/2003 1 of 1 SWG2002-00497
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} DESIGN FORM- PAGE ONE Revised January 4.1999
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x'A deatgn will be reviewed when 3 coples of each of the foDowl�igflCdNts are submitted:
meted design form that has been sign and d I sketch,incloding all applicable Items on checklist
r •�. Saabd' tot plan,including all applicable Items on c � s �Ing all applicable Roma on checklist
,.
y a Permit Number S Designer's Name: fed✓a�rc�1T.nSe�y
w Designer's Phone 0:
�fAl pplicant's Name: D-'r/�� Assessor's Parcel No.: 32/ 39'7.i r�0/03
l r " '' - - (rwelve-Digit Number)
tR Marlin Address: O �• G^ Te
z m•B 6A_ w, l¢ !9' s8w Subdivision: # 2G S9
(Nam
City state zip
du, elDivtsion/ti oeklLo
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p 3 1
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� �•' ' • ' Treatment Devine '
n O Glendon Biofilter O Sand Filter [I Mound O Sand Lined Drainfield
�ty(�. .,
O Aerobic Unit-Make/Model: — O Djsinfection Unit - Make/Model:
r�r Drainfield Type '
Q 'I O B �utrock
Gravity< reach O Gmvelles Chambers
r - Septic Tank/Drainfield Specifications Laterals
A ✓L✓ Schedule/Class �3`LIt
;NumbebLr of Bedrooms d . Lend 6 7
Datty'Flow = Diameter -el in
Sephe Tank Capacity o0 Number
lR'eeeiving Soil Type(1-6) Separation
!Receiving Soil Appl.Rate O, b end/tt�
Required Square Footage BOO Orifices
;Designed Square Footage o ;t Total Number of Orifices
pepeentRedudionTaken O % Diameter
ed Width '3 ft 1 Spacing ed Length 7 ft S acin
Eleva6an Measurefh : s ' ' :ro "" -- Manifold
1 Schedule/Class 95r�rr b3
;thrgutai Drainfield Area Slope % Length x /5,. - ft
Slope if Altered % Diameter . if .. rf in
Depth of Excavation from '3O in Preferred M��ldogfagurntiop Usayd7 [ ty�No
t iaal Grade (up-slopc)
52 in TranspokVipe
(Down-slope) Schedule/Class �$TH7 3o3f�
Length r,W,
Designed Vertical Separation .6 in Diameter �" �/ in
7 k
,GGM611eu Chambers Required? ❑Yes 04. �❑Optional Dosing and Pump Chamber
'p Required! ❑Yes O'No Number of Doses/Day..
Dose Quantity Aq
Pump/Siphon Specifications
Chamber Capacity
(Dtffeiencc in Elevation Between Pump Shutoff and Uppermost Pump Controls: Timer(or)Elapse Tmre Meter(circle H required)
"
'Orifice:. ft 6 If Timer Pump On .Pump Oft °" s
ppamost Orifice is❑Higher, ❑Lower than Pump Shutoff' . ' Check the following cotriponents if they drain betwee6 doses * '
�tklaLtedTotal Pressure Head:- ❑Latetlats ❑Manifo[d ❑Transport
TOW Pressure Heed
(Attach Pump Curve)
ry
sex.
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J;t ,i`DESIGN FORM-PAGE TWO Itr,isea'' I21.j`99B
ta 1 /�,
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.se. R>, a:c. b.q«o
9�
�- f loof iScaled Piot Plan Scaled Layout Sketch Cross-Section 8ketch„�;
D M',Tvst hole locations "tprifield onentation and layout Re[erc depth from origluatgrade
O Pfoperty lines m/frrenchlbcd dimensions and critical eptic tank lid and tel cover` * s
EV,Existing and proposed wells within dices within layout depth
a 100 R of property lines m/D�ox/"rT'L",locations £,
friGcaI distance measurements to cuts, p�eDttc tank/pump chamber location Reference depth from original grade 9 s
banks;and surface water Gi66servation port location andtrictive strata:
[9� fe Y6
oeatton and orientation of curtain" l� -out location terals,trench/bed top and botico
£ and all absorption components fDfold placement (S//f attain drain collector g `
IDS Location and dimension of primary IObrifice placement . Sand augmentation u
system and reserve areaeral placement with distances to
l�3/ ldings cedge of bed Otherp'oss-section detail:
0 7.,DD on of slope indicator LL� udible/visual alarm referenced C9�bbsorvation polls and clean-outs
� terlines - �of drawing shown on scale bar
C S
F �
�easements/driveways/
�� aya
heal MIN
ltChA'h�Ca:t'o�,btalrania¢r tfln �,
resource lands(if applicable) 1. I e a eSt et#ralt o(f :at f y
arrow and scale of drawing
shown on scale bar
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AddiUonal.information
9 O Design staked out
1 O Operation and Maintenance Notice (, ;.
{ p' Attached
a
j O Waivers)Attached
ov.,� . .. .>•?b : .... ...„. �r.,r . k:x '�. �.. . ,G<z saw b r��..>. ' �j q;',
r rTke undersigned designer❑does, D'des n oot,waive the requirement to be notified by the installer of the installation and given 48 ;
rA hours to perform a final inspection prior to cover. r
Signature of Design Date /
A y
The undersigned has reviewed this design on behalf of Mason County Department of Health Services and determined it to be in '
+'t compliance with state and local on-site regulations,
I Environmental ealth Specialist Date
C� Caution: DESIGN APPROVAL IS VALID ONLY UNDER 771E FOLLOWING CONDMON:
r ✓ The design is stamped"Approved"by Mason County Department of Health Services.
k;,,w n ✓ The On-site Sewage Permit has not expired,the Permit Explration Date Is: 12 16 rkr
./ The system is installed by a certified installer,unleis prior authorization is obtained 13tont Mason County aid,
rM� Department of Health&Meos k
," ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval d1
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AS,BUILT FORM RevisedPokumy It IM
Applicant Assessor's
Parcel#3 �3 —7 S- �/D f 03
Permit Number SWGO�Z- fi'Dyg7 (TWON04WROMben
Installer i aX,;C P r- D k a>� Subdivision
(NemeiDWlabnlBboka.M)
Deslgna �G(U�crccr 'Y,rc, ,
NIA Yea Prior to Completion
1. SEPTIC TANK f
A) >5ft.From foundation?............. ........ ... ............... —
B) . >50 It from wells and surface water? .................... ........
Q B14g stab-out to septic tack clean-out if not 1-2%? .
D) Ba@les intact and clean? ......................................
B) Dividing wan intact?..... . ................ ............... ..... ✓
F) Risers installed for access? .......... . .... ... . :. ... .... —
G) Tank Size: 'LOV gal.;Mam&ctme
11. D-Box
A) Leveled with water? .. .. .......................... .......... ..
B) Speed leveler used? ..... . .. .. :.......... ............... ......
Ill. DRAINFIELO
A) >10 ft from foundation and>5 ft ftom property lines? ............... —
B) >100 ft from wells and surface water? ............................
Q >10 It from potable water linen? ✓�
D) Laterals level to±1 inch$end caps present if hoped? . ..........
B) Gravellessch�bers utilized? ......... . ........................ ..
F) System dimensions the same as shown on the design?....... ......... —
G) Gravel clean,properly sizat,and proper depth? .................... —
H) PREaeURESYalEraa
1) Send quality ASTMCY33? ...... ........................... _
2) Head height uniform and x24 inches? Aesual head beight .
3) Clean-outs and observation ports present? ...... ............... —
4) Mound: Side Slope 3:1? .............................. .. —
5) Owner informed electrical connections must be made by
owner or licensed electrician and inspected by Ldcl? ..... .... .. —
IV. PUMPIPUMP CHAMBER
A) Pump make Pump model —
B) Chamber size gal; Mamdnchue
C) Height of pump off bottom of pump chamber in —
D) Pump chamber draw-down per inch
B) Pump capacity ons per minute
F) Pump controls:Timer.(or)Blapsed Tfma (circle if htataNed)
lftimer is used:Pump O t _
G) Screen basket or effluent fdtwn one)installed? ......... ....... — — —
H) Riser installed for access? ................ ...... . ............... — — —
I) Alarm Installed? .. .......... . ........... .............. .......
&uJ
T -d ESEZ-LZt.-09E assRed R11ed 9 C100 aLOrTT SO 4Z Rew
3 z�'#°��Az3�y
C2?, ��4tt, :a�.at.,.a.......t3 ..4.,. ;t S,.ve-�?:+.�£e.$sffig`f .$'(.$ryaa°.;-ia�Inf.•.�k�f?.,t.
:I" I:
■ Drain Drainfield&manifold
orientation &layout TranchroW dimensions
and critical distances
within layout
■ SR&4umptmk
placemant
■ Location of buildings.
■
out location.Loocation of walk&
■ Undisturbed native soil
betweentranchm
117,0
. I
3
Sc£v'
x
,.,�..�. -all(
MI m and dab the cartification
at I installed the system
I from of - =x I without, .I:V -ar .,.
S are sham above.
B. ZMCD
I contacted the designer and left the did not contact _ final cover became the
system open for inspection up to 48 bra prior to designer waived the
1 I: I
II n information rl . u , r n.: die . II ; .n .
then immediate suspension . ;
Signature or minaller
7bo undersigned approves this Installation on behalf of Mason CountyDate
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