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Home My WebLink AboutSWG2003-00283 - SWG Application / Design / As-Built - 6/23/2003 MA$ON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG _ y N /Date N o 426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Receipt No. N PHONE (360) 427-9670 Amount$ — m P ERTY OWN S d� DATE: ��0 3 CHECK APPLICABLE ITEMS t/ o DAYTIME PHONE: NEW SYSTEM MAILING AD RESS: T 3 ,'-� REPAIR SYSTEM STATE: ZIP: TABLE 6REPAIR w CITY: MAINTENANCE REVIEW m kNLl�� A. V SINGLE FAMILY ✓ z PROPERTY ADDRESS: � OTHER: 3 SPECIFIC DIRECTI S FOR LOCATING SITE: n _ PRIVATE WELL m a_ G>H � � FL D'Vd COMMUNITY WEWPUBLICSYSTEM +� L $'v (�=-- � "Fv CllDW —+0 t4f F! !�' CA7-RC# SYSTEM NA # S ITT+ (�y:1�-�%[� r SYSTEM NAME f�. APPLICANT -ND L40-,I LOT 07J 9"V*r NAME 11 Name of WSJ `` '' Lot �7/ _ft.x�ft. MAILING ADDRESS o Installer I GAL Size: �- acres TELEPHONE O Name of um er o SIGNATURE Designer �"�"A'� Bedrooms X IJ OFFICIAL USE ONLY BELOW THIS LINE DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONSI� m x - lo 0-71fy , Ao b � 2 n o fn O SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely INSPECTOR(print name) PECTION SIGNATURE DATE PERMIT EXPIRATION DATE •All systems require ongoing Operation To Maintenance(O&M)as specified in Mason Tounty 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 Dermit ex ires 3 vears from the date of site review.Denial of this permit may be apoealed to the Health Officer within 10 days of denial date. DE016V REVIEW APPRO L BY: DATE: INST T N APPePD BY: DATE: cud TOP: Hilalth Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy MASON COUNTY DEPARTMENT OF HEALTH SERVICES id July 21, 2003 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 CARLSON Case No: SWG2003-00283 Parcel No: 321347590104 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: 7/21/2003 1 of 1 SWG2003-00283 DESIGN FORM - PAGE ONE p ttavhsed laeury`'"9' A design will be reviewed when 3 copies of each of the following items are subrhlt[epi E I V E D a Comi"ad design form duct has been signed and dated st ft ScaCrowled Wyvul dia tch.I�p own d 608W plot Plan.Including applicable - OGa J'i' Designer's Name: ( 6-A) IA i M :Sec- permit Number. DWG `Z gb 42./s43(nt/ Designer's Phone#: �p7 Z r.,1Dgg �a ILL S Q�l Assessor's Parcel NO.: Applicant's Name:Mailing Address: n^ (1'welvo-Digit Numbs) 6X l3 7b S y Subdivision: " ' � S 76V sga 4 L• - CSYI LlJ A (Prattrmivistos/61oeY/t ot) city state Zip •x� x..> . ..,,. .< Dt_SI�N PJ4E2A1H �15 u g Treatment Device ❑ Glendon Biofdter O Sand Filter O Mound O Sand Lined Drainfield ❑Aerobic Unit-Make/Model: — O Disinfection Unit - MakeJModel: Drainfield Type ai O '�7`T"r-e-nch ❑Gravelles elles Chambers Gravity Laterals Septic Tank/Drainfield Specificatio3ns Schedul Class Number of Bedrooms Length Daily Flow 75C-n-- eDd Diameter -s' Septic Tank Capacity t + �� eal Number Receiving Soil Type(1-6) Z Separation r oC ft Receiving Soil Appl.Rate 1. O ep� Required Square Footage �� n Orifices Designed Square Footage 3 b Total Number of Onifice,,%. Percent Reduction Taken oft DiameI g��NJ Trench/Bed Width ate ft Spac r t-T- TVA DF-PT m Trench/Bed Length Elevation Measurements IaJL 1 $ 20� nifold Schedule/C ft Original Drainfield Area Slope �� Length New Slope if Altered Diameter G 2 7 in Preferred Manifold Configuration U.;edT Yes ❑No Depth of Excavation from (Ur-lope)Original Grade ZZ Transport Pipe u Length eL ti in Designed Vertical Separation �.+- in Diameter Gravelless Chambers Required? ❑Yes 9WO �❑optional Dosing and Pump Chamber , 1 ❑Yes-0 no Number of Doses/Day Pump Required? Dose Quantity Pump/Siphon Specifications Chamber Capacity Pu Shutoff and U st Pump Controls: Timer(or)Elapse Time Meter(circle If roquired) Difference in Elevating Between Pump Shutoff Timer. Pump On .Pump Off Orifice: ❑Lower than Pump Shutoff twit the following components(f they drain e� Uppermost Orifice ❑Higher, /vl ❑Laterals ❑Manifold ❑ Capacity /Capacity @ Total Pressure Head: . Comh tad Total Pressure Head: (Attxh Pump Curve DESIGN FORM- PAGE TWO itnlsedApnl24 tugs a t Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Test hole locations Drainfield orientation and layout Referenced depth from original grade: Property lines -0'-Trench/bed dimensions and critical tic tank lid and drainfield cover Cl .xisting and proposed wells within distances within layout depth 100 ft of property lines _0 D-Bau/"T"/"L"locations critical distance measurements to cuts, epti tank/ mp chamber location Reference depth from original grade banks,and surface water rvation port location and restrictive strata: D-Location and orientation of curtain ClClean-41o'ki tetals,trench/bed top and bottom drain and all absorption components anifold plagement Cl !lector ion and dimension of primary O Orifice I O Sion system and reserve area feral placement,with distances to p� a-buildings I O&" edge of bed , 7 Other n detail: /l¢rodion of slope indicator O Audible/vjlp�t of rtNieferenced bservation po and clean-outs f7r�aterlines tale of w' shown on scale bar O'1Coads/easements/driveways/ Cross Section taform fiontor motmd parking Layout information for mound system system O Critical reso ,, scale ca/ f applicable) and ff sca 7 {)verali flit dimensio Ia SettCed p at cente t aAtT edgo i#£ North arrow and le of drawing p Vp scope,dow ndsCope fieti shown on scale bar fill width >7 Side vl. stope O Op slope and,do �. Additional Information CP-Design staked out O Operation and Maintenance Notice Attached ClWaiver(s)Attached LICENSED DESIGN DESIGN APPROVAL The undersigned designer do 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 co (�-Z 2-03 Sig . e o 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 regulatio r ` Environmental flealth Specialist Date I Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDMON: ./ The design is stamped"Approved"by Mason County Department of Health Servicers ,-L b ✓ The On-site Sewage Permit has not expired,the Permit Expiration Date is:_6 d The system is installed by a certified installer,unless prior authorization is obtained from Winn County Department of Health Services. d Dramfield site conditions have not been altered to adversely affect conditions of design approval � e u k 06 Ar� � V) 2� APPROVED Mc H AL H DES \ T u u 1 B 2003 I.MW , uno uo vf"em Tom SEAL •ouWETER FRpr Et1NAGE I f�OATIM�wT I AMROVEO soURCE U �y�T METER EEotowwm �spTI�TAlIIi '• APPROVED MC HEALTH CEPT JUL 18 2003 CEW Pure Performance The OSI Biotube"Effluent Filter is the most advanced in the industry, Extendable PVC Handle engineered to provide maximum protection for your septic system. 'Air Vents Features and Benefits • Improves effluent quality. Average Total Suspended Solids Scaling Ping (TSS) is less than 30 PPM, nearly 2-1/2 times lowertnan a non- screened system! • Allows for smaller diameter Folyprop,11cnudrainfield pipe. Lowers drainfield material costs • Superior patented design. Extends drainfield life. Reliabie, corrosion-proof construction. • Easy installation. Installs in minutes in new or existing tanks. . Solid Base • Simple, hassle-free maintenance. PVC Outlet Fitting Available alarm. Indicates when maintenance is needed. • Ideal for variable-grade"sewers: Allows reduction of the td�ds�ott line size and associated costs • Custamsizes. APPROVED MC HEALTH DEIPT Inlet holes Call for availability. JUL j 8 2003 CEW tN P7 P-T- pIT?: I ou1 Z'=° —F4NK 4' diameter model 4 r a � o o Q li- it vi +n 10, f a r k 11 i APPROVED MC HF.Al.T°-,i DEPT j JUL 1 8 2003 CEO/ �►- � --ter L � e �v y 0 u N '0 ti1ga�O � 1•vOil, � r N aj Q Q9� Y e� n I d VV O F LC N_ i cp va PROVED 6 Q c ei 08o f4CLu- LT7 DEFT a r1 e 1 3 9 /J� C/ I V � �� MEAN 4L t O 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 while the soils are wet. 2. Use EXTREME care in site preparation. Remove"NO"top soils. Use ore In tree and stump removal. Leave root systems intact. 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 burned 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 sites, 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. 1B. 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. .r L:,,r 24. A curtain drain (if required by designer or health department) is to be installed ' n . IDE P-( 8 inches into compaction and tight lined to daylight, meeting all county codes. Dow. sione side is to be lined with black plastic. JUU1 $ .Z003 CEW 'AS-BUILT FORM Revised February 18,1998 5 L 10 F:We T1 ATI Applicant (J�0�6yZT- OA�Zk Gy\ Assessor's Parcel# Pennit Number SWC0603 00,2C' (Twelve-Digit Number) t_)�j ja c�7 C Subdivision Installer Flo (Name/Division/B LtO Designer t:F SmALLERIUNECULIS N/A Yes Prior to Completion I SEPTIC TANK A) >5 ft.From foundation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B) >50 ft from wells and surface water? . . . . . . . . . . . . . . . . . . . . . . . . . . .. Q Bldg stub-out to septic tank: clean-out if not 1-2%? . . . . . . . . . . . . . . . . . D) Baffles intact and clean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ✓ E) Dividing wall intact?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F) Risers installed for access? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . G) Tank Size: I Z-grO gal.;Manufacture A--ct-45 11. D-Box A) Leveled with water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — B) Speed leveler used? . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — III. DRAINIFIELD A) >10 ft from foundation and>5 ft from property lines? . . . . . . . . . . . . . . . — B) >100 ft from wells and surface water? . . . . . . . . . . . . . . . . . . . . . . . . . . . . — Q >10 ft from potable water lines? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — D) Laterals level to± I inch&end caps present if nt!!Te9 . . . . . . . . — E) Gravelless chambers utilized? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F) System dimensions the same as shown on the design? . . . . . . . . . . . . . . . . — G) Gravel clean,properly sized,and proper depth? . . . . . . . . . . . . . . . . . . . . — H) PRESSURE SYSTEMS 1) Sand quality ASTM C-33? . . . . . . . . . . .. ... . . . . . . . . . .-Za�ij)(tteight 2) Head height uniform and 2o 24 inches? A,. I . . . 3) Clean-outs and nervation orts resent. l . . . . . . . . . . . . . . . . . . . . . 4) Mound: SideSlope3:1? . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 5) Owner informed electrical connections must be made by ✓ owner or licensed electrician and inspected by L&I? . . . . . . . . . . . . . IV. PUMP/PUMP CHAMBER A) Pump make Pump model B) Chamber size gal; Manufacture Q Height of pump off bottom of pump chamber_inches D) Pump chamber draw-down gallons per inch E) Pump capacity gallons per minute F) Pump controls:Timer(or)Elapsed Time Meter (circle if Installed) If timer is used: Pump Off used: one)installed? . . . . . . . . . . . G) Screen basket of:q[�Iuent filter(circ or . . . . . H) Riser installed for access. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I) Alarm installed? .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Q��> l -F>:Ullfi I�t�41AtlN�' CHECKLIST 43-�Drainfield&manifold orientation &layout .2' -Trench/bed dimensions and critical distances within layout [r � e�"mp tank placement. 7 rLo'8 $ Location of buildings. At .0 bservation &clean- out location. Cant¢ y, lYLocation of wells& 4n T4N-r- �i�r t roads. P-Undisturbed native soil between trenches. I x°° el LI G 3 E�1MH14, l 81kG1� North arrow lYf u q RI G too T NMI Gt r. CAUTION: �deNi:designer, but sous in certain to septic tank location end drain&eld orientation made in the field by the installer are generally acceptable to both the department health gner,bo could in certain cases compromise the viability of the system. It is the installer's responsibility to obtain pnor wntten epprovd from either the department designer before making any deviations from the design that affect the system viability. Any deviations from the approved design must be shown above. GERTIPI Ai noN of INiaTAi TYOF1 Installer Check a box from Row"A"and"B",sign and date the certification A. ❑ I certify that I installed the system without any ,,W rcertify that all deviations from the design stamped deviation from the design stamped"APPROVED"by APPROVED"by MCDHS are shown above. /M� CDHS B. I certify that I contacted the designer and left the ❑ I did not contact the des'ggnner prior to final cover because the system open for inspection up to 48 hrs prior to designer waived the noot cation requirement. cover. 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 ce 'f�cation. a-03Slgna a er Date The undersigned approves this installation on behalf of Mason County Dep3sumen/It o Health Services. Sanitarian I Date