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Home My WebLink AboutSWG97-0538 - SWG Application / Design / As-Built - 8/21/1997 l PERMIT NO. SWG MASON COUNTY DEPARTMENT OF HEALTH SERVICES ` u Date `' N 426 W.CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 " ° PHONE (360) 427-9670 Receipt No. Z -- Amount$ m m -PROPERTY OW LH. CHECK APPLICABLE ITEMS Y NEW SYSTEM MAILI G DDRESS: DAYTIME PHONE: 12. y _ 6 REPAIRSYSTEM m CITY' STATE: MAINTENANCE REVIEW w fog qs�f/ SINGLE FAMILY m PROPERTY ADDRESS: ! OTHER c SPECIFY: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m COMMUNITY WELL/PUBLIC SYSTEM SYSTEM WFI N 0/7 IvZofaw La nE/iC� 6'o a� /ayG ! 6 SYSTEM NAME IQ 2 /t'JAit Sad EQYO t0rz C17 a NAME A ELICAN Name of Lot 330 ft.x ( . ft. MAILING ADDRESS I� Installer Size: S acres TELEPHONE o Name of um er o -S SIGN TURE l Deal Bedrooms 3 J p / I� I� W PLCff Draw a imeWnal plgplan, / �� ry I �� incluw Z l a I ❑Prec,locArion of tit bor i x N ho ow" me d dMncesa �' _��j yy y pr boQaries pdy./ I njtJi / lSfitl �► y ❑Entry-bad;other rows, driy J 0- � 'Ti- NOTE: DO NOT DRAW IN 1 M)'y ^ t'�// IV SYSTEM DESIGN ,\ ��y K \Tlq. T z I V � �Tc a�t`eti VV£��— Sul r �L USE ONLY. DO NOT WRITE BELOW DOUBLE L E. T 4 SOIL LOGS /roe San -�'.3 0-8 /da/+•,y s�r,� Dg—39 !le/y A / �—y� lamery 7^5 ne S4 nit 3/ —(pit 1/G� / ]/Hirt 3a�1^f �8�//!1J� ve^ ]fine//s4nt Mow/n 9 �0�/�9 prd�4 6iy dui .! DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS Finding Score Designer Level: ❑One ,Two Soil Type Septic Tank Daily Soil Depth / i"n'. �_ Capacity: IXOGal. Flow: 960 GPD Slope ^�la % jAppl. jInfilt.Parcel Size Ac. ate O- (d GPD/Fr' Area p FT'Distance to Shoreline;i3o ft. �_ Total nsp or D to 04 COMME TS/ ONDITIONS FOR APP VAL •All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer. •All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted for a homeowner installation of a gravity system. 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 specked use of the property or any site alteration affecting the system design may invalidate this permit. •This permit expires 2 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. SffE DESIGN VIEW: Approved ❑Not Approved INSTALLATION: Approved ❑Not Approved BY: DA7 BY: DATE:3_ O TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy �` �` D m \ Revised April 1998 DESIGN FORM - PAGE ONE a �+ ' A design,r,�,il'�tl,�be reviewed when copies of each of the followin ms a tri ad: Completed daaign form that has been signed and dated Scaled layout skatohsketch, ncluding all applicable items on checklist st s Scaled plat plan,Including all applicable items on checklist Cross seottoEMAI l i ld`+"`�l�ppgj(fi? .ARd%1DENTIFi000 t(�Cn'E�( Designer's Name: +PT 1 trMSO✓1 Permit Number: SW( 7 - b S 3� Designer's Phone#: yam-OSSD Applicant's Name: �� ink Assessor's Parcel-No.: �2135 2�Oo030 ! (rmlve-Digit Number) Mailing Address: q`a0 E. M l IC� � � � C,6 y�, V(a. 9 A�G14 Subdivision: Stage zip . . (NamelDrvtsion/BIocWLot) City DESIGN PARAMETERS, Treatment Device - ❑ Glendon Biofilter O Sand Filter O Mound ❑Sand Lined Drainfteld O Aerobic Unit-Make/Model: O Disinfection Unit - MakelModel: DrainfieldType MAR 2 1 2000 O Pressure ❑Bed ❑Drainrock Gravity Trench ` s Gravelles Chambers Septic TankfOrainfleld Specifications Laterals 3 Schedule/Class ft Number of Bedrooms god Lend Daily Flow Diameter in Septic Tank Capacity —� a Number Receiving Soil Type(1-6) 8 Separation ----- Receiving Soil Appl.Rate = Required Square Footage 9 Orifices Designed Square Footage Total Number of Orifices Percent Reduction Taken ode Diameter rn -�n TrenchfBe6Width 3! � S ft Spacing TrenchAW-Length — manifoldElevation Measurements Schedule/Class ft Original Drainfield Area Slope eke Length In New Slope if Altered 2 N Diameter Depth of Excavation from Preferred Manifold Configuration Used? 14 Yes ❑No Original Grade in (up-scope) Transport Pipe ?O n (Down-scope) Schedule/Class Designed Vertical Separation 3 Le in Length pt Diameter Gravelless Chambers Required? XYes [I No ❑Optional Dosing and Pump Chamber Pump Required? ❑Yes -0 No Number of Doses/Day Pump/Siphon Specifications Dose Quantity --- Difference in Elevation Between Pump Shutoff and Uppermost Chamber Capacity Orifice: ft Pump Controls; Timer(or) Elapse Time Meter(circle it required) if Timer: Pump On , Pump Off Uppermost Orifice is❑ Higher, ❑ Lower than Pump Shutoff Capacity @ Total Pressure Head: eom Check the following components if they drain between doses: Calculated Total Pressure Head: ft ❑Laterals ❑ Manifold ❑Transport (Attach Pump Curve) DESIGN FORM - PAGE TWO Revised April 24,1998 DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross -Section Sketch ($ Test hole locations 1O Drainfield orientation and layout Referenced depth from original grade: R Property lines 45 Trench/bed dimensions and critical 4* Septic tank lid and drainfield cover Existing and proposed wells within distances within layout depth 100 ft of property lines 1* D-BoxP`T`Y"L" locations Critical distance measurements to cuts, Septic tank/pump chamber location Reference depth from original grade banks,and surface water Observation port location and restrictive strata: L Location and orientation of curtain /Clean-out location Laterals,trench/bed top and bottom drain and all absorption components 1 Manifold placement {b/ Curtain drain collector Location and dimension of primary / Orifice placement W Sand augmentation system and reserve area Lateral placement,with distances to Buildings edge of bed Other cross-section detail: Direction of slope indicator Audiblelvisual alarm referenced Observation ports and clean-outs 4M Waterlines Scale of drawing shown on scale bar Roads/easements/driveways/ ,. Cross-section informa6an for mound parking Layout infdrmation for maundsystem: Isystem: O Critical resource lands(if applicable) � erali fill dimensions bttled cap depth afcenter and.edge of: IM North arrow and scale of drawing t7;tj�t-51ppe dowtislope,and;eridslope shown on scale bard tclth tdewali::slttpe, — --_— O t1p slope and dowoslope 6ed:elGvadol Additional Information Design staked out &peration and Maintenance Notice tarve Y GtacheA MR O"C D MC HEALTH DEPT DESIGN APPROVAL The undersigned designer❑does, I does not,waive the requirement to be notified by the installer of the installation and given 4£ hours to perform a final inspection prior to cover: ---a"Pt tee,.,', -10-Oi7 Signaturck es°gner 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: I=:,- �- � IzI I Qo Environmental Health Specialist Date Caution: DESIGN APPROVAL IS VALID ONLY UNDER TILE 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: ✓ The system is installed by a certified installer,unless prior authorization is obtained from Mason County Department of Health Services. ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval r� i W 'k Mo WELC5 Wlrr-410 IDo '��/ , MAPpRo pEo A�I MAR 2 1 2000 J PSO P i I 4o7,�pvc,-no�f Foe ZN 1LTRATp'R �l SePnG N 'D�'BoX pAKy- tj Taf4k 4nv T (pw)j?o u E PRoPosED 1 S,� 1 oo� IkJN SIC S RESERVE hk.&A (ryi� 5 P61 O F Z ,.,, I � IJ. CJA w1 SrccD LEVE!_EKS 467, {�DVCIION � fv_c. I Z -Eema I rn II` IS' - M APPROVED EPT MAR 2 1 2000 PSD �T RAC LAYOUT- GPAp�NAL O1=1G1NA{, (aEgp� Iz Z4" �N STD, r N FI Ll-PLATO P- 3(o�r 'CLEAN-" I- At( ESS R-ISeRs TU G R fi (lYP� 12oO GA-C. Z CormP: EFFLUENT To ' .Rnx LErLINS SEPTIC 'TANk FILTER. `IdSIoPE .._ �►4 Yo t1T AND _G2b55- c�[lot� �� L o F Z Sofk� : AS �o i ED AS.R T FORM ' ta,rsva Applicant C ��r r\n�r Assessor's PP Parcel# I S Z Z Oo0 30 ber) Permit Number SWG9�- OS�`�' (Twelve-DIgIt Num I]�, Installer n k n�tt�' n� _` �� amerOlWslonfelocWtoy Designer -11 � S�rrrs ors 'ILJ' 'APR 0 , H. s a >M; S , ,.. .. ..�•� �" N/A Yes Prior to Completion I. SEPTICTANK A) >5 IL From foundation?................. .. . . .. .... �— B) >50 ft from wells and surface watal . ....... . .. X Q Bldg stub-out to septic tank:clean-Out if not 1-20"1 . .. . . .. D) Baffles intact and clean? ....... ............ .. . . . E) Dividing wall intact?. ... .. .. ......... .... ... . . . . . .. . .. . . ... . .. F). Risers installed for access? .... ... .... ..... .... .. . . . . . .. .. . . ... . G) Tank Size: 17 00 gal.;Manufacture Fret I1' 11 II. D-Box A) Leveled with water? .. .. .. ... ... ... . ..... .. .. . . . . . . . . . .. . . ... . - -- B) Speed leveler used? . . .. . . .. . . . .. .. ... ... . . . . . . . . . . . . . . . . . . .. . III. DRAINFIELD . . . . . . . . . . . . . . . A— A) >10 ft from foundation and>5 ft from property lines? -X-- B) >100 ft from wells and surface water? . ...... .. . . . . . . . .. . . . . . . . ... X _ C) >10 ft from potable water lines? D) Laterals level to±1 inch&end caps present if not looped? . . .... .••.. E) Gravelless chambers utilized? .. ............... . .. . . .. . ..... ... . — F) System dimensions the same as shown on the design? ... . .... �_ �— G) Gravel clean,properly sized,and proper depth? .... ........ to PRESSURE SYSTEMS � 1) Sand quality AS1M C-33? 7-- 2) Head height uniform and z24 inches? Actual head height •• X — 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 L&I7 . . . . .. . .. . . .. IV. PUMP/PUMP CHAMBER pump model -x — A) Pump make P — B) chamber size gal; Manufacture C) 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 On Pump Off G) screen basket or effluent filter(Carole one)installed? ..... ........... � H) Riser installed for access? .. . ...... .. ..... ... . . . . . . . . . . . . ... I) Alarm installed? ...... . . ... .. . ........... .. . . . . . . . . . . . . . .. . . . c � � cnEaa rsr 6q Drainfield&manifold A Sr S Q n orientation &layout J ❑ Trend/beddimensions and critical distances LA within layout ❑ Septiclptirxpai r placement. ❑ Location of buildings. T1/A ❑ Observation port.- [� r ,au4�aaafitit� P� �/ MS��`r� ❑ Location of wells& ++ roads. ❑ Undisturbed native soil [+ between trenches. ❑ North arrow t CAUTION:Minor adjustments to septic tank loc"n and drain[ield orientation made and die designe,but could in aftein eases tompmmttt the viability of the system. It is the�inst Ilu'i ra Install arc g:y Ito pp die dcpatunent showndeW e!+ent or the designer 6eCors making eny deviations from the design out affeG the ponsiba' too prior smaen approval from either the system viability. Any deviations from Me approved design must be t '� L�iEf2TIFlC/x1C31 fi Fits Dt1 W. MINIM Installer Check a box from Row"A"and"B",sign and date the certification A. I certify that I installed the system without any ❑ I certify that all deviations from the designjhereinis deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above MCDHS B. 1 certify that I contacted the designer and left the ❑ 1 did not contact the designer prior to final system open for inspection up to 48 hrs prior to designer waived the notification requireme cover. I further certify that all information contained on this to is accurate. I understand that if the information containaccurate,there will bejust cause for immediate suspension ofmy installer certify ion. ignoer The undersigned approves this installation on behalfofMazon Coun D at County ent of Health Services. anttanan `2 S- ate