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HomeMy WebLinkAboutSWG2004-00168 - SWG Application / Design / As-Built - 4/6/2004 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG — c N a Date ' N Y Y W 426 W. CDAR/ P.O. BOX 1666/SHELTON, WA 98584 5 ° Receipt No. - / C1 o E y PHONE (360) 427-9670 Amount$ — iv PROPERTY OWNER: DATE: CHECK APPLICABLE ITEMS NEW SYSTEM MAILING DAYTIME PHONE: ADDRESS: �. E. ,r AU R REPAIR SYSTEM CI STATE: ZIP: TABLE 6 REPAIR m oa5 MAINTENANCE REVIEW m PROPERTY ADDRESS: SINGLE FAMILY c OTHER: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m k$tJ ` i c" r COMMUNITYWELUPUBLICSYSTEM SYSTEM WFI# SYSTEM NAME iZ �" APPLICANT NAME j r Name of Lot ft.x ft. MAILING ADDRESS 'PO lJ]1rI N 31 I� Installer =V~`' Size: .$ •..� -L acres TELEPHONE (v Z•- r. Name of umber o SIGNATU E Designer .,iM (4&.Nzy Bedrooms X k, OFFICIAL USE ONLY BELOW THIS LIN DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS W m 3 1-0 U � 6G •` ✓�-mil �-� lf"""" Ir �O APR 5 2004 SERVICES SOIL TEXTURE CODES: V=Very G=gravelly S=sand L=loam Si=silt C=cla E=Extremely INSPE print name) SPECT N SISNATURE y DATE PERT }IA�ON DATE J •All systems re4filre ongoing Operation and Maintenance(08M)as specified in Mason County 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 permit expkes 3 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 da s of denial date. DESIGN VIEW PPROV �/ 1 D TE: INS I APERD�B BY: DATE: � c y 2 a ��j -7 L I dLf TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy MASON COUNTY Iti DEPARTMENT OF HEALTH SERVICES WA 98584 April 29, 2004 PO BOXSHELTONL (3 0)427-9670 FAX (360)427-7798 Jim Henry ELMA (360) 482-5269 BELFAIR (360) 275-4467 SEATTLE (206)464-6968 RE: Design for IRWIN Case No: SWG2004-00168 Parcel No: 321352390001 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: 4/29/2004 1 of 1 SWG2004-00168 UESMYN FORM- PAGE ONE Revised JtausW 4.1999 A design will be reviewed when 3Mies of each of the following Items are submitted: Sodsd P p1 =ra ai pppib b Rom on checklist aWned and � nD�a Rea�b It Scaled =kwkKgnmems own a Permit Number qWG64 - 66 unS� Designer's Name: Designer's Phone#: I'll-7Z.y L Applicant's Name: f3tt`-ur I R w..J Assessor's Parcel No.: 3aI3.!�2-3 4000 1 Mailing Address: '(771 E. S:A4Tt 2T 3 (rwelve-DigitNumber) 5 6I LT 1 icJ4 4&SS'J Subdivision. to 2-44 4/ LOT- city State Zip - (Na=01vlslrmM odAA)Q a.I ..awv o,H . ff Treatment Device O Glendon Biofilte Sand Filter O Mound O Sand Lined Drainfield 0 Aerobic Unit-Make/Model: — O Disinfection Unit - MakeW0del: BadDralnfiel D (3 Gravity 0'tfench E Din Iro1 qff&Cn Septic TankfDralnfield Specifications Laterals Number of Bedrooms -3 / MMai SERVICES Day Fly' `�406 cod Diameter Septic Tank Capacity /ZOO gol Number Receiving Sod Type(1-6) Separation 4 ft Receiving Soil Appl.RateVdV Required��e Orifices r o Number of Orifices Percent Reduction Taken % Ttal •� Trenctiffied Width 3 ft Diameter APPROVE � enah/Bed �y /Sa ft Spacing As-�R® iEEPT MC HE� 4liaEPT Elevation Measurements ScheduleKlass APR _ Original Drainfiekl Area Slope � % Length 2 9 2004 o ft New Slope if Altered % Diameter /rS in Depth of Excavation fromG��4' in Preferred Manifold Con tf&{i�ti611e/�,U3ed? Yes ❑No Original Grade c�(U��) Transport Pipe Movm4lope) Schedule/Class Z�' Length ! 'I(O ft Designed Vertical Separation 2- Y in Diameter .7 " in Gravelless Chambers Req� ❑No ❑Optional Dosing and Pump Chamber _ Number of Doses/Day 3 " Pump Required? lies (3 No Dose Quantity 2 2- cal Pump/Slphon Specifications Chamber Capacity [2 eel Diffmace in Elevation Between Pump Shutoff and Uppermost Pump Controls: Timer(od Elapse Time Meta(circle If r*Wlmd) Orifice: 2 °5' it IfTimec Pump On Pump Off Uppermost Came Is erHigha, (3 Lowe than PdmP Shutoff Check the following components if they drain between doses: Capacity @ Totat Pressure Head: !tk•s OM ❑Laterals ❑Manifold ❑Transport Calculated Total Pressuic Head: /2.2'-J ft (Attach Pump Curve) DESIGN FORM- PAGE TWO RevindAprU24,1998 Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 9'Test hole locations @`lDrainfield orientation and layout Referenced depth from original grade: 8-1properiy lines fYTrench/bed dimensions and critical Septic tank lid and drainfield cover 0'Existing and proposed wells within istances within layout depth 100 ft of property lines ET D-Box/"T"f`L"locations )PKC ritical distance measurements to cuts, Septic tank/pump chamber location Reference depth from original grade banks,and surface water O'Observation port location and restrictive strata: Arl,Ocation and orientation of curtain )3'Clean-out location E'Laterals,treach/bed top and bottom drain and all absorption components CY'Manifold placement O Curtain drain collector Z'Loeation and dimension of primary Orifice placement O Sand augmentation system and reserve area 6'�Lateral placement,with distances to O' Buildings edge of bed Other cross-section detail: B'Direction of slope indicator R'Audiblelvisual alarm referenced PYObservation ports and clean-outs 8'Waterlines O'Scale of drawing shown on scale bar fYRoads/easements/driveways/ puking H' Critical resource lands if nCa� � oarfor add 4(• applicable) 9'North arrow and scale of drawing ss , shown on scale bar Additional Information )"Design staked out O Operation and Maintenance Notice Attached O Waiver(s)Attached The undersigned designeJR(does, ❑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: - nature of 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 regulation CL I z oy Environmental Health Specialist Date Caution: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ./ The design is stamped'Approved"by Mason County Department of Health Servi ✓ The On-ske Sewage Permit has not expired,the Permit Expiration Date Is: y%29/0^] d The system is installed by a certified installer,unless prior authorization is obtained from Mason Carty Dep utrucat of Health Saviors. ./ Dminfield site conditions have not been altered to adversely affect conditions of design approval JIM HENRY DESIGN SERVICES, INC. MASON COUNTY DEPARTMENT OF HEALTH SERVICES ON-SITE WASTEWATER DISPOSAL SYSTEM DATE: April 1, 2004 APPLICANT: BRENT IRWIN 4771 E. STATE ROUTE 3 SHELTON,WA 98584 LEGAL: LOT 1 OF SP#2891 PARCEL#: 321352390001 �V3 HF _ PROJECT DETAILS: N!ttt_ NUMBER OF BEDROOMS 3 FJ(MRES pe/1t1U� GALLONS PER DAY(GPD) FLOW 360 APPLICATION RATE 0.80 DRAINFIELD -Absorption Area Required 450 SQ.FT -Absorption Area Designed 450 SQ.FT -Trench/Bed Length 150 FT -Trench/Bed Width 3 FT DRAINFIELD CROSS SECTION - Bed Depth 6 to 9 INCHES - Graveless Trench 12 INCHES -Vertical Separation 24 INCHES - Fill Depth 12 INCHES SEPTIC TANK - Size&Composition 1125 GAL CONCRETE -New/Existing New 1 �,lM>>ll�JIM HENRY DESIGN SERVICES, INC. APPLICANT: BRENT IRWIN DATE: April 1,2004 PARCEL #: 321352390001 PRESSURE SYSTEM-3 LATERALS System Parameters Pressure Calculations Orifice Size 3116 inches Minimum Orifice Discharge Rate 0.62 gpm Residual Head at Last Orifice 2 feet Total Lateral Length 147 feet Orifice Spacing 2 feet Number Orifices Lateral 1 25 Number Orifices Lateral 2 25 Number Laterals 3 Number Orifices Lateral 3 25 Lateral 1 Length 49 feet Total Discharge Rate 46.5 gpm Lateral 2 two 49 feet Lateral 3 Length 49 feet Friction Loss Pipe Class 200 Tightiine Friction Loss 4.06 feet Lateral Line Size 1.5 inches Manifold Friction Loss 3.43 feet Lateral Elevation 100.5 feet Lateral Friction Loss 0.55 feet Friction Loss through System 8.04 feet Manifold Length 40 feet Manifold Size 1.5 inches Dynamic Head Risidrai Head at last Orifice 2 feet Elevation Difference 25 feet Add-on Friction Loss 0.2 feet Elevation Difference 25 feet Tightline Length 140 feet Total Dynamic Head Loss 12.74 feet Tightline Size 2 inches Total Discharge Rate 46.5 gpm Add-on Friction Loss 0.2 feet Total Dynamic Head 12.74 feet m by � cv r Z e x ��w •"�N z A O '7 p N P, C cn O ❑ �?� v, U T W ' d o d sn = O M 0 LLJ V Y ,� ON U z U cv 0 z aw N 0 ` O w (n z LL Lij CD W CD m M O T x a � z } � M 0 N 0 z t+I C7 i/i Q C W � � W W 2 n •k Vi = O 0 G J a c ca U m en M 0 o 0 � q R' Gee' u fY F i2 d Co W J O O U Q Q W O ~ p d Y V Z Q W �-'^� O '«zw2 m a CS WW �W y °` 0 o . 2 LLF- Oz 9� z c O W 0� dZ v OQ> W > f U 0 O 7 g Qa �— 0 ` O Lu ME w LEE O } - 5 Jaw m Z �'a W W QJ > Q2' U 0 rWui z c.> ¢ T � M w W o � wzJo F- -acv oc W Y W w Y W J �qOW 6j F- O z v NN Co Y C cc >�` a� C L w N 0 mo = m i m � c Q t c E z o m co WW 3 m w z m m - `o c O .cm. 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P•dw•M"Ice aw• "aioie ep0°°�NbWI l i���"mww •.arnrwM.I a1z nMlwn W.".at•ma oume s0in0-ee—wah•F—W16P*' aMws v bMW•n rRud Wb wM eMw waW at 70'F.•na 12W W ae Nev"k M' ?TD:-'I°2'' - I� HYDROMATIC' GP SFM Fl1 RISERS TO SURFACE APPROVE® MC HEALTH DEPT NNTelIPIOD FY•d( TO ALARM&POWER ❑ V t�� I APR 2 9 2004 C.., 4C w C uCZG NaNwA,aM �;Zoo &,4L- poAp etiAMWP, CEW waFar PLWON I | MR m . L § , \ . 2 § \ k 2 ` ; { \ / . 8 � � 7 . ./ §d � \ � 4 � |■ ■ w , . . ! � / k m \ . rPR WED | < B © SEE"N DE PT \ � / . mmf2aG4 7 § . ID CEW � §f � � \ § & ' / . AS-BUMT FORM Revised February 18,1998 . ... 11iRG1G1TfIF `�11IEMEN Applicant Y\A- - V'la)I V\1 Assessor's Parcel# 3aI 35 �93 9OQnI Permit Number SWG 04 - 60 ( Lo (Twelve-Digit Number) Installer Subdivision Q8�9 I Lod- -I ` (Name/Division/BlocidLot) Designer C WA pI,Y'( i IrtsrallftC;PIECKLISC , ............................::........:.. N/A Yes Prior to Completion I. SEPTIC TANK A) >5 ft.From foundation? . . . . . . .. . . . . ... .. . . . . .. . .. . . . . . . . ... . . . B) >50 ft from wells and surface water? . . .. . . . . . . . .. . . . .. . . . ... . . . . C) Bldg stub-out to septic tank:clean-out if not 1-2%? . . .. . . . . . . ...... . D) Baffles intact and clean? . . . . . . . . . . . .. . . . .. ... . . . .... . . .. . . .... X E) Dividing wall intact? . . . .. . .. . . . .. . . .. . . . .. .. . . . .. .. . . . ... . .. .. F) Risers installed for access? . . . . . . . . . . .. . . . . . .. . . . .. . . . . .... . .. . . G) Tank Size: 2-00 gal.;Manufacture ► ( O�G1L t o 11. D-Box A) Leveled with water? . . . . . . . . . . . . . . . .. . . . . . . . . . . .... . . . . . .. . . . . B) Speed leveler used? . . . .. . ... . . . . . . .. . . . . . . . .. . . . . . . . . . ... .. . . ._ 111. DRAINFIELD A) >10 ft from foundation and>5 ft from property lines? . . . . . . . .. . . . . . . B) >100 ft from wells and surface water? . . . ... . . . . . . . . . . . . . . . . . . . . . . _ C) >10 ft from potable water lines? . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . D) Laterals level to±1 inch&end caps present if not looped? .. . . . . .. . .. V 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? . ...... . ..... ... .. . . . .. . .... . . . . . X 2) Head height uniform and 224 inches? Actual head height . . X 3) Clean-outs and observation ports present? .... . . . . . . . ..... . .. . . . — �- 4) Mound: Side Slope 3:1? .. . .... . ... ... .. . . . .. .. . .... . .. . . . �C— — 5) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&I? ... . . . . . .. . .. IV. PUMP/PUMP QRAMBER ' A) Pump make ; Pump model 6P L{C) B) Chamber size ) D gal; Manufacture J j4jQ A t onne j -X- C) Height of pump off bottom of pump chamber (ram inches — — D) Pump chamber draw-down gallons per inch E) Pump capacity 4 • 5 gallons per minute F) Pump controls:Timer(or)Elapsed Time Meter (circle if installed) If timer is used: Pump Off G) Screen basket o ffluent filter cle one)installed? . . . . . .. ... . . .. . . H) Riser installed for access . ... . . . . . . . .. . . . . . .. . . . . . . . . . .... . . . . . y 1) Alarm installed? .. . . . . .. .. . . . .. . ... . . . . . . . . . . . . . . . .. .. . . . . . . . ❑ Drainfield&manifold orientation &layout ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank placement. ❑ Location of buildings. ❑ Observation port&clean- out location. ❑ Location of wells& roads. ❑ Undisturbed native soil between trenches. ❑ North arrow CAUTION:bTinor adjustments to septic tank location and drainfteld orientation made in the field by the installer=¢anorelly acceofable m both the deQartmeat and the designer,but could in certain caves compromise the viability of the system. It is the installer's responsibaity,to obtain pI r writ0en hearth depntment or the designer before making any deviations hom the design diat affect the system viability. Any deviations from the approval fiom either the ahovm above. approved design must be ..>�u=, a .. ... ati Installer Check a box from Row"A"and"B",sign and date the certification A. 'J�--I certify that I installed the system without any ❑ I certify that all deviations from the design stamped deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above. MCDHS B. ❑ I certify that I contacted the designer and left the �I did not contact the designer prior to final cover because the system open for inspection up to 48 his prior to designer waived the notification requirement. cover. I further certify that all information contained on this form is accurate. I understand thidif the information contained herein is not accurate,there will be just cause for immediate suspension of my installer certification. w 71J�I'a Nignature of Installer . /Dattf The undersigned approves this installation on behalf of Mason County D r t of H ervfces. 7 ZI/�jy sanitarian ate