HomeMy WebLinkAboutSWG2004-00039 also scanned to box 1120 - SWG Application / Design / As-Built - 1/29/2004 ON-SITE SEWAGE SYSTEM PERMIT
PERMIT NO. SWG W O _OCi03 _.-.--- c
MASON COUNTY DEPARTMENZ.OF HEALTH SERVICES N
v; o
426 W. CEDAR I P.O. BOX 1666/SHELTON, WA 98584 Receipt No. Z
PHONE (360)427-9670 Amount$
DATE: CHECK APPLICABLE ITEMS {/_ 9 m
PROPERTY OWNER: __ — NEW SYSTEM _ .
_r,, K L_ �— DAYTIME PHONE: gEpAIR SYSTEM_----- —
MAILING ADDRESS n 5 (,� _. 3' /•j �/ g -- TABLE6REPAIR __ —
STATE: Z1P' MAINTENANCEREVIEW `D
CITY: ---- SINGLE FAMILY___
r: o LyA�• WIE. g ua - --
OTHER:
PROPERTY ADDRESS. _ yl� PRIVATE WELL
.30 JE nuf-
,y tON ELLIPUBLIC y„
SPECIFIC DIRECTIONS FOR LOCATINi S 1,09 A' �� _ SYSTEM WFI k
f0�� ✓E LK �C - 0 SYSTEM NAME I�
T C h a 3 APPLICANT I�
NAME
MA INGADDRESS IW
Lot —ft'x : ft p wv
Name of Z.
acres TELEPH E vi ID
Installer 134e-jals L44) '2/Ne Size: __.- SIGNATURE 0
Name of um er o X - A '�
Designer Bedrooms
OFFICIAL USE ONLY BELOW THIS DEPARTMENTAL COMMENTS/CONDITIONS
m
DEPARTMENTAL SOIL LOGS
F
_TK I b
o_3p` USA = pc
3d 35 �y \\
o_ Gs�
32 ` � � �1 RECEIVED
'JAN 2 9 2004
tea- 4i 426 W. CEDAR STD
SOIL TEXTURE CODES:
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely DATE PERMIT Pi ION DATE
INSPECTO (print name INS EC ION SIGNATURE .L
V" nor approval is granted otherwise
1 Ail systems require ongoing Operation and Maintenance(08M)as specified in Mason r a Py O i nal S�a$d an tad otherwise.In such cases a preliminary on-site
•All on.slae sewage systems must be ems must be irnstal tailed by a Mason ned by a CountyCeR ed�lostal9ereunless rdor appal Engi a r,unless p'
meeting between health department staff and the homeowner is required.
•On-site sewage system design approval does not imply other building site requirements(i.e.RLC,Water Adequacy)have been met.
•Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit. ATE:
•This erma ex ire.3 ears from the date of site review. enial of t^DATE:a ma be iN aaledMOTION A Health
ROV officer BY in 10 da s of denial date.
f 'A
06
DESIGN EV APPROVAL BY: ` ( O
TOP: Health Dept. COPY
MIDDLE: Designer's Copy BOTTO : Applicant's Copy
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES ecru,
warerQudl
funwrownwadHei �Y
BBLFA[R(360)275-4467&4468
Application for Waiver/Appeal TOLL 1m -j asi rI 8
Amount Pald:
Receipt Number:
instructionslid
_...: r
mm'ON,
PART 1: Applicant/Parcel Identification
ICI K 1 17 2 /1K L Date
Name of Applicant �/4$
,� 7✓� / Q S p/ Telephone a 53'
Mailing Address
Assessor's Parcel Number 01
Subdivision Name and Lot af
'JAN 2 9 2004
PART 2: Nature of Waiver/Appeal ❑ F Sanitation Re426 CEDAR 5T1
n1s
❑ On-Site Sewage Requirement ❑ Solid Waste Requirements
a Building permit review policles ❑ Group B Water System Requirement
ji; Location, WAC 246-272-09501 ❑ Water Adequacy Requirement
a Holding tank WAC 246-272-12501 ❑ Enforcement Timelines
❑ on-Site Standards ❑ Departmental Determinations
�a Certifrcaften contractor(pumper, ❑ other
deslgnrr, installer. O&A4Spec)requirements
eal include justification,additional material may be attached)' s
Description of Waiver/App C J v 4 =
C
s r r o 0
()it
Applicant Signature:
/i:IWDAT.4VXCHii7:1WAIr6BWr lipdau:April25.1997
` jealth Depar
PART 3: tment Evaluation(Staff Use Only)
113. •type of On-Site Waiver(if applicable):
I A.Type of Determination Required: ❑Class A C3 Class B O Class C
O Appeat )(Waiver None required
Identificaton of Specific Code/Standard/Detertnination(include date of determination or latest
2. revision):
code/atandard CSC ,t,�(o_2'�Z, •OgSUI
3. Nature of Appeal:
rin
4. Hearing Official: u
p,ilealthOfficcr
❑Board of Health �j Health Services Director
O pollution Control Hearing Board ❑Bnvironmental Health Manager
❑ Certified Contractor Review Board
5 itigat1n Factors: 1 13
t
1112151
I 0
1 ` JL1 J3,14A l
nd mitigation required by state and local
!have reviewed this Waiver/variance re9 uest. It is complefe. a
6.
policy has been submitted.
Date: Z
Staff:
PART 4: Determination of the hearing
official
The hearing official has determined that approval of this request will not adversely affect Public health and
is hereby granted. This decision is based on lire following findings and conditrons:
tentially have an adversely affect
royal of this request could Po
p The hearing official has determined that apP
public health and is hereby denied. This decision is based on the following findings:
DateA04�
Hearing Offs
A=N�iz MAWDATAURChWEIWAIVER I:'P UCdde.AV6t ISM t"7
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
June 12, 2004 PO BOX 1666 SHELTON,WA 98584
SHELTON (360)427-9670
FAX (360)427-7798
Arrow Construction ELMA (360)482-5269
230 E Warren DR BELFTIE (206) 464-6968 I
SEATTLE (206)464-6968
Union WA 98592
RE: Design for DRAKE
Case No: SWG2004-00039
Parcel No: 223305000184
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.
i
Please call me at (360)427-9670, ext. 554 if you have any questions.
Sincerely,
Pam Denton
Environmental Health
Mason County Health Services
COMMENTS:
6/12/2004 1 Of 1 SWG2004-00039
DESIGN FORM- PAGE ONE MamO am eI�,
*A M r'evlevwd when r or~oh of the fallowing WWd' r1-
A bNN�rs w sta od aaara�rrara aMasah YroMrdaw
� �e /Mn. y�all�ipp�Yb�INar ae draaAast � brnsaraeaiaaa
i; :
r ..nY PARC "10►EN�
Desir Ws Name: JV r
PrImm Nmnber DWVWS Phone M: , z 3 O
Applicant's Name: Mr�[L Assaaors psrai
MailingAddrea: r nrreAL VdAr> WA. 9$Qa3-500 Subdivision:
CRT
:DESIGN PARAM
Treatment Dwk e
O Moved O Sand Lined DraiofieW.
OOkOd"BMW OSrrdFiller i<i.Itr�c
�aabk Unit MshdModei:p_t o�u�r.. — �4UaOA Unit - Make/Model: i o t
Drakdk"TYPO GkQ�
Q DcabrOd 4 J
O Trench dearstla Chambers
Wasson
S as laterals
�f O
tlOplb TanklDrOkdlatd gp<miflcatlonO Sc raduidClass
Nrlblr O( eeala -a TO— Old Diameter
Deny row Damee ter
Stlytle Talk C�Oeiry No RW t:t o 100.-. mid Number
lleoeida{Soo TYPa(1.6) Separation t«• ' T—
ReeaFlKSoii A*P4110 Orir4
Fie g Ra- f Total Number of Orifices
FaeeM IIedOGba Tskat DiameW
spacing �i
( Width —__13s
TMCI W Length Manifold N n
e IlelCla»Elevalbn M"Sur*m"tsoriginal u �
Drab"Ares Slope 9 __b l aOtth 2-- in
WSW Slape if A tw..A b Diameter Yes O No
Preferred Manifold Configuration Used?
Depth of Excavation from Ny+lie) Qijj�Pipe ----
Original Grade
qaj�u1�Cllss
Length
+ i a _ _jn Diameter
Designed Vertical Separation �.---
�dt O Yes �No O Optional Dosing and Pump Chamber
Oravelless Chambers Required? Number of DosesWAy /I
Pump Re"Ire49 ( Yes ❑No Dose QuJWtkY
pump/Siphon Specifications Chamber Capacity
Shutoff and Upp oa a �P�aob' Timer ior) Elapse Time Meter ieacN ar.a +di
Difference in Elevation Between Pump y�—y IfTimer: Pump Oo PUMP On
Orifice:
U�Iarat O�is iglra, O Lower than Pump Shutoff
Check the following aomPoe"ts if they drain between doses:
C�kY®Told bum Had: 1 o ['�� (dsnitold O transport
CIcnlsted TOW FfVWM H: fie)
PAGR/ OF4�PNTS, _
April
j DESIGN FORM- PAGE TWO "mi" 24.1996
"�' `�,�" _ �0�51(3N`CHECKtJ3tS
Scaled Plot Plan Scaled Layout Sketch cross-Section Sketch
O�Tem Isle locations fr�Dnlnfield orientation and layout Referenced depth from origleal grade:
fcr may ling a-Tteaehlbed dimensions and critical Septic tank lid and drainfield cover
W Exbtilg and purposed wells within dbtam:es within layout depth
too R of ptaperty Ilees O D-Bot rrPL"locations
G--'0khal dbsrna masaermenta to cuts. er Septic tank/pump chamber location Reference depth from original grade
beaks,and sofas wafer eObsemtwn port location and restrictive strata:
t7 'Loeafion and erlesantlonn of curtain cycleas-out location C'f Laterals,&,enclt/bed top and bottom
drab and a8 aboaption components c'TMaalfom placement O Curtain Min collector
er Leeman and dhoe nsioe of primary O-brifice piaument O Send augmentation
system and reserve area O't doso platzmad,with dishnces to
d� edge of bed Other cross-section dealt:
Q'Di actin of slope indicator Q'Aud bWvbW slam referenced O Observation ports and elan-oua
so�gydhtp 0-Scala of tinwbtg shown on scale bar
S 'RoodshooemovWdrivewsys/ Cross-sactlon iaformoUeu for metaled
„sing �/ tt(m faJ�mtW�yaMT..t`I ayatemJ / .Fff S.,nJ�l�:
Critical resource lands(i(ipApliable) } dbaesfiop3 s Cl Settle up depth at center anal Ad"o[
Li,XNotdt arrow and soak of drawing "mod mds bed
O Up slops;' ..:
shown on scale bar fill 0 swe4all slope
Fr • O U slo and downs bed
c;
elevatiea
"" Additional Information
�? elDesign staked out r10 -'Tot dkkrjl
O Operstion stud Maiotatwu Notice
Attached
Waiver(s)Attached
rn�r p APPROVAL
TM undersigned designer C`J does, O does not.waive the requirement to be notified by the installer of the installation and given 49
boos to perform a finei inspection prior to cover
of erigne Doe
he T undersigned has reviewed this desi on behalf County cat of Health Services and determined it to be in
compliance with state and local on-site regulations:
Glryld�
f
Env Health Specialist ate
ib: DLSIGH AKUOVAL IS YAW Wr ONLY D911 THL FOLLOWMG COMDMCW11;
The design Is stamped OApproveC by Mason County Department of Health Services.
The On-ske Sewage permit has not oxpied,the Ism dl Expiration Date is._ Z
J The system b btstalled by a mdGW bstalkr,unless prior authorization is obtained from ason County
Deperhat or Haft Services.
Drainfleld site conditions have not been altered to adversely affect conditions of design approval
N C
I ,o
ov
ATk5T Ho LLS Lol
- -
_
CJ
SILT/GRAVE
{{;, 0"- 34'• SA MC AS AI
N 3 0'-35" 3nra1= As w i `o�,�Nuv'�' 4�II
C TAP }
LCA
84,m
pn21 01) O
�V Fa i I
pHPGc M a23ao •o oo1R4 � t
100
� Y�1'11� Np1�1e
ReseRVE�a 3 •'
\� .n c
rt i RE SL'Rvs '1i
r 50l
i •.� .. _ _...._ _ . . Scars: / - ?p'
Zy'• C.�.... nr ap /e0'
iJ DDES NER
ttt MAY 172004
oz
CP\'�
I•a G�;o
,f\
At
T ,, vIGW F ---VALVE CONTROL( Y-pll'
\,� SCREW ON CAP
NOTE. 45 DEGREE ELBOW
a0=OBSERVATION PORTS--TO BE 4" P6RR
PVC PIPE FROM BOTTOM OF TRENCH LATERAL
Oierlc=
TO FINISHED GRADE. REMOVABLE END OF
CAP SHALL BE INSTALLED ON DITC r DETAIL
BOTTOM WITOH GLUED ORT N TEEE. NCHOR ON ` _Ip CLEAN OUT
MINIMUM OF ;i IN SYSTEM.
NOTE, CLEANOUT TO BE FROM 0 TO 6
LATERALS ARE TO BE CENTERED INCHES BELOW FINISHED GRADE.
IN TRENCHES ` ERER QUIREDSATITH ENDROF EACHCLEAN OUT 1 LATERAL—
IAA GK
L"
p O
9 Ar� fyt�'Pr IrJ GFp�L 3gRrnlr// ENnMANJF
OKIfICES Cf8" "C 9 oRr" cEs)
�• L r .__._ ..._ ._ ..yr.--- —
1� I
u Au
a ta` � rr f'rcm h1an �( ,4
li•M1r `u S •
y� 3�i• � r�yS�S I`' F/�co� 4„ F
N
Fw
MAY 7 2004 i
1
��G
O
DL•TC•RMINE THE TOTAL DYNAMIC HEAD:
Selected residual preaaure: 2.�00�ft•
9S' TranspuA "
Pipe friction loss=: _410 n.
Line N I 35 n. ......... 14 n
Line w2 y5�ti n........... a o ft.
Line NJ 3.5 n........... a q n.
Line 04 /a•`� n............ n.
Line NS n.............
Total elevation lift................ . ft.
TOTAL DYNAMIC HEAD:...... Fr.
SECURED LID WITH OAS TIGHT SEAL THREADED UNION
2P DIAMETER
ACCESS RISER SERVICE
FINISH GRADE VALVE'
R\5
't�Nt� of t
FROM SEPTIC �� `�\ � —►TO ORAINflELD
TANK
V EMERGENCYSTORAGE ANTI SIPHON
VALVE
HIGH WATER ALARM LEVEL INDEPENDENT
WORKING VOLUME —� — FLOAT STEM
NORMAL TIMER OFF LEVEL _ _ _ _ FOR FLOAT
MOUNTING
A* •. CHECK VALVE
i SUBMERSIBLE
I- SEDIMENTS CENTRIFUGAL
..,,,,• PUMP
b. PUM�P/Cp,H/�AeM' 'BER 0
/
i
MAY 17 E004�
Pa.,E: or /pPWR;
r
J'
�l
perf19120
Dta
pump Characteristics
MoorINN SAMW"NOW" W1 MN1 no WM 0 Aeon*PA" MII M12 -
iNW 15A 7.5 0 IA IS vx 3450 row4 1 S— --- ---WM2 MIN Moos am 05
btamalRobb MI2 - i - -
N lsdt.S 4.5 4A 1.7 1-5 0• 24 a
NOW 450 CAPACHY-U.S.G-P.M.
vx NS0 - -'
ip 20 30 L� SO 60
rdW4 144 1SOS 140 57S Tohl Nood(foot) _
N,rN
60 1/2 NP 105 77 5 ,� 0
6,NIwNtwt GPM 1 NP 137 120 96 67 31 0
j 14VI NltSl O
a n$N Dimensional Data
i Stu rwTI ' .) I.uaaakaYial.r
&74
i NPf 1.NMMaArwwpm
Pwu(wk M11 14/3.faWA14IIW.IY wi ISO' /-� WmarWN
V.4 4S,ISTVK 1427W.1r p1.1SMIN N/3, 1 I.iaaMsdwl�R a1
SIVK I%2M.2r A-16/4,SIWA 1%SS4V.Sr 1 .padw•
tK-Is/S.SIW�3%"@%2M4 .S/SV.Srpl .-tlel I S.RmawMrld+wni.
raWp{M wlPdwk ail
/ +•irtNdpallowdMwt
Materials of Construction �, MO.
e .t:tFOQIwx Am
x..�. Std � � ' wd.sata
I.NII.0 d NdK tit 01 Fj
ca ww .
sdxw+4 Ud11"
Glut (et M
1 SW Foe CwM/CMwdc
sar.
SMFttd S�N��i� tx�re
-Mlswe Mw-N t.-�/e ..
�Nt V*Mw Id we"
IRwtrt�l SN�Slow wuWM
NN fall kw w
F,HN•nt SNW SStd _
a
AURORA/MYDnOMATIC PIIMMPS, Inc. MAY 1 .7 2004 ,
1840 Bony Road,Ashland,06io 44805
(419)289.3042
PAGo-z
�esc�t�
nIMaI finance
Pressure Distribution System$
i. Install laterals with contour of the ground.
2. Install trench bottoms level.
3 Install locator tape or rebar on top of all drainfield laterals.
4. Install observation ports as indicated on the plot plan (minimtun-2 per
drainfield with bottom extending to the drainrock/native soil interface).
5. Install drain field during dry weather and soil conditions, any soil smearing must be
eliminated by hand raking.
6. Install threaded clean-outs at the ends of all laterals ( cap mist extend to
within 6 inches of finished grade and be marked with locator tape or rebar.)
a Install audio/visual high water alarm. Redundant off switch NOT i2�Z ator-cA
8. Install 1/8 inch mesh non corrosive pump screen (min. 12 sq. ft surface area, not to
interfere with controls or floats.) Or Pump screen may be substituted with Bio tube in
septic tank.
9. Install check valve in pump outlet line to prevent system from draining
1 back into the chamber
10.{ Tee to Tee construction between laterals and manifold with orifices oriented at
6 O'clock. Install laterals al the Dept
approval
with
turn orifices dofices at 12 wn (6 O'clock) and glue
after pressure test and Health Dept. app
laterals to manifold.
, ck prior to backfilling. If the drain rock
W Filter fabric required over drain ro
extends above natural grade. run the filter fabric at least 2 inches down the trench
wall.
12. Encase all water lines within 10' of drainfield area
13. Divert all storm water run-off away from on-site sewage system.
14. No curtain drains allowed within 10' of the up-slope edge or 30' of the down-slope y
edge of the drainfield and reserve area
j 15. have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
16. Inspect and clean pump screen every 6-12 months as needed .
'nspect floats and test high water alarm every 6-12 months as needed.
18. All materials and workmanship must meet County and State regulations.
19. Deviation from this design without prior approval from the Designer and,.Mason
County Health Department will make this design null and void.
20. All manhole lids and access, sampling. or inspection ports must have locking covers.
21. All pressure systems with pump chamber higher than drainfield must have a i/8" hole
drilled in the discharge pipe above the pump to prevent siphoning.
22 . All transport lines under driveways must be encased to prevent
crushing.
23. 'OWNER IS RFBPONSIME FOR ALL PROPERTY LINES.
MAY 7 ZUU4
PAGECPF�PM:E<:
h
von
,Tk"3T NOLI-5 _ O L�
33" 5/L- �
Cci1r-rnr_p SILT/Grtavc S
#�- O"- 36" SAMS 45 *f SV
43 0'-35° 3AML A
tp�4N�
coo
�PV c
�.e
�t` R
JV15
c �5" E
tL�'M1r+o�� G
� � �CA a.N
p
PLOT P—L h7'
n._i.uol ; MIKE O.RAKB
r
• o•
0
� —Re$^ 0-1 pR�3 r,•
Ia0 RE SEEV EIP 3 sI
Q �Qr SERV ti ,
VSS{
r'• 75 R C'�LJ£ PV, ybo'�'
i d 4�°J
� S�. So•
SCALE l"=30'
29
SIONER
EXPIRES
rn i 0t's a�(e Da
Applicant Pace
(rwqWO4XORH,,,,,y, 1
PerrdtNumber SWa� 0()o
vision
Nood-S [012uT,ny subai tam
Designer
NlA Yes Poor m petitptetlwt
I. A >5&From
y
foundation?.......................................
B) . >so s from�>septic a �if not 1-2%? .............::::
DBldg$dow bet a and ckma? ............... .. ................
>� Dividing wall hnaeri................ ... .
F) RisM 3sstalied for aoOM? ...........
. �_ _ ,_-f
0) Tank Size: 9ho 6a-'Menutactore -Az
11. D-Box
A) Leveled with WSW .• ... ..... .......................I...
B) speed ievelerused? ...............
III. DRAINFIEL.D and>5 ft from property hnw? ............... --
A) >10@frofoundatioa
m �•
B) >100 ft fium wells mad suefKO water'! ' _y
C) >lo ft from potable mt� ....not loopod? ...........
D) Latuats level to_ h dc sect cap PresO
nt If
g) GM*am clambers sized? .......on the d 4::::::::::::::::
x) PaFseu dgoa1 yJ
1) SandgoalitYAS1MG33? ........... _1G
nmi and t21 hsehw? AdUalhead helBht f
3) Clemoutswd observation parts Present?
Mound Side slope 3:1? ...........must made by
owner or licensed electrician and Inspected by LAM :....�... --
IV. PUMPIPUMP CHAMB • pump mil
A) PUMP make: `-
B) Chamber aim-&� gd; Mat d Inches
C) Heist of pump off bottom of Pump BIOS per loch
{ D) pump chamber drmw-down _ moons Per minute
j B) Pump ►tY Time
(c rol le H installeM _
F) pump controls:Timer.(a1 B� o� �-^� nC� t�/EQ--
Iftimer isused (drok one)OMP isstalkd? ....�...... . t�'� ,.
l3) screcnbaslaotorefiivamt � ,L 3 2005
owe
1I) filtor
Riser k0 alled for access? .......................................
I) Alarm hmtelled? ........:.............