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HomeMy WebLinkAboutSWG2004-00613 also waivers - SWG Application / Design / As-Built ON-SITE SEWAGE SYSTEM PERMIT PERMIT NO. SWG _ — i m n MASON COUNTY DEPARTMENT OF HEALTH SERVICES — n N �'i <�� 426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date oReceipt No. 0 H PHONE (360) 427-9670 Amount$ d NE <`• I CHECK APPLICABLE ITEMS O�ERTY O / ?&AovZyD fV NEW SYSTEM MAILING ADD SS: A A DAYTIME PHONE: REPAIR SYSTEM AV i 3Sii [3 NC+IA NI C • TABLE CITY: ZIP. MAINTENANCE REVIEW � Go!V7 ,) TATE: SINGLE FAMILY c PROPERTY ADD SS: Y LA - —TAqj A OTHER: 3 (D PRIVATE WELL P CIFIC DIRECTIONS FOR LOCATING SITE: Syr COMMUNITY WELUPUBLIC SYSTEM I SYSTEM WFI k R 0� IAAmo SYSTEM NAME I� a APPLICANT U7=PHON n �ff x*Z� ff Name of LotInstaller , '"'"�' �' Z� acres Size:Name of s /Q�''{'� um er j Designerr I h �^•v '1 Bedrooms OFFICIAL USE ONLY BELOWkTHIS LINE I I� i DEPARTMENTAL COMMENTS/CONDITIONS DEPARTMENTAL SOIL LOGS � 9 lop(5"Ck_sfolj- ' I9 4,'A'"L poor• ° LA- 4o Wis sad RECEVED SOIL TEXTURE CODES: NnV1 2004 V=Very G=gravelly S=sand L=loam Si sift C=clay E=Extremely INSPECTOR(print me) ` \ I CTION!SIA E Df`TE P RMIT EXPI TION TF�, �.���y ST3 CCAA npc /O 7�`J�J/All systems require ongo ng operation and Maintenance(O&M)as s in eson County On-She Standards. •All on•she sewage systems must be designed by a Mason County CeD igner 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-she meeting between health department staff and the homeowner is required. •On-site sewage system design approval does not imply other building she requirements(i.e.RLC,Water Adequacy)have been met. { •Any change from the specified use of the property or any she alteration affecting the system design may invalidate this permit. •This h expires 3 sera from the daleof he review.Denial of this permit me be to a Health Officer within f days of denial date. DATE: �) DESIGN REVIEW APPROVAL BY: DATE: INSTALLATION APPROVED BY: BOTTOM: Applicant's Copy TOP: Health Dept. Copy MIDDLE: Designer's Copy MASON COUNTY auc 10 20 DEPARTIIINT OF HEALTH SERVICES MASO tvaar� Application for Waiver/Appeal B�'A°t��►&4468 TOLL FRBS 1400.562-5= Amouw Paid- l©J'— FAX(360)427-7798 Ame*Number: -9k )Qi)� „�'� Instractiona �CA7��v f� 1 OMEN PART 1: Applicant/Parcel Identification Name of Applicant BRIAN&RUTH NELSON paw 08 AUGUST 2005 Mailing Address 13511 BINGHAM AVE. E Telephone TACOMA, WA 98446 A311e3110r s Parcel Number PARCEL#. 22330-50-00167 Subdivision Name and Lot HAVEN LAKE, TR 167 PART 2: Nature of Waiver/Appeal a On-SRe Sewage Requhmeats O Food Sanitation Requlnments a BN"WPNWNMnA,. Raquiemmo x LocoOmWAC24&27-05�0/ O OrOW B WdarSyseemRegsiremmb o eoldlnarmstWAC246-272-12501 o W@WAd*V*wR@T*w = o O.Mlss7re.dordr 1 0 &&mammt'rimesms Detensinadoas a designs,maWler,.O&M bemena O W Da"Won or waivedAppeal Oinclude jodfication,additional material may be su choQ: kifAIA(2requlrea setbedc of tar between disposal componentand Private well.ApPlberdseekstoreduceaetbeckto75'with Pdatemitigationmeasures: 1)Pretreatment meeting Treatment Standard 1 wfthout disinfection.2)O&M notice to title has filed so owners are aware of on-oin maintenance obillgafions.3)Site low in hydrogedogic suseeptib"for corrfamination of e water due to shallow confining laywalaquitards preventing effluent from penetradng deeper than 38". 4)Neighboring well has been notified of pending development via certified mail. MpRe•aiSipwure: N:IWD4rAUaCraMWAfMWP Updit:Apo 2f,ree7 I i PART 3: Health Department Evaluation(Staff''Use Only) IA.Type of Determination Required: I B. type of On-Site Waiver(if applicable): ❑Appal Waiver ❑None required ❑Ciau A ❑Cbun B ❑Clue C 2. Identlficatm of Specific Cc&,Staaad/Daermimation(include date of determination or latest code/standard revision): WAC, 21- G - 2.71Z - ogSO o-M 3. Nature of Appal: ax o� �-tEr. •N W2 4. Hearing Official: ❑Bard of Haft ❑Hamm Offim ❑Pollution Control Hearing Board ❑ eahh Services Director ❑ Cartified Cmb=W Review Board Avuommental Healm Manager S Mitigating Factors: © r,y AV,<; vj s t c..le.J 6. /halts reWewed this watmvlvarlanee requa4 It 4r complett and mitigation required bystate and heel paNry has been submitted. Staff. �, ( fir Dom: PART 4: Determination of the Hearing Official The baring oHkW hiss determined that approval of this request will not adversely affect public has m and Is haebygranted. This decision is based on dw following findings and emditiae: Lto 0 4n (S u r{Q� Pan ?� fn a �v/ Cdprn o The baring official has determined that approval of this request could potentially have an aversely affect public halm and is hereby denied. This decision it based on the following Rndimgs: Hearing Official N:IWDAT.A4XCH/Y6%Wd1FEA % th4w:Apra is.1997 MASON COUNTY DEPARTMENT OF HEALTH SERVICES August 29, 2005 PO BOX 1666 SHELTON,WA 98584 SHELTON (360)427-9670 FAX (360)427-7798 Tahja Syrett Designs ELMA (360)482-5269 70 E Weymouth Place BELFAIR (360)275-4467 Shelton WA 98584 SEATTLE (206)464-6968 RE: Design for NELSON Case No: SWG2004-00613 Parcel No: 223305000167 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. 279 if you have any questions. Sincerely, Amanda Reynolds Environmental Health Mason County Health Services COMMENTS: 8/29/2005 1 of 1 SWG2004-00613 g fig• §�-! -4 v 41 I<I': t c'tiIsIr! ,tilt/ msl'4(1'ailm o/mptic N I Nit m ol; /ol l<';/olLmg l oto N am Nwnmg soil on hchall ul , whokmilstl-tclotadjoinilig �ours- loctncd :n. am ti licensed ;clluc systctu dcsittncr in Ma-mw CoulltN ' and huvc r+uhuiilted it septic system ticsigu of :'v'lason Couui}' I h•alth !bl' NOW uci1hbor s l�rol;cric- ht rcvic�ciut� the desit;u. I sec that tlic hes, pos'mhlc locution G,r a septic :gsicnt on the ncighhorin' ploperiv is I J awry lions your c�istul G+�c11 site -\IlhouFh icchl�;cttlly t, scihnck of I t1U bctwcen septic ss.,tCMi c nd seed, 1, m,ually reyoitcd_ the xunc mud Count}' regularly �,pptove s3steni pl:wellient do>vu I„ LU Irons well si,., 11 't'ruuil Imni illjon nicar;ures me nicl. In ordr-r to puin the l oillO'; upprocul u, wdmr slit setback Ilan Ioo l(; ?S . the p 4)poxd septic system has to n Ice I a certain IN:vcI oI tIcrdn let)t ( I I cat rlcnl S tat drud 1). The Slute sets paraunOeis Itgardint the Ie vcl ok lrcaoueot a septic systcm Inuvides hclorc dischurgintl ctilucut into tile soil. 'I Ili, f trcauucnt arc tl� 1611ows: No 'hrcatment obtained with s n:gular t7ruv tl) or pressura dish ihulion septic systeui- 'Ilcalment Standard Z ohlauncd \witn a. "mid llltt'ution SV1ICnl of aerobic (h:1inlcclioH w5tri n. Treatment `standard I uhntiucd With :: t,Icaidon ISioiiltcr .,vswm oc 2lnothcr nur6 Ixopriruim s�'sl::u,_ tom' ��vstcnt. a6icll me,,�i. f raulucnr ,titxndani lu urd.r to gain ow ( uuntp o) Ihr rLduccil scthucl._ 1 tnu ohhlwtcd w notlf)' you of the lnvpOscd devrIOJAI III I ,lStiUIC NOt, ih;lt Ih, w he plurrrl uu Ihr adjonnn�, p:opert,, gill f1c u(nhsuiutriy uu a¢hcnc iulhact to �nul 1tCll yuulil. of yuw Ill onrrl} in :11. II Y,II 11.Re III Y 1luc�Grms reE!,aniin� till,: situuliilu, lllctt.vc tick' to cunutct myscll. Mason i 'uuntV flraltll - I�if80Pi d_oulilb j i(ill) .i.',! f6 U Nla,)!i l mll(o I icpt i if 1 lcnith :+i�r. :i.b IA' ( e(V;u ;S!. , N.( I;u>, 1Ot4, 4llk Hon, 1k A l)N R, f Fob) dabja-S.vrell 70 1 6Vcynwulh N. Sitcltun, Ni!V ')K51d luhjas4rettdcsil,uuiu-.hntlnriL,:on: 7'bar+k >cu�,l r11 11 . I A I uL.)' Fahja-,5prell f.tlelmurrr_ 19011'1:ill 11 p rupr.cJ .:J jaccnl l'i u�ii rl� U11uri PAGE L OF Rerhed lacy 4.1999 DESIGN FORM-PAGE ONE A deslpn will be rervievmdd�w�hen D_QWJM of each of the rogllo WkV items we submtMetll r awYd pn olelf.MwY+�anY sq�PPh"snMe,w.'�dlwM.�en c�h.o"9�xsl : Cro�.:�tlm+wfali.�� bm'«�a�`` 77 117 27 Designer's Name: _TO BYTAHJASYRETT Pamir Number: t3'_� - Uaigw's Phone µ: 360-427-0255 BRIAN& RUTH NELSON Assessor's Parcel No.: 22330-50-00167 Applicant's Name: (Iwclve•)iait Weber) Milling Address: 13511 BINGHAM AVE. E HAVEN LAKE TR 167 TACOMA WA 98446 $uMivisien: (NaaalDw6wwSlodAM) CItY Sole Zip77, ( 'G0A \ /Treatment Device Glendon Biofiltm L Dralnfield Type Glendon Biofilter Laterals-1 MODULES Septic TanWDralnfield Specifications Number of Bedrooms 2 Dairy Flow zero all - t -Q9 Septic Tank Cap"itY 1200 cal 'n �:`' Receiving Soil TYPe(1-6) 4 � Y� Receiving Soil Appl.Rate 0 6 ¢� -�� �` Required Square Footage 400 Orinoes ►STANDPIPES' Designed Square Footage 300 tt Percent Reduction Taken 25 %• 'fly Width SEE DETAIL fl _ Length SEE DETAIL ft U` S FLOW SPUTTER MastHold—►AS PER GLENDON S P Elevation Measurements 5% New Slope pe if fialdAhmed Area Slope SAME E _% Now Slope if Altered Depth of Excavation from N!A in Nii ) Transport Pipe final Grade original N/A n 40 (Dowr-etove) Schedule/t'irr»- 25 Length 00 in Designed Vertical Separationin Diameter Do$"and Pump Chamber Numbs of Doaea/Day (;I FND )N Yes GLENDON^ oil Pump Required? Dose QuaodiY 1200 gal PumpOphonSpeowwations CbamberCapae' Shutoff and Umoat Pump Controls: Time Time M koN N roq&od) Difference In F,levstion Betwoes Pump 2D-ppU ft IfTow. Pump0a GLENDON ,Pu PDN GLENDON CkiBoc UP1ermOat 06fies is 11 Higber,-3tewer, than Pump Shutoff capacity ae�9@TOWPresa GLENDOPkom gNyysed Tetai Praaaana Head; GLENDON R (Attech Pump Curve) USE PUMP AS PER GLENDON SOP PAGE L OF Rarhrd APdI 24,199a DESIGN FORM - PAGE TWO l?ESk37J CNEC US" Sealed Plot Plan y Scaled Layout Sketch Cross-Section Sketch yy }� Drainfiold orientation and layout Referenced depth from original grade OV Test we locationsg : d.dimensions and critical lX Septic tank tad and dntntleld cover Property lines 9l Existing and proposed we within distances within layout depth too ft of property lines Critical distance measurements to cuts. Septic task pump chamber location Reference depth from original grade banks,and surface water 6bserraeienPeet location STAND PIP IX restrictive stratsrwhlbe, �E�Obottom Y m FLOW SPUTTER 9 Q.-IWA Arai-called Looetion and dvnension of primary JCS, system and reserve area Other cross-sectlon detatb Buildings -edro"CI r� Di Direcection of slope indicator � Audrbklvisual alarm reforanced » STAND PIPES Waerilm Scale of drawing sbvwu w,scale bar Roada/easements/driveways! yy piing ps Critical resource lands(if applicable) North arrow and scale of drawing shown on sale bar Additional Information XDesign staked out r7 operation and Maintenance Notice WILL BE SUBMITTED BEFORE DESIGN APPROV*C`___� Attached X Waiver(s)Attached jESIGN API�AOVAL. The undemianed designer R deas i,Rdoes 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. Sienature of Des sner Date Services and determined it to be in The undersigned has reviewed this design on behalf of Mason County Departme nt of Health _ oomplimoe with state and local on-site regulatio/ln�` Environmental Health Specialist Date DIMGN ATPROVAL IS VAUD ONLY UNDER THE FOLLOWING CONDn7 ertt of Health res. J The design is stamped"Approved'by Mason County Departs J The On-site Sewage Permit has not expired,the Permit ExPiratlon elan la:ti c ✓ Ill,system is installed by a certified installer,unless prior wAhorindon is obtained from Mason County Department of Has"Sarvica. ,r i.TrainBeld site cosditlons have not been altered to adverse atftct"041 ions Ofdaign PAGE_-OF Glendon Biofilter Design Checklist 1 REQl11RED: DE5IGNED. --------------------- -- f. Minimum Verdcal Separaflon: fi 12' + 30^ 2 Maximum GroundSlope: -- --- 20%or Tftcl K3. Basin Capacity:2.2ft�per gallonOf waste per day #bedrooms x 120 x 2.2 =W of basin volume 528 cus cu ft wired ----- ------------ -------- 4. 10im Length: #bedrooms x 120 60 ft 64 ft 5. Mhnlmum Inflltration Area: — -- # bedroorns x 120 200 SQ FT 300 SQ FT ..5 soil awficaborl rate -------- 6. Basin Liner. 30 mil PVC OK 7. GroundSlope_vs-Absorptron Am:OnSIOpes DOWNHILL greater than 5%only the dWr't'ope perimeter and ��x MORE than 5% sides used of the side perimeters are useable for rim length and absorpbon area ----- — - -- ---—---- S Setbacks From Glendon Biofllter I Must conform to WAC 246-272 OK _ systems--- ------ 9. influent Wastewater StrengN►: -- ------ Must be typical of domestic OK household sew e ---�- TOBY J. TAHJA-SYRETT (360) 877-0387 ----__.---_..__-..--_---- 113 Nash Valley Drfve, Shelton,WA 96594 I, _ - - SOIL LOGS ^ 0-30"GSL - --- - -- - - - - GLENDON BIOFILTER 30'' +TILL _ - SEPTIC&PUMP TANKS TRANSPORT LINE / 0-36'GSL - - - --- - -- IDOUBLE ENCASED L 36"r TILL W/IN 50'OF WELL) 2 BEDROOM BUILDING - ENVELOPE(APPROX) 1 ------- EXISTING WELL �I 100 EXISTING WELL EXISTING BUILDING 2, s O 4 S 1 75 it 2 i 50' T V� �V MAX BLDG ENVELOPE 1:40'x 70' III I \ \ - BULKHEADIOHWM *41/ -- — PROPOSED WELL EXISTING WELL - EXISTING ti i DRAINFIELDs HAVEN LAKE DRNE/PARKING a'1 v EXISTING BUILDING I I- 'COMMON LINE' _ (APPROX) —71 SITE PLAN: FOR: NELSON JOB #: PARCEL#: 22330-50-00167 DATE: 25 OCTOBER 2004 BY: TJS DESIGN PAGE OF NORFH ARROW: SCALE: V = 50' 0. 100' I © TAHJA-SYRETT DESIGNS __ --- C7 TAHJA-SYRETT DESIGNS III �•� N I y �,•.a ll( U� Q o � " ko. ui f z St. `------ --------- W 'D U w C9 � U ¢ O z — Q a 1 > I rn Z d Z I 2Z 4T Fa- w Z w Y z zy0 QWULUU' pCY lJ tiwW F a �a F-U�nLL UQ�>zY a �m2v'ain p — ammaaoro rn ¢x ' O Boa Q i Zdt-.vt a�L�F-rn Cj � i; Z � z2zLLtvLL Vj�Q Jam¢ r O C, m J4'UOsw- fY_ s Z ' i Y IG E=—� AanO dwnd SOdaNn'd9 _ z w Y d F- J � rrs � v l.lr Tt ; •� w 1 « H Yr'I 'ti It N Z .s �' of W 11y Z ZmC9 � / i� II I I �,I I 18 00 1000 BACKSLOPE 6;0 l 10 00 ' I 14 00 1000 STAND PIPES FEEDER LINES � CONCRETE BASINS PRIMARY ABSORPTION AREA(300W) RESERVE ABSORP[ION AREA(300W) y I'I FLOW SPIT IER ITRANSPORT LINE l-1 q II I II t� > rv` co4 J DRAINFIELD_LAYOUT DETAIL 6'S FFOR: NELSON ,PAR L#: 22330-50-00167 DATE: 25 OCTOBER 2004 BY TJS DESIGN PAGE OF NORTH ARROW: SCALE: 1" = 10' 1 -- --- U � 20' ' I ©TAHJA-SYRETT DESIGNS J i, 1 l I I,•II VALVE BOX SECURED WITH#2 STAINLESS SCREW - 4"SCH 40 PVC STAND PIPE BACK-SLOPE FINISHED GRADE SAND CAP -- ORIGINAL GRADE ` SAND FOOT _ 12"+ �-=- 30 MIL PVC LINER I'FEEDER LINE -.. CONCRETE BASIN (6'X10'X5'DEEP) RES FRIC BUM mfLIVE LAYER - - - - li FILTER MATERIAL AS PER GLENDON S.O.P II'il 4"PER( PIPE RUNNING LENGTH OF SHOWN ROTATED FOR CLARITY) N 1 h _ __-I,WwK J GLENDON CROSS-SECTION FOR: GENERAL USE DATE: REVISED JULY 2002 BY: TJS DESIGN PAGE-7 OF 11 SCALE: t" = 3' 0. © TAHJA-SYRETT DESIGNS __- PAGE 1 OF l� HOME-OWNER RESPONSIBILITY: GLENDON BIOFILTER SYSTEM Operation & Maintenance is required by the state of Washington, and Mason County for this Glendon Biofilter System. Mason County also requires an operation & maintenance notice to be recorded on the deed at the Mason County Auditors office. Mason County also requires that a contract be signed between the owner and an authorized Ohm technician. A current list of certified O&M technicians is available from the County. O&M personnel must also be authorized by Glendon Biofilter Technologies in order to perform 0&M on this system. 1. Septic Tank: The septic tank should be checked for sludge levels every three to five years depending on occupancy of the home. Sludge level in the tank should be held below 10 inches. The outlet filter should be checked and cleaned every 6 months, or at least at each inspection by certified OftM personnel. 2. Traffic: Ali traffic must be directed away from the Biof tter Area. The area of the Biofitter must be fenced off from any livestock. 3. Plantings: the area of the system may be planted and landscaped with most plants used for landscaping, including grass. Any material that may have a tendency to seat the air from the Biofilter must not be placed over the finished sand layer. 4. Minimum Performance Monitoring: The designer recommends that the following components be monitored as follows: A. Septic Tank 1) Measure stun and sludge levels - Punp as necessary 2) Look for evidence of water intrusion (Certified O&M personnel check DO levels) 3) Check condition of inlet and outlet baffles, repairing as necessary 4) Remove and check lids to make sure they are intact and secure 5) Wnw"and dean filter screen if necessary TOBY J. TAHJA-SYRETT (360) 877-0387 113 North Valley Drive,Shelton,WA 93594 PAGE '�OF ' B. Pump Chamber 1) Test all floats by manual operation,correcting problems as necessary 2) Remove and clean pump screen if present 3) Measure draw down and check the length of pump cycle 4) Test the timer and counter manual operation if present 5) Measure scum and sludge levels, pumping as necessary 6) Look for evidence of water intrusion C. Bioflfter Absorption Area 1) Check for ponding of effluent 2) Check area to make sure it is maintained free of roads, structures, or vehicular traffic, and that surface water drainage and downspouts are properly diverted 3) Check effluent level in basin of B"tter(to be done by authorized Glendon Bkifilter OftM representative) 5. Inspection Frequency: A. 6month checkup - performed by certified OEM personnel B. Year 1 checkup - performed by certified 01iM personnel C. Year 2 checkup - performed by certified O&M personnel D. Year 3 checkup - performed by certified 08M personnel TOBY J. TAHJA-SYRM (360) 877-0387 113 North Valley Drive, Sheiton,WA 98584 PAGE L(i OF I I INSTALLATION / MAINTENANCE: GLENDON BIOEILTER SYSTEM 1. Install giendon biofilter during dry weather and soil conditions. 2. Install risers on septic tank and pump chamber. 3. Install effluent filter in septic tank outlet. 4. Install audio/visual high water alarm. 5. Install check valve in pump outlet line to prevent system from draining back into the pump chamber. 6. Electrical controls must include provislon for timed doses only, to allow a ma)dmum of the daily designed flow into the Glendon Biofilter. Automatic high water overrides must be eliminated. High water alarms must be shut off manually. A dose counter is required. All floats must be installed on a separate mast. Do not attatch floats to the screen basket or pump discharge tine. Electrical control equipment must be located near the pump tank, and accessible to operation Ft maintenance personnel. 7. Divert all storm water run-offs away from on-site sewage system. 8. No curtain drains allowed within 10 ft. of the up-slope edge of the drainfield and reserve area. 9. No curtain drains allowed within 30 ft. of the down-slope edge of the drainfield and reserve area. 10. Have the septic tank and pump chamber pumped or inspected every three to five years. 11. Inspect and clean effluent screen as needed. 12. Inspect floats and test high water alarm every 6-12 months as needed. 13. All materials and workmanship must meet specifications of Glendon Biofilter Technologies, as well as County and State regulations. TOBY J. TAHJA-SYRM (360) 877-0387 ---� 113 Worth Valley Drive, Shetton,WA 98584 PAGE=OF i' 14. The Glendon Biofitter system must be installed by an installer licensed in Mason County, and approved by Glendon Biofflter Technologies. The following is a list of contractors currently licensed to install the Glendon Biofitter System: B-Line (360) 426 - 4221 15. While the Glendon Biofitter system is very dependable, an operation & maintenance contract with a qualified 0&M technician is required. A notice to title for ongoing operation & maintenance must be recorded on the property deed at the Mason County Auditors office. The above is required by Mason County Department of Health Services, and the Washington State Department of Health. 16. Deviation from this design without prior approval from the Designer and Mason County Health Department will make this design null and void. The prepared plot plan is not a survey, it is the owner's responsibility to verify property line locations prior to installation. Any discrepancies must be reported to the designer immediately. TOBY J. TAHJA-SYRETT (360) 877-0387 113 Morth Valley Gnus, Shelton,WA 94684 o0 AL I GI EN DON HOOF It, Sil � IIII � lC& PUMP IANKS IRANSPURI IINC U Db C' - (UUUBLF FNCASFIJ �� If fll1. WdN .U'OF WPI-U IAEDROUM BUILDINh I-NVEI QPL(APPRGX ii F XIS TING WEIt li b.lu' XISIWG VVL LI w [XIS IINU BUII_DINIi M 1 a it MAX 6l UO I ENVELOPE �.� �I ao'x 70' Ili I I �`'► ' E3ULKRL AG/OFIWM I PRUPOSt D WELL I Ali,(ING,AIL, i . L xIU I IIJI: � rn+.AuaI IPLus MAVEN [-AKE URIVBPARKING (I_iI ING' BUILDING, 'COMMON LINf-' l ail ;AF'PRUXI i ITF �1S PLAN 10IR NFLS()N I1013# _ "Uc( t L 22330 50-001 L. 2G 0CT0E3LR 2004 - - -- - 3Y I .S UL_ FaIGN AGF of c NQ'2111 ARF<c IW .0 SCALE. „— 0 100� (c) TAHJA-SYRETT DESIGNS - -- --- --�-- --- -- - --- . I'- FP am LOGS OLg/aON 610FILTTi2 QO YX OSL 30"•TN l % __..- --- SEPTIC 6 PWP TAMK3 yi T RAN.SP011T UNE �.._.— (DOUKA ENCAMD �a TILL / / �/ '` 2 W R OF W AL / / 2 NEL OOM YWA MO 4 EMVELOPG GMPRO>n / p(IB'fINO WELL 1 0 D _ / EKwnmo W6LL •-I ewotrw J 176 6UlXNEADgMWu PROPOSED Will. EXISTING WELL EXSHTINO DRANFIELDS f / HAVJW LAKE DRNERARNINO _..� / \••.\ i EXISTING tMALDINc i (AfTROX) , FOR:.NFLSON JOB M: P 6•: 22330-60001$7 DA. : 25 OCTOBER 2OU _ BY:T DMK3N PAGE OF ORTKARROW: BGALrr: 1" + W _VTAHJA-SYRE17 DESIGNS _ R OMT FORM Alit�nt �Q tJ sea yarcei# ZZ33o-s� - oo i ��- PmmftN=ba swo - bf}(of3 Installs R— L}t N� Subdivision l_K TV- (61, D�g1►e1• t-bt�� -rl�-t S a- S`1(� WA Yes PrioreoomViadon 1. SEPTIC TANK A) >5 ft From foosdados?.......................................... ❑ 0 ❑ B) >5o ft flan walla and surface water? .................. ......... ❑ 0 ❑ C) Bldg slob-out to septic tads aka not If not 1-2%? .................... ❑ 0 ❑ I)) satBes intact and elm? ......................................... ❑ 0 ❑ B) Dividing wall intent?............................................. ❑ 0 ❑ F) Risen installed for access? ........................................ ❑ 0 ❑ •o) Tank Sias: 12 0o gal.;Mmuf dare Pacn (t c t 11. D-BOX 0 ❑ ❑ A) Lavelod with water'1 ............................................. B) Speed.lovelerused? ............................................. 13 ❑ ❑ 111. DRAINFUMD A) >10 ft from foundation and>5 it from property lines? .................. ❑ 0 ❑ B) >100 ft from wells and xm*w water? ............................... o o C) >10 a enm potable water Brea? .............................I..... D) Laterals levol to±1 inch&end crepe present ifnot looped? .............. 0 ❑ E) tiravelleaschambersWBiaed? ❑ F) System dimeoslons the same as shown on the design?.................... 1.3. .-: .. 0 ❑ (3)..(halielalea4 properly sized and proper depth? ....................... ❑ 0 ❑ II) PaanaaE BYST9aa 1)-*md quality AS•1M G33? .................................... 0 ❑ ❑ 2) -Seedheight uniform and 2:24 inches? Actual head height ..... 0 ❑ ❑ 3) Clean-arts and observation lam present? ........................ ❑ 0 ❑ 4) Mound: Side Slopo 3:1? ..............:...................... 0 ❑ ❑ S) Owner informed electrical connections must be made by owner or licensed electrician and inspected by L&17.............. ❑ 0 ❑ IV. PureiPump CHAmB A) Screen basket or rent filter circle one)installed? ................... ❑ 0 ❑ B) Riser installed for access?.......................................... ❑ 0 ❑ C) Alarm tostalld? ....................I......................I.... ❑ ❑ 0 D) Pump make Pump model kA& 851 E) Chamber size 7-400 gel; 50 pYift h; Chamber Mmufachn'e ?Qznd O (t F) Pump chamber draw-down inches per mmutc; Height of pomp offbottom of pump rJ inches 0) pomp controls:Timer(or)Elapsed Time Meta (circle if Installed); Iftimer is used:pomp Off cmucuier ❑ Dnhlfieldd madfold orimadioo at layout . _ . wuhin layout ❑ � ehAN res to orL+q�rurl layout iric/ude ❑ sept doW tank �--y P'800eamt (j) 3;. aus,, �ol�cwiNS oY�lri4) +tank layer+ world ❑ LooRdonofbuBdiogs. ►M14- tN PJF be)N� �oodeep, we o part&tam - R+ A� b io+ubc, 'K 4c- chambeo P om +" ssi{, J-0 pUkhp Up t-0 PUMP + OkZ ❑ Loodkn ofwbd joint +wo , ),20 0 rook of OlveTke- ❑ Undlawtednstivesod 9R1. -F-Anks -FageOleY lretmentteoobes. ��) Please see alth&d photos Aizink. inst?lMoyvs ❑ North wrow OYaR saa�d;�aR�iae�rdBYo&IdakoNtbamdeintl�e6ddti9_fisirulfrRLr�fr�wteaet R6iaar�ia aq darl�aR��faRtaa 4rl^�rta6atfa'aaala b aorta iwa t italre -Checkaboxtiom Raw"A"and"B";zlp and datatbeceaNficadon. : .. - _.._.__.,.. .. . .__......._. A. �Ihat I ioshllad the systm witbout any I] I certify that ail deviations ftom die design stamped from the design stamped"APPROVBU"by APPRov®"by MCDHS are ahowm above. MCDHS 8. f6 I car*that I oontaGad the designer and loft the ❑ I did sot contact the prior to Seal Douse becm�a me system open,for inspection op w 4g hrs prior to designer waived the�mtion rogairmmt cover. I hAw cadfy that all information contained on this form is aaatrate. I wArstand 768 Moon oontabW stein is■at accmam,these wM bo Just twee for®mediate m pczWon of my installermr r erLAW Ile undersigned approves this installation on behalf of Mason County 4 6 " f Healt ervi . 4(as/u7 1 t i (7 r y c s� IJ t,AL ' 1-1 •`1 h x � -� �� r �r 1, �e r p�� J r ( �J k r C ky, , 1 . TMi '1� i ✓��&�� ♦ 1 �, t. .�ypr.. 4 ,2. i