HomeMy WebLinkAboutSWG2002-00435 - SWG Application / Design / As-Built - 10/17/2002 y � k { "a
PERMIT NO. SWG rn
MASON COUNTY 0EPARTMENT OF HEALTH SERVICES
Date )-1 -O�} t < 0
426 W. CEDAR/P.O. BOX 1666/ SHELTON, WA 98584 Receipt No. 5.
PHONE (360) 427-9670 Amount$
DATE: �/
PROPERTY OWNER S Z CHECK APPL ABLE ITEMS 30.
`m
r ��Q DAYTIME PH• E' NEW SYSTEM
MAILjAJG�DD�E�S r n — �Q 9. REPAIR SYSTEM
rr ! u TABLE 6 REPAIR m
"'
CITY: STAT
^ n y n RjJ 0 MAINTENANCE REVIEW m
SINGLE FAMILY ✓ Z
PROPERTY AD RESS. I I 0
IrZB I' u,ev%1-J�_,_ 0/. OTHER: 3�
PRIVATE WELL �
SP I&C DIR QS(A ROC�ATfI4N-G SITE, � . OMMUNITWELLPUBLICS
�DZ � /L 5 SM
SYSTEM WFI N
0 0 SYSTEM NAME or 4tl_
APPLIC MW
•Er.�ifdSS NAME
Name ofTV" I Lot �3 o ft.x 7 S ft. MAILING DInstaller o� .
Size: acres TELEPHONE
N
Name of q um er o SIGNA
{�/ in
Designer ""a4loei Bedrooms IX
OFFICIAL USE ONLY BELOW THIS LINE
DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS
0
0
x
w-61 �-Inre�- �� 1nolQs �
a
RECEIVED
pCj;2 5 2002
426 W1 CEDAR
SOIL TEXTURE CODES:
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INSPECTOR(print name) INS EC,ZON SIGNATURE DATE PERMIT EXPIRATIO DATE
} VN �LlS )O
•All systems require ongoing Operation and Maintenance(O&M)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 expires 3 ears from the date of sRe review.Denial of thispermit may be appealed to the Health Officer within 10 days of denial date.
DESIGN REVIEW APPROVAL BY: DATE: INST/�LAT N APPROVED BY: DATE:
2q � Y6�_ Q
TOP: Health ept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
li 6 ai
March 29, 2004 PO BOX 1666 SHELTON, WA 98584
SHELTON (360) 427-9670
FAX (360) 427-7798
ELMA (360) 482-5269
utchs Bulldozing
B
PO Box Bulldozing
BELFAIR (360) 275-4467
Belfair WA 98528 SEATTLE (206) 464-6968
RE: Design for BJORKQUIST
Case No: SWG2002-00435
Parcel No: 223305000331
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. 554 if you have any questions.
Sincerely,
Pam Denton
Environmental Health
Mason County Health Services
COMMENTS:
3/29/2004 1 of 1 SWG2002-00435
DESIGN FORM- PAGE ONE '°evisdhnury
''!99
A design VA bd reviewed when 3 coWes of each of the fonowhV items are submitted:
ss, ,q� te beena�"wenson �sd"w aero 'ensOernaeocwrat
'-- rc• `✓ !t A' r lyr�ry Well
Now
' I Designer's Name.
Permit Number
Designer's Phone B: Z
ppplKaat's Name. Il 4�l D/� S7 Assessor's Par el No.:
blailing Address: O- a 000 67-05rA
Subdivision: ��mxsMiiwdffi
s -ii . 'ter �.,` g'.. ,-
aM a �
�z3=.enr?.. ,.
-v r�dsaa '�u��:�c c S�,��13Y,•E
Treatment Device
Q GlicudmBiuGlter iI Sand Filter Q Mound Sand Lined Dminfiel ,
O Aerobic Unit-MaketModel — EllDis'enfoUion Unit - MakelModel: "
Drainfield Type
Pressure ®Drainrock
Graveey ®Trench CR Gniveltes Chambers Psn
Septic TankfOrainfieidSpecifications Laterals
ScheduleiClas
Number of Bedrooms 3 Length r, &-4 !a T n
Duty Flow 2 -m Diameter 3 in
Tank Capacity 2alNumber
Receiving Soil Type(1-6) - Separation 1 C7 ft
Receiving Soil Appl.Rate d it
Retlalred Square Footage orifices
(Ova tr -of Orifices
Percent Reduction III&CIR l
Desipoil Square Footage
A004E— `� T�eter otal bCS �
_ti Spacing
T esichtBed Length —
ElevaaonMeasurethef _ Manifold
fr§
SchedulaiCUs
Origma!Dri infield Aim Slope —% Length 7 in
Near Slope if Altered u�• I Diameter
Depth of isy.cavation from in
Preferred Ma,iifold Configuration Used? Yes Q No
OriggnlGnade lP ( i in Transport.Pipe
(Down-slope) ScheduWCla:s ft
Length2 en
Designed Vertical Separation ZV- in Diameter
Graveness Chambers Required? Yes No M Optional Dosing and pump Chamber
PnmpRequ'ned? tk Yes QNo of isesll3ay
Dose Quandt, ell
Pucnpigiphon specifications Chamber Capacity O O O ¢al
piffamse in Elevation Between Pump Shutoff and Upper Pump Cou"s. Timer tixi Elapse Torre Metes feude srequkwQ
Ors. rn a ifTona pump On Ala4 .Pump off AJ A
Unumod Orifice is W Higher. Q Lower it= Shutoff . Chock the fol:owing cempuneuts if fly drain between doses.
�s@ Told Pressure Head I-l.o� L,atcals 0Maoifoid O ThOSPOld
To"` ) ��.a
S 2'�'i� c�~�.-�=axi5i]nY�3�'H43�faHf:W4SaK�- e..4
r :aivr.aY:.vm�aarvzca�5'�S�iiS�+s3a,s..�.sli
r k f ♦ 1
Stow Layout Sketch
or-&kficm mimtafim and
i -al
GF-Treachi-bed dimensions and
Yl
■ f- locatio
banks. ns
chamber 10046M
Crobservation
location
mad
orientation of OutI �.a 11 ..r •■
,,n and all 90MOM wmponcnft
it
V12001 and reserve area p 4
f. ,
1 —dgc of I
i ■ WAisual 1 tl 1� ♦
• �:', r t lof
■ slope Audl
• i {„ V U > v
4: It : t 4 .•�. _
.�}`xo-NR `��sr�?tCtAYF�M
WPM
k., _ fi■ ♦, lands
amw and seek of drawing
shown 1.1 scale
Addifionrs T•
Dakp am
Allachad
• rAttached PSD
m-
OR
.K4 x . r 1 .. �..:
�K -I1 , does not waim ihe the institflation and given
erltdom,
hours to perfurm a final inspecti prior to cover
DepartmentSignature of Designer Daft
7U jiudaugagid has reviewed this design on beliall7of Mason County
compliance with staft and local on-site regu
Envi
1 .1. . .. Health S4pecialistJI
DESM AMROVAL IS VAUM ONLY UNDER THE f f' I f' f. J
Of The f .... .I ,.. { 1
jU gum is .rlcertifiedr 1 . m&wbmbm is WAmod fim Mmon C;o=.g
Department
l.r f •.r'.' affixt waillilans
7Z33a- 5' 331
60
L4 `)
� cll
me
psi)
1
eel
f
t
@ R
J
a ^i
t �N
t T
� a
IN
ti ro �K
o �,
NA-
00
Z� e6 W.,�tE� �
Q
L�
s
M
-� = ju
M
V �
a
.•� t0 moo`
L,
M
L;
M
i,
d`
�l` 1
M
Sj Q Q
9 Jr
C9
a a w sl
A
''
1 4"
� '-lam
e.18 y " �
, r t
Pe
Ut
rformance D to
I
3: 1
Pump Characteristics
Puap/Molar Utdl SrbmersRtk
Manual Madels OSP33Mi OSP33M2 1 t W
ArtemaNcModels " OSp33Ai OSP33A2 1
1e 1 1
Horsepower 1/3 I
Full land Amps 7.8 4.6
; I
Moser Type � SPra'Pbase
R.P.M. 17SO ° 1
t 7-
I 1
Phase 0 1
voltage 11 S 1w 230 • 1
°n to 2n ]0 e0 so 60
Hertz 60 Cx►At rrr uS Ii Ptt
Operation IatormHttat
iemptrorort
140•F Ambient Total Head If"O 8 12 16 20 24 25
NEMA Design 8 GPM 1/3 HP 48 39 22{8 7 0
Insulation Clots F e �- ®` TH 1) p
pischorge Size 1-1/2-NPi vie
Seeds Names S/8' Dimensional v• � 4
Unit weight
P`J
Pa.+ar Cord 1913,SJTW, 18/3,SJJw —r-
10 std.l20'opt.) 20'std. i ( i 1.6 snm ro iA"
JAkA
.� L srarnw.a.:
IAoterials of Construction l—' 1 Possum
Won or"
:zanme Sleet x•2'a ae >i,,ira
:/•i' s S.%e:ar,eda,lsAa
abekatiag Ot'} Dielectric OR ( ciemoaaa,s
t
Motor Housing Cast Iron I11da"
i tor3e•arm+asan
Pump Casing Cast Iron t acm
Steel
Shell
Mechanical Saul Tacos Corboa/Caromic
Shall Seal Sod Body:gross
. Spring:Slowest Steel t I true
8egows:llvwx
;mpepor 8roaxe
1uLa � c.
upper Bewiag Single Row Bap Beating
1.ewer 8txirg Single Row Bop Bearing L i 1
Use I Cast Iron
°auenors Stainless Steel r�su:ac
AURORA/HYDROMATIC P�Mpse Inc.
1 RAA Rnnaw Rnnel Achinnel ntpin AARn ;
I oA ro55
sacVmm uo wo"OAs t10MT So" sueeee ue.m yanWrt uu tMaa.eee
1
ro rvr► �,aa.ae.wa
wwam.w+e uvn ��
waaaaat wurna
mm"s
Asa
ne�ea.ra a•
• US�1�
4
Construction Requirements
1. Determine location of underground utilities before digging. 1
2. Soil must be dry before proceeding with indda*.
3. Do not remove any top soil and leave root syst*m Intact while preparing site.
4. Install laterals with the contour of the ground an' install trench bottoms level.
S. InstaN observation ports~36" of all t
6. Once the trenches are excavated the side wafts and bottoms are to be raked to
open the Witraticm surfaces if Ov" Is any or compaction.
7. The edge of the drainfield trenches must be a n#nimurn of five feet from any
property or easement
S. Install a check valve in the transport line.
9. Effluent screens must be used to prevent Conte` ination of solid matter.
10. Storm drains must be directed away from the dfainfleld.
11. High level water alarms should be installed as "y warn owners of pump
failure.
12. A bio filter or tri filter must be installed in the ot#let side of the septic tpnk
for proper filtration. r
13. Risers are to be installed for easy access for pOkmping or re{ � `
14. AN materials ",construction must meet the 4quimments dTt#x�kT 7
Health Department.
15. Deviation from the design without approval frorh the designer and CVqD
Health Department will make the design Invalid;
16. AN orifices must be installed at a 6:00 position.
17. AN manifolds must be preferred with riser and no for any access for
18. Flt purposes.bi ie Is ired prior to bac kfilling.
19. All curtain drains must be 6" Into restricted layeg with an outfali of 30-
below drainfield.
20. Maintenance is essential. Clean the fifters ever,# 6-12 months and pump the
septic tank approximately every 4 years.
�qr+
77
tWe Called In: Caller . lA ✓1 Phove. 43_I_o_o -`�76-(�,1_0
la-�� SWG#: �C1Da-�D `f�, 5 �� 1P '7eFF
Ipstaller: Parcel#: 3 30-50 - n 0 3 3 340-310
Designer: go-A, Tfi M f Subdivision:
Applicant/Owner: •r^ (3"()f is u,54 Site Address:
Q Gravity 0 Sandfilter
Df-PrIessure ❑ ATU/Proprietary Filter
Mound ❑ Glendon Biofilter
❑ Sub-Surface Drip
Inspection Schedule: (check one): YES ❑ NO
Built On-Site?(check one): WYES . ❑ NO
Staff Initials: I )
Appointment Date: Time:
Comments:
Is budding present? ❑ YES NO
Does necessary soil depth appear to have been altered since design approval? -�r—VES ❑ NO
System appears to have been installed under suitable soil moisture conditions? V YES 0 NO
System has been sitedkwnshucted to prevent surf tcagroundwater infiltration?
If gravel and/or spec per sand has been used,is clean and of pro sudgrade? YES 0 NO
Have all horizontal setbacks been maintained? — ❑ NO
Disposal 100'from wells/surface water? $ ❑ NO
TankvT ansportllters 50'from wells/surface water?Have waivers been applied for?
If so,have all waiver criteria been met? ❑ YES 0 NO
Has the system(layout/coroponents etc.)been installed as-per design? ......❑ YES ❑ NO . .
If NOT,has designer concurred with changes? ❑ YES R NO
YES ❑ NO
f N Tank inlet/outlet appear to be watertight? FN
Risers to grade&appear watertight?
Lids secure if Please secure
//1'�q����}� }j��idds!RANIj
Y AN' Cleanout installed? N Pump 010164 or in vaultT
I/N Baffles with adequate clearance for inlet pipe? N Discharge a as per design(check/ball valves,etc)?
/N Outlet filter as per design and accessible? N Float position correct for dosing&to prevent hang-
/N Outlet piping sufficiently stabilized to prevent ups?
settling? 1' Floats on separate tree,not attached to discharge?
Y Timer,ETK Counter present if required?
�/ Transrt line correct&installed to prevent ?
I
Y/N Lateral&orifice placement/sluelding as per I SwW Wer has a Pwnp Well.•
design? Y/N Lid ofpump well vented?
Y/N Squirt height uniform and adequate for orifice Y/N Discharge lime as per design(check/ball valves,etc.)?
size? Y/N Float position correct for dosing&to prevent hang-ups?
Y/N Cleanouts present,accessible and anchored Y/N Floats on separate tree,not attached to discharge?
Y/N Float level prevents bottom of filter sand from floodin
Y/N Observation ports to proper depths and g?anchored? Location of Pump Float:
Y/N Air coil present if specified on design?
Y/N Pump float mounted to float tree 3m below under drain pipes?
NEW
Y/N Treatment unit present? Y IN Disinfection unit present and as per design requirements?
Y/N to be installed
i
Y/N D Box accessible fiom finished grade? Y/N Trench/Bad width&length correct?
Y/N Speed levelers used? Y/N LateraUTrench separation adequate?
Y/N D-Box water-leveled? YIN Trench/Bed bottoms appear level and in ontom?
Y/N Lateral pipe diameter/class cainct? Y/N Trench depth coned?
YIN Observation ports as per design and anchored? Y/N Gravolless chambers if on ?
N Prel erect manifold configa ation need? N Cleanout ports as per design and anchored?
N Manifold length correct? N Trench/Bed width&length correct?
EIN
Valve box for manifold awessible from surface? N Lateaal/franch separation adequate?
N" Lateral pipe diametedclass correct? N Trenches/Bed bottoms appear level and in contour?
Orifice spacing/diameter correct? Trench depth correct?
fVA Orifice shields if on ? Y/ Gravelless chambers g=if required onMINNOW
?
In addXm to presswe checklist.• Y/N T minimum fmm edge of gravel bed to side slope
Y/N Side slope 3:1 edge?
YIN Mound constructed perpendicular to slope&in Y/N Monitoring ports to gravel/send/soil interfaces present?
contour?
Y/N its control panel a`Glendon' authorized panel? Y/N Stand pipes present and accessible fiom surface?
Y/N Shape and layout as per design? Y/N If slope>5%is absorption area on dgwoslope only?
Y/N Square footage of send areas coned? Do not walk on Glendon!
Comments:
:he undersigned has reviewed this installation and verifies these findings on behalf of Mason county Department of Health Services:
unitarian Signatare: E� � d Date: —
AS-BUI T FORM Revised Febmery ts,1998
► CIfLtlb#1<tF)Gi4'FI �V
Applicant /33-04,(CQtiZST Assessor's
Parcel# U330S000331
Permit Number SWGa!22_ 0py3S (Twelve•DigitNumber)
Installer /larl Subdivision 670 114vent LAKE JW
(Name/Division/Block/Lot)
Lcrf 33/
Designer 6rrlc% cir2J
(idS7ALC. #'trtiSC.lf LIST
NIA 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 1-20/o? .. .. . ... . . . . . . . . . �.
D) Baffles intact and clean? . . .... . . . . . ... . ... . .. . . . . ... . . . . . .. . . . X,
E) Dividing wall intact?. . . . . . .. .. . . . . . . . . . .. . . . . .. .. .. . . . .... . . .. _ZC
F) Risers installed for access? . . .. . . . . . . . . . ... . . . . . . .. . . . . . . .. . .. ..
G) Tank Size: /,;W gal.;Manufacture A C -CA5Y
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? . . . ... . . . . . . . . . . . . . . . . . . . . . . �L
C) >10 ft from potable water lines? . .. . . . . ... . . . . ... .. .. .. . . . . . . . ..
D) Laterals level to±I inch&end caps present if not looped? .. . . . . . .. .. y
E) Gravelless chambers utilized? .. . . . . . .. .. . . . .... . . . . . . . . ........
F) System dimensions the same as shown on the design?. . . . . . . . ... . ....
G) Gravel clean,properly sized,and proper depth? .. . . . . . . . . . .... . .. . .
I-I) PRESSURE SYSTEMS
1) Sand quality ASTM C-33? . ..... . . .. . ..... . . . . . . . ..... . . . . . x
2) Head height uniform and 224 inches? Actual head heights. . . — ly
3) Clean-outs and observation ports present? .. . . ... . . ...... . . .. . . . —sL-
4) Mound: Side Slope 3:1? . .. .... . . ....... . . . .. . . . ... . .. . . . .
-
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 5 d S'O Pump model ff yDCo aatG _�
B) Chamber size gal; Manufacture A�,w_r �A!. E ca-57
C) Height of pump off bottom of pump chamber inches
D) Pump chamber draw-down i gallons per inch � 1�D wr�,4 1 ET
E) Pump capacity o� e 1M Ci //it
gallons per minute
F) Pump controls:Timer(�d Time Meter (circle if installed)
If timer is used:Pum On Pump Off
G) Screen basket or ant fd (circle one)installed? . . . . ..... . ..... . — —�
H) Riser installed for access? .. . . . . . . . . . .. . . . .. .. . .. . . . . . . ... . . . . . . —�
I) Alarm installed? . . . . . . ... .. . . . . . .. .. . . . . . . . . . . . . . . . . .... . . . . . X
...,. . ._:. T
Ce>;ctu,rsr
Gi( Drainfield&manifold
orientation &layout _ fa sw rFn�—
Gd( Trench/bed dimensions v- seh E -Sa — 3
and critical distances �A rLS kfE
within layout s,� J r° onr cE�rreZ
Ci( Septic/pump tank 685a 41*7 rp l
placement. PAO � /�TE2✓E -
- So
C LC..u/av(S
Ed Location of buildings. Tv 50WAa
Gy vE
Or Observation port&clean-
out location. .4AA PwZ-
Gd' Location of wells&
roads.
Wr Undisturbed native soil 12
between trenches.
Gd North arrow pun�0 avT
�Ta SNLG�'�E
I
3
sNEO w
CAUTION:Minor adjustments to septic tank location and draiofield orientation made in the field by the installer are�eae�( acceptable to both We nt
and the designer,but could in certain cases compromise We viability of the system. it is the installer's responsibility to obtain poor cvrithn approval forma a th t
health department or the designer before making any deviations from the design War affect the system viability. Any deviations from the approved design must be
shown above. y.
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 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 bra prior to , ` designer waived the notification 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 Zon.
igna or Instauer/ Date
The undersigned approves this installation on behalf of Mason County Department of Health Services. f
Sanstana3 `f I�'I
�� at