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HomeMy WebLinkAboutSWG Inactive - 12/17/1976 -- 'sth-& Bi26h, P.O. Box 746 THIIRST.ON-MASOiU HEA1'.T.H DISTRICT No. Shelton, Wash. 98584 OIVIPIOM or INVIROMMINTAL NIALTM Courthouse Annex Phone: 426-4407 Olympia, Wash. 98501 Phone: 352-4851 EXT 84 Prospective OWNER North Mason Frienda of the Library PHONICR5-3232 OWNER'S ADDRESS P-n- Box 161 CITY Bel fmir STATE We. 9A52A SEND REPORT To North Mason Timberland Librar lTY Belfair STATE We, 98528 SEWAGE CONTRACTOR ADDRESS (If self, confer with E.H.S.) LEGAL DESCRIPTION TrAnt 1AP Ran R- ThelerIn flown and aardan Trmntn , Maxon County SeePARCEL N0• 32, Township 23N, R.1R LOT SIZER-IM wn ram INTENDED USE OF BLDG. Future library NO. OF BEDROOMS NO. OF BATHROOMS BASEMENT PLUMBING: YES NO NAME OF WATER SYSTEM INDIVIDUAL PUBLIC COMMUNITY i DIRECTIONS TO PROPERTY: (Be Specific) 6001to 900# north of Dentiatls effiea and Bellair Blame 8ahool, on West side of highway, Test holes 30 paoes from -h4-hwav an Foment 7A w-,nnite 0 ni""ember- mmil-box 2 1 a 20 DRAW ASKETCH SHOWING: 1. Property lines, location of hrlvse on the lot, and dimensions of the lot. 2. Location of the house and sewage disposal system in relation to streams, lakes, wells, soil log holes, patio, driveways, underground tanks, water supply lines and easements. }f'' J - /r nce,le I pbse�ve® �er� Prop ,n ° E6emae'W wry S"Oot The septic system is an approved, temporary method of sewage disposal until sanitary sewers are available. DO NOT WRITE IN THIS SPACE CphjJ 1 �Ovla : T �1��S e�ar�vneh� wiuS� �e MINIMUMS: \_ Septic Tank1i1,sJ^('ue1i7 � Qf,6 LLi �1? _ Drainfield �� v 1 ��v,�1�W , �' ,� _le•(_YYY),� �� eOf �'►'►;�I�mum re.�alreme��s ©f ^lie sewa.�� g�s�en1 l / SITE AP ICATION APPLICANT'S SIGNATURE /�• DATE SITE INSPECTION FEE RECEIPT NO. 'Hi' APPROVE NO APPROVED BY Dat Date Inspector -.H.S. / SEWAGE APPLICATION NEW / / ALTERATION / / APPLICANT'S SIGNATURE DATE / /74 FEE AO C a RECEIPT No �BY PERMIT NO. APPROVED BY Date Inspector/E.H.S. 428 Birch Street OLYMPIA, WASHINGTON 08501 J. V.DESHAYE,M.D., D.P.H. 529 W,sl Foudh Avcnue CISTRICT HEALTH OFFICER SHELTON, WASHINGTON 2,06 - 753-8067 May 12, 1977 SHELTON, WASHINGTON 98584 Dept.of Social 6 Health Svcs. Bldg. Post Office Box 746 206-426 4407 Louise E. Morrison Timberland Regional Library 1006 Sleater-Kinney, S. E. Re:Timberland Regional Library, Belfair, Wa. >dotL7lo• �6�5 Dear Mrs. Morrison: ' I have reviewed your Environmental Check List Form and the Declaration of Non-Significance. We do not have information to add to those documents. The necessary permits for a sewage system have been obtained by the North Mason Friends of the Library. The permits are valid until Jan- uary 1, 1978. A copy is enclosed for your records. Please contact this office prior to construction to determine the size of the sewage system, or if construction is not to begin in 1977• We will be glad to assist you in any way we can. Sincerely, J. V. Deshaye, M.D. , D.P.H. District Health Officer Marjory Dilworth-Dale, R. S. Environmental Health Specialist MD-D:vl Encl. ON-SITE SEWAGE SYSTEM SITE EVALUATI bISPO PERMIT NO. SWG 95- Cn n MASON.COUNTY DEPARTMENT OF HEALTH SERVICES / a Date `- 426 W. CEDAR/ P.O. FOX 1666/SHELTON, WA 98584 " o Receipt O y PHONE (360) 427-9670 Amount$ Z f ' m m / CHECK APPLICABL TEMS ✓ 3 < Vr-K�1 vn0.1 l�l I�12''6VCI NEW SYSTEM 2 iCtl ONE: REPAIR SYSTEM u'c,e CeJ �+✓�iAs�✓ MAINTENANCE REVIEW m R /r��,(-� 71P - SINGLE FAMILY m Vl !�i cr- vl� � STHER Z PECIFY: 3 PRIVATE WELL m COMMUNITY WELLIPUBLIC SYSTEM Gs! Yr SYSTEM WFI# I\ SYSTEM NAME �a APPLICANT f. f 7 NAMEOf CA �tyJ Name of " '" Lotb ft. MAILING ADDRESS IW Installer f L!7 Size: I 2 acres TELEPHONE Ln Name of Number o SIG �( Designer Fy, S Bedrooms GI PLOT PLAN Draw a dimensional plot oraqfALI including: �tu �b(�W 0 x o/ p o IO ❑Precise location of test holes,showing measured dista ° t� J 4`p� property boun a� . r X ��1. ❑Entry road;of ds, D 3 k driveways. P gyp . I MAY 5 19 N\ 4tp _r' z NOTE: DO NOT DRAW a� SYSTEM DESIGNN v HEALTH SERVICES' OFFICIAJ USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. SOIL LOGS Z $ 11 'L e5-b �lLlonr�f4� o 'l� ScbN - o- a, I �k A - 7 C' fse..v.. - I Sty# OZO 41 Depth from Original V 4 U" � -'t Grade to Restrictive tYL LStat.�v� �IC1(NO "-�- Layer or WaterTable:�_ In. DESIGNER SIGNATION SCORE Findin MINIMUM SYSTEM REQUIREMENTS g Score Designer Level: ❑One Q'iwo Soil Type _5— Septic Vertical Separation �� Ca in. ci Daily Capacity: ty: f Gal. Flow: � GPD Slope L i 0 Appl. Infilt. - Parcel Size 7# /t Ac. �fn Rate *#5 GPD/Fr' Area FT2 Distance to Shoreline W Oi. TO—tall InsP o_ - <-- Date C� Ub COMMENTS/CONDITIONS R APPROVAL ILAA All septic systems must be designed and instalIJ by contractors certified G Mason County Department of Health Services,unless prior approval is granted by the department,or the design is by a professional engineer. Septic permit 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 2 years from date of site Inspection.Denial of this permit may be appealed to the Health Off loer within 10 days of denial date. SITE REVI DESIGN REVIEW:O Approved _j Not Approved INSTALLATIONA Approved O Not Approved BY: gi�e� DATE: BY: DATE: BY: DATE: TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy 'MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTO pNp6,,)WA 98584 F70 AX 4 7--7798 APPLICATION FOR RE-INSPECTION DIRECTIONS 1. Complete Part 1-3 and submit to the Director of Health Services, PO Box 186, Shelton, WA 98584. 2. The on-site lead will make a determination in Part 4 whether a reinspection is justified. When a rein- spection is made, the findings of the second Environmental Health Specialist are written in Part S. A final determination by the lead is recorded in Part 6. 3. Applicants are billed an additional $75 when a reinspection is required, and are expected to pay for any necessary laboratory costs associated with soil tests, unless the health department is demonstrated to be in error concerning soil type. 4. Findings and determinations of the lead may be appealed to the Mason County Health Officer at the ad- dress listed above. PART 1: REQUEST FOR REINSPECTION Applicant's Name: C_ 4(142V14z Wma Address: I :l/_• 610x 131A M. N WA . 5a9 Telephone: 3me1 sb"P'P�$Pc7T WMn rL 3 Health Department finding being disputed by applicant: r_1 19r-1 u Anticipated depth of watertable Soil type/application rate u Depth or presence of mottling n n V New drainfield area to evaluate LI Other (please specify) PART 2: AUTHORIZATION APPLICANT bV t'AV, L►ty \( DATE R:OR-SITRIRR-RVdL.N Revised 12/05/91 PART 5: REINSPECTION FINDINGS SOIL LOGS TEST HOLE #1 TEST HOLE #2 j +I�" Fiq-oIe-Appr W bwwd, 3,14y loww o-a� ygwhy s loMw 1 o-a6- 3tAv6j SAWJ (o� ac,io Moto +evw��� a Js 64 Nno�ld a�•sI". �,oeNcb . ywd7 IO"w gMd�nyio Sty (mea. g+ lly s" L"Nd kx1t., io SOH I I I DESIGNER DESIGNATION SCORES TH*3 Parameter Finding Score O-lb"•sovj�j 104',,, Soil Type (6.V- woMW SAV� lap„ Vertical Separation 4 in. Isfh Slope y-lo} opt Tk r4 Parcel Size .11 Ac. 40 Distance to Shoreline aioo ft. 0A I 0-{i,4• O(d W11" 10*A Total: ;lllp}s Ib-'i4" waiLeF Ioyw MINIMUM SYSTEM REQUIREMENTS ' Parameter Requirement Designer Level 7 Septic Tank Capacity J&Whrik gal. Daily Flow *gpd Applicaition Rate .(o gpd/ft2 Infiltrative Area w ft2 OTHER COMMENTS i L( 1}l*,2 uU, Environmental Health Specialist Date PART 6: REINSPECTION DETERAIIINATION g&61S On-Site Lead Date S Billing Amount Receipt Number R:ON-SITE\RR-RVAL.R Revised 22/05/194 PART 3: PLOT PLAN Use this space to draw a detailed plot plan, or attach one to this application. A detailed plot plan is one that shows the precise location of the test holes, existing septic systems, dimensions of the property, and location of any wells, roads, or other buildings on the property. ` \� I � j I I � I � I � � I I � PART 4: DETERMINATION OF LEAD Y�I'Reinspection is justified. n IJ Reinspection is not justified, for the following reason(s) : (_I�L:(1- U 9-9-g s On-Site Lead Date R:ON-SZWRS-SVAL.W Revtaed 121051,94 SITE NO. MASON CO NTYVOKTH DEPARTMENT , FOR DEPARTME use ONLY ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR AMOUNT NUMBER 428 WEST BIRCH STREET • SHELTON, WA. 98584 I RECEIPT PHONE (206) 426-5561 APPLICANT SIGNATURE James EI. Robinson ADDRESS PHONE 4904 Kitsap Way 206 377 0066 SITE: APPROVED O NOT APPROVED PROPERTYOWNER North Mason Library Building imberland onal r 3 �2 7 BY: ADDRESS { 5 Airbd strial Way SIWONE DESIGNED SY TEM REQUIRED CONTRACTOR Hemley Septic T9011KR - SEWAGE: APPROVED ❑ NOT APPROVED LEGAL DESCRIPTION - See attached drawing Al ) BY: TYPEOF 0 - ttOT'y NO. OF L SOI TYPE BUILDING Library BEDROOMS None 5IzE0 O EPTH TO WATER TABLE PERC. RATE SINGLE FAMILY PUBLIC WATER Be Tr a er g WATER SYSTEM ❑ SYSTEM IX NAM 1 SEPTIC TANK(S) IpOa- GAL. PUMP REQ. COMMERCIAL ONLY - LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL_ IA4"A40A FEET DIRECTIONS TO SITE: FILTRATION AREA LMAMM^'u' '� SQ. FEET QUANTITY OF One mile south of Belfair on west APPROVED STONE-CU. YD. SAND-CU. YD. side of Belfair - All Highway. FILL REQUIRED CU. YDS. FINAL INSPECTION REQUIRED BEFORE BACKFILLING 72"STRAW DEPTH OF BACKFILL ( OR PAPER STONE PIPE SIZE < STONE SITE PLAN AND SPECIAL STIPULATIONS mo_ j I UNDER TILE (INDICATE DIRECTION OF DRAINAG ) CROSS SECTION OF TRENCH E .97TJ��fR p� . r COMMENTS: S THIS SITE PERMIT EXPIRES 1 r. hI timberland regional library service center: 1006 sleater-kinney s.e, lacey, wa. 98503 (206) 491-8475 (mrs.) louise e. morrison, director April 26, 1977 ly�� hF4RST�<< 19,1 ' Thurston-Mason Health Department 110 West "K" Street Shelton, WA 98584 Gentlemen: We enclose a copy of our Environmental Checklist Form and a Declaration of Non-Significance for a proposed new 3,000 square foot branch of the Timberland Regional Library to be located on State Road 3 near Belfair, Washington. We will be in need of a permit for a septic tank and wish to make an early start on our planning for that building. Please let me know if this provides sufficient information. If not, are there forms which we should fill out or other steps which should be taken before such a permit could be issued? The North Mason Friends of the Library recently donated two acres of Tract 16 of Sam Theler's Home and Garden Tracts as a site for a library. During the time that property was in the possession of the Friends of the Library, they had a percolation test done. In fact, the test was done prior to their purchase of the property some four years ago. We probably can track down these records if they can be helpful to you. Please advise what our next step should be. Sinh�/I �' Louise E. Morrison Library Director LEM:lb Encls. i serving grays harbor, lewis, mason, pacific and thurston counties RFC i ' . #�. +c. is `'., F < j F 1860000 SEWER DRAINFIELD SAVE `" N LF TRENCH REQUIRED, `; TREES j s BENCH PROVIDED �s 9 N rn 57 ; z g. 4 o }IP _ 1"0 PERFORATED PVC = � cn DISTRIBUTION LINE (TYP) DIRT H I` . •�8 �49 4' N DRAINFIELD SETBACK & �.,48.1' FOR PERIMETER FIRE JE ACCESS AND POTENTIAL =P ,•, —�2 4� o RUCTION TO EXIST. INGRESS/ 41 =� " RESS/UTILITY EASEMENT ss.. 5� 2"0 PVC TRANSPORT LINE (TYPICAL) '.s b. -. GALlO EPTIC•TAW a x a DOSING PUMP CHAMBER 72"0 MH W/ DUPLEX N; 1/2 HP PUMP SYSTEM A (SEE DETAIL), C a ll�lleo ref`. ~� f .MASON COUNTY HEALTH,DEPARTMENT 428 WEST BIRCH STRffT SHELTON, WASHINGTON 98584 t PHONE (206) 426-5561 raAsvr, coua+Tr HEALTH DEPARTMENT RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTEM OWNER,I /� N. .Ni9jO.J L./Q,f,9yg' ADDRESS 'J//GO0J7;Vf& WY ©4,19Y�P1,AlU2 THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. LEGAL A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER DESCRIPTION S17Z;- W_4 S�! WITH PROPER MAINTENANCE AND CAREFUL USE OF WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH COMMENTS AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SITE FIELD X LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO. SIZE FAULTY FIXTURES. DEPTH TO MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER (� FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND LG�/"l STle ;5U4J wL THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. CLEAN- SIZE ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR- SEPTIC TANK (t) 2 Up Py g ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS DRAINFIELD ELD ! 2— O FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA Z�D SQ. FT. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS TILE DEPTH Z y ❑ CORRUGATED RIGID ❑ CEMENT RECORD WHEN HE COMES. HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE ROCK �� DE PIPE DEPTH �L" TOTAL CU. YDS. DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS SPACE RESERVED FOR RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD: SQ. FT. SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING NORTH ARE LATER CONTEMPLATED. SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO THE SEPTIC TANK AS THEY WOULD INTERFERE WITH �16RAKY A CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE � @i4e1Nf. DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH THAT SURFACE WATER IS NOT POCKETED ON THE M DRAINFIELD. ANY SETTLING OF THE GROUND OVER THE � TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX- CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. 3 WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT EQUAL TO ONE HALF INCH OF RAIN PER DAY. Iy� t Ab FOOTING DRAINAGE, DOWNSPOUTS AND WATER SOFTENER RECHARGE WATER SHOULD NOT BE CON- 4{ NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE q01 DRAINFIELD AREA. - D THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY CHANGING THE CHARACTERISTICS OF THE SOIL. THE NORMAL USE OF BOWL CLEANERS OR CLEANING COM- POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW SOUTH DOWN THE OPERATION OF THE SEPTIC TANK. n THIS IS AN IMPORTANT DOCUMENT DATE APPROVED BY KEEP IT WITH DEED OR OTHER ESSENTIAL PAPERS. DA CERTIFIED BY �•