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HomeMy WebLinkAboutWAT Application - 8/28/2008 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Personal Health PO BOX 16M SHELTON,WA 985M LOCAL(360)427-9670 67 Application for Determination of Adequacy BEL IR FAAX(360)427--7i98 Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system util'¢ed. 3. Submit completed application,with attachments to the health department for review. PART 1: ApplicantlParcel Identification Name of App1icant1�Srce2—L.&+4_ 1 KRUFn69iP Date Mailing Address/4' 4/F, oymfr /,04 Telephone Assessor's Parcel Number 17�?C/2//0e)/5?fj Type of Water System Check One): Reason for Application LChreck One): PublicfCommunily Water System(2 or mom W, Building permit com ectiomp' o Land use application, if so.. ❑ Individual water source(one connection), ❑ Division of land: if so.. C Well #of Parcels'+ SPL ❑ Spring/surface water o Boundary line adjustment ❑ Other(explain) ❑ Omer(explain) —If you have more than one residence ❑ Replacement(please indicate name of water system connected to this well,cheek the Public box. below,If applicable-no signature required) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water System Name of Water System l Water Facility Inventory(WFI) Number: �.�3�� D (write'none"for two party) or1'/ I am the manager of this water system.The water ssyystem has been approved for a y v services. There are presently,CQconnection(s)in use.This will be the c3 99 connection. ❑ I am the manager of this system.This connection will be to upgrade or change the use of an existing connection on this system(ie:recreational to full time).Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this(these)connection(s)without exceeding the limits of the water system or any limits set by s to and local regulation. Signature of Water System Manag �— �q>`Date R 09 r:THN RWWATE"MW Update'.Apn12006 Individual Water Well ❑ Water well report(attach to application)Depth ft. ❑ Well capacity test(attach to application) gpm opd awe n so en pe s we capacity tes a e me a we is construct esu from these tests are noted on the water well report. Results horn these tests will 6e accepted. If the water well report cannot be located by the applicant or if the water welt report does not hem. oepacdy rest a wall capacity test which provides stabilization of draw- down and recovery data must be edormed b e licensed contracts ❑ Satisfactory bacteriological test(aflao to apPIRmu n) Individual SprikalSurface Water ❑ WDOE permit(attach to application) ❑ Method of disinfection g p ❑ proovidess"ter to believe of 2 ga that lllonnstpe per barce cainud n the followinat least g o abservat ons ay andlor AUTHOR OF STATEMENT DATE REIATIONSHIP TO APPLIGNT IN ADDITION TO PROODUIG THE ABOVE STATENEW.THE APPLICANT W U NEED TO ARRANGE AN ON-SITE INSPECTION BY THE HEALTH DEPARTMENT PRIOR TO DETERMINATION OF ADEQUACY. Departmental use only. Do not write below this line. CPART 3: Health Department Evaluation (Staff(lse,Only) Dc SATISFACTORY DETERMINATION:Applicant's water supply appears adequate to meet the needs of its intended use. This determimbon does rhot address adequacy of the distribution system, guaranfee an adequate supply of water/ndehrutetyinto the future,or guarantee comphance with all applicable WDOE"ter resource regulations. ❑ UNSATISFACTORY DETERMINATION Applicant's water supply does not appear adequate to meet the needs of Its intended.use for the following reason (s):" REVIEWER'S SIGNATUR DATE I:WI FVRMS1WAlERA0I.00C Updahe'_Apri12W6 fASDH COUNTY Fc::3.T11 Gonrt House Amex .- Shelton, dnplicatiam'No. None: 6310" pate ° ... Pro-:erty CFmer I/v 1 AAdreos _'._ ^,1- 'lec)se t'rint Name or :nnlic:n+ _�,Q/K(,ZZ _._ Address _. L?Plegee 3•int Loaation of Pronerty (detail@Q directions for. 10cating) [ 1'� Peeid - 2'o. Bedrooms tarnly: --City O� 11e11 ( )� Spring ance (�,) Comae ciol ) - Tyne: SRCTCIi PLA1F. AS DESDIIIATTQD 017 BACIISIDD. SEPTIC TOX 3le0 Gellons. DRAIIIAG> SYSTE. 1MTTH /ed feet, lnd/or other Check for installation of - Gcrbcge grinder ( ) Pa:tometic dishimsher ( ) Automatic laundry msohine ( ) New and eddross of .S[ /j' Sevrge Contractor - - - THC DHD-"IIGICD hereby applies for a permit to construct a new (,O}-rnd/or alter ( ) e sewage systen on.obove property. The oonstraotion and apecifi- cetions are to be in accordance with the ":also and =1e1.111^tiara Governing Sewoge DisnosalP of lieeon County. a Applicant's Signnture kle /,/ T Address 1CI ChecL- whether - Cimor lessee ( ) or Contractor ( ). HDT1 : Ploc ee refer to ":ales sad :sgulotions GoverninC ;;sva;,re Die?oeal" and the soca")anyin,^, drawings. / Permit i'o. Dote Iasaed I%f 131, Dates lnsnactod P4awr::a / �{ Apnroved by: SHETCH MD DESIG14= THE FOLLOWUG: 1. Property lines and names of streets. septic teak and/or other, drainfield, 2. Locate all building, driveways, p distribution box and trees. r 9. Dimensions of septic tank and drainfleld. Loosti4. bodies f water within 100 feel— ge ooaraewea system.e9t.5ouvd� or other Location-and .type of wells or other water supplies vi$fiin 100 feet of aevage system. - - � Y by r _ ou' y N0rfid S�orr � . fl �—rF .PF«i » l=,'. l{rl � � �, T' E ---"' j' f r/ Y I C /N f '. y 14• r r rh l C ch ` a ._ x i 'Tf 1a3a9-vi- cor3o �"Z3'�9 S aDE SYSTEM CWPIPICATIM Property Owner/7Lr, Address ade s-- I✓- Savage Contractor —O hi 'rt o e • vate 4;/iVl, Parcel# 1. Scale: 1 Square = 101 2. Draw in physical structures to be on lot. 3. Show location of well or any, body of water. 4. Show location of septic syatem in relationship to structure. 5. Asaums an elevation of 100' at one lot corner & indicate the other lot corner elevations in relation to it. 6. Use arrows to show direction of slope. loo' Lo41M ` DG Septic Tank Volume .tea Dr.lonfield Lnngth Cubic Yards grevel used /o- I certify that this syet. is installed as shown above, end that all- requirements and standards of Thureton-Maeon Health District have been satisfied. 9ignetuxn�w ' ��t'•^-c Contractor'. Lionise X L 2 f'c,Z- [r,722 June, 1970 i ONSITE SEWAGE SYSTEM APPLICATION MASON COUNTY PUBLIC HEALTH Official use only e 428 W. CED BOX STREET PERMIT NUMBER: SW MC'-QZ - OO-1 I SHELTON.WA 90584 DATE RECEIVED: 0-7 AMOUNT RECEIVED:$�iL O (380)427-9670,Ext.352 O O7 APPLICANT CNECK APPLICABLE nEMS Y S JhCK J RNS �� 'ON o= p NEW SYSTEM a Z 0 REPAIRSYSTEM m m MAILING ADDRESS DAYTIME PHONE p TABLE B REPAIR c PO, R/I% I(� �iUb_53b_3y� p TANK REPLACEMENT S IJ0 p RV HOLDING TANK ONLY y CITY HTATE ZIP _ (re uirnawaiver) m FAI Y W k ggy2g p INSTALLATION PERMIT ONLY SITE ADDRE95 �Ot BINGLE FAMILY Z 2318 o N E �7K(L (LOUTS 3 I fit°LEM� OTHER Please dasamA c oulMe• 3 NAME OF DESIGNER PHONE NUMBER hl-T(L"D7J ' s' ai�{gJQPI INOjgo plyi9N ff�) to17q-5z3 DRINgNGWATERSOURCE NAME OF INSTALLER p PRIVATE INDIVIDUAL WELL O p PRNATETWO�PARTYW U.x COMMUNITYIPUBLIC WATER SYSTEM NUMBER OF BEDROOMS- LOT SIZE: ACRES FT%FT SYSTEM WF1A Iu 'y1I.�_Qy'L/1(� , I' /' I%� �(� SYSTEM NAME: lV5", t ( sI — SPECIFICDIR TIONS FOR LOCATING SITE. m I� D Site must be tlaqged from main road and test holes must be flagged with test hole numbers 0 to Official use only below this line " I_ SOIL LAGS COMMENTS/CONDITIONS I !(J,J RECEIVED id OCT 2 2 2007 Ogg W, CEDAR STt SOIL TENURE CODES, V G=_qmvelly S=sand L—kam 5I=31I1 Cmday E=adnmely EV RSIGNATDRE DATE DEMGNEKPDIATIONDATE DESIGN APPROVED BY DATE u 6 o bec zo to 11k1,607 INSTALLATION ItEPAID DATE INSTALLATION BXPDUDO DATE INSTALLATION OVEDBY DAIS 1 AaWead l/I20aT MASON COUNTY DEPARTMENT OF HEALTH SERVICES November 06, 2007 Indigo Design PO Box 163 Poulsbo WA 98370 RE: Design for JOHNSON Case No: SWG2007-00711 Parcel No: 123294100130 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, a .4 Amanda Reynolds Environmental Health Mason County Health Services COMMENTS: 11/6/2007 1 of 1 SWO2007-00711 DESIGN FORM—PAGE ONE A design will be reviewed when 3 ct sl is of each of the following are submitted: O Completed design form that has been signed and dated. Scaled layout sketch,including all applicable items on checklist Scaled plot plan,including all applicable items on checklist +Cross-section sketch,including all=pticable items on checklist Permit Number. SWG 07 -m7 k1 Designer's Name: (L Applicant's Name: TAC-K JOtftr_04 Designer's Phone Number: ?gyp-`I'14'5133 Mailing Address: P•D• WA IIIq Designer's Address: P•O.6f/X I(G3 BGI&I✓ Vdk G ral f 0t(t ,WAr 9g3510 City State Zip City State Zip Assessor's Parcel Number. ��2�1- L - QOL3C ,r a6T rvry A Treatment Device ®Gkk ddon BiofiJlJtcr ❑ Sand Filter ❑Mound ❑Sand Lined Drvofidd O Recirculating Filter,Type: '❑Acrobic Unit MakdMadcl D Uisinfxtion Unit MakrlMadel Other: Drainfield Type ❑ Gravity ❑Pressure ❑Trench Cl Bed O Sub Surface Drip Septic Tank/Drainfield Specifications p�.. Laterals c�xusnes} Number of Bedrooms Se HFALTR Daily Flow b gpd Len At Septic Tank Capacity gal Diameter V U 6 ZU07 in Receiving Soil Type(1-6) Number Receiving Soil Appl.Raze gpd/ft' Separation n{ ft Required Square Footage ft' Orin Designed Square FootageXfk fe Total Number of Orifice¢ Percent Reduction Taken % Diameter in Trench/Bed Width ft Spacing in Trench/Bed Length 1I��A Mani Id Elevation Meaauremenis H((Cj'n0 Schedule/Class Origisl Drumfield Ar ea: %a Length ft New Slope,If Alteredfusion in DepthofExcavation ) in tied manifold configuration used? ❑Yes o from Original Grade ) in Tmout.rt Pipe Designed VeNcal Sein Sch Class Graveit-'ChambersYes b No Optional Length Pump Required? C3 Yes 0 No Diameter in P'Nuipecifications Dosin and Pus amber Difference in Elevatiump Shutoff and Uppermost Number of doses/day Orifice Ft Dose quantity gal Upperm 'gee O Higher ❑Lower than Pump Shutoff Chamber Cap gal C (aj 7oW Pressme Head glint Pump Is: Timer(or)Elapse Time Meter irck(freguired culated Total Pressure Head ft inter: Pump on Pump off Comments TActc �a�d N1 )'"-f an/Z 9t T%c orAc— r.rT of TAc 1/1r%,-- sic 4(J... In•vr .+�b s.� J c.c w+—ex" 7.,7 DESIGN FORM—PAGE TWO Assessor's Parcel Number.__ _ I — b D I3j� Permit Number SWG Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch fib Test hole locations $ Drainfield orientation and layout Reference depth from original grade: ,43 Soil logs FIN Tmochlbed dimensions and Septic tank *% Property lines critical distances within layout Drainfield cover �l Existing and proposed wells D-Box/Valve box locations Reference depth from original grade within 10o ft of property Septic tank(pump chamber and restrictive stmm: �( Measurements to cuts,banks,and locations ❑ Laterals,trenchibed,top and surface water and critical areas Observation port location bottom Location and orientation of Clean-out location Cl Curtain drain collector curtain drain and all absorption Manifold placement ❑ Send augmentation components Orifice placement Other cross-section detail: Location and dimension of ,rp Lateral placement with distance ❑ Observation ports/clean-outs primary system and reserve area r-Ac to edge of bad I Buildings Other Information ❑ Audible/visual alarm referenced Yes No it Direction of slope indicator vC Scale of drawing shown on scale ❑Design staked outWaterlines �r bar ❑ W Recorded Notices attached Roads,easements,driveways, ❑ A Waiver(s)attached parking ❑ IN Pump curve attached /J North arrow and scale drawing ❑ Mvaluation of failure shown on scale bar Non-residential justification ❑ FWaste strength ❑ WIOW The undersigned designer ❑does,Cl does not,waive the requirement to be notified by the installer at time of installation. / Signature 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 regulations: Environmental Health Soccialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDMON: v' The design is stamped"Approved"by Mason County Department of Health Services. The Onsite Sewage Permit has not expired,the Permit Expiration Date is: /Voo' (or Z-0/O v' Drainfield site conditions have out been ahered to adversely affect conditions of design approval. Please Note: The system must be installed by a certified installer,unless prior authorization is obtained from Mason County Department of Health Services.An Installation Permit is ro q uired. Revision Date:223/06 Wastewater Systems Indigo Design, Specialty Engineering ■ Monitoring&Maintenance P.O. Box 163 • Poulsbo,WA 98370 • (360)779-5233 9-24-07 Reference: BELFAIR MIXED USE BUILDING ASSESSOR'S H Attention: MASON COUNTY ENVIRONMENTAL HEALTH PROJECT NARRATIVE This building currently has upstairs offices which are being served by four approved and permitted Glendon m-31 units which equates to a peak flow of 480 gallons per day which is more than adequate for the upstairs. The downstairs part of the building is being developed into a small restaurant which will serve sandwiches and cater to the lunch crowd. There is not enough space to accommodate an on-site septic system which would meet approvals by Mason County Health for this projected use,so we are proposing the use of three holding tanks to accommodate the projected flows as outlined below. This proposal is only temporary as we understand that the area will have a sewer system with a sewer line in front of the subject building sometime in the next couple of years. The holding tanks and the existing on-site septic system would be abandoned at that time. The holding tanks will have a redundant alarm system which will allow for adequate surge capacity. We also propose that there be a contract in place with a licensed pumping company so that the tanks could be checked and or pumped on a regular basis. The total volume of the three holding tanks will be at least 3,750 gallons which equates to 2.8 times of the projected peak flows generated by the restaurant and employees. The existing upstairs office already has a permitted use and appears to be functioning normally at this time. � o�g 1 PROJECTED FLOWS FOR THE NEW CONSTRUCTION RESTAURANT 36 total seats and stools Using the USEPA 2002 manual on page 3-7,a figure of 3 gallons per patron was used. Assuming a turnover of 10 times per day at 3 gallons per day=1080 gallons as a peak flow Assuming 3 fulltime employees at 15 gallons per day=45 gallons as a peak flow Assuming the kitchen will use 200 gallons per day=200 gallons as a peak flow TOTAL PEAK FLOW= 025 GALLONS PER DAY TOTAL HOLDING TANKAGE Three 1250 gallon tanks plumbed together=3,750 gallons This total tankage represents a factor of 2.8 times the peak daily flow The tanks would be plumbed normally with the alarm set in the bottom third of the third tank. A regular route set up by the pumping company should be able to keep the tanks relatively empty. CONCLUSION The figures represented are what we would consider peak flows if the restaurant was immediately successful and being used to capacity. Reality dictates that flows would likely be substantially less in the first year or so. The tanks would be pumped out in any case and sewer could possibly be installed before peak flows were achieved by the restaurant. Sincerely, Eric Knopf �� 2 Chapter 1 Establishing Treatment System performance RequRemerVIA Table 34.Typlml weetewelerflow rates brown commercial sou rces^° Flow,gYbnNurathday Flors,atwwowtlasy Fa Via. Ual Rails TYPW Nmp Typical Aepon Paasnger 2J 3 8-15 11 ApaMrent house Person 4040 50 150-3W IN AVhsmohile service slasw VeNde served 8-15 12 30-67 45 Empbyee 9-15 13 34 7 40 Bar Customer 13 3 4-19 11 Ernpbyee 10-15 13 M41 49 9oimiq louse Person 25-61) 40 95-M 150 DepaMnont dom Toilet mom 400-600 Soo 1.501 1,900 Errybyae 8-15 10 30-57 38 Hotel Guest 40-00 SO 150-233 190 Employes 8-13 10 30-49 38 Imannal buitAg(smiary waste 0*) Employee 7-16 13 26-01 49 Laundy(see-seance) Machine 450450 sm 1,700-2,501) 2,100 Wash 4555 50 170-210 1SO OI6ce Employee 7-16 13 2 61 49 Public lavatory User 3-6 5 11-23 19 Reaaanml hAh toilet) Meal 2-4 3 �15 11 Comentorwl Cuabnwr 8-10 9 30Je m Stodordar Cuablrer S-0 6 11� 23 Bar/mcb{il tangle Customer 2.4 3 8-15 11 Erupting owes, Employee 7-13 10 26-19 36 Parting space 1-3 2 4-11 a Theater Seat 24 3 8-15 11 'home ayne^a xni,g rrore Nan 20Peapb mghlbe�a9elaud un4er USEPA'e Gwr V lXi4e1q�wq Yye IbnCmlml IVIC)Pmgrsm.See hap/Mww rya.yorhehwater/ueMMfor mere lrnwmaeon. 'lhesemle'am�pprere Ne eXed of NN�eammplyin9 won Na US Energy P0"k (EPACT)ofIM `DIP""WbR vM iesm Sl wOl waowa1BlmrimY nS tme Yva l by Ca%V VIC m'f1lai—siopmled9mundwaNr.Se, hop/AwwaApagoMakweteMk blml for more inbmaeon. Source:Criss ma Tchebamgbus,1990. 3.3.3 Variability of wastewater flow Figure 3.3.Daily indoor water use pattern for single-family resldence Variability of wastewater flow is usually character- ized by daily and hourly minimum end maaimwn 15 4- T-TOILET 0—DISH WASH L-LAUNDRY W-WATER SOFTENER flows it inamnlaneous peak flows that occur 8- BATH/SHOWER 0-OTHER during the day. The intermictut occurrence of i 3. individual wastewater-generating activities can I0 g o create Inge variations in wastewater flows from IJ residential or rwnresideatial establishments.This A. e ] 2 variability can affect gravity-fed onsite systems by ] 3 a potentially causing hydraulic overloads of the system during peak flow conditions. Figure 3-3 T T illustrates the routine fluctuations in wastewater "w+ flows for a typical residential dwelling. 0 0 w 3 6 9 N 3 6 9 MN wastewater flow can vary significantly from day to TIME OF DAY day. Minimum hourly flows ofzem we typical for Srauce:UnlversdY01W6cmtin,1978. OSEPA On91te Wastewater Tleatment Systems Manual 3-7 MASON COUN'ry PERMIT NO. D.DEPARTMENT OF HEALTH SERVICES - 426 W.CEDAR I P.O.BOX 1S66/SHELTON.WA 9BG84 FNN IA'31-q7 Re a No. �RI PHONE(360)927-9670 OunlSFHOPLKIYGIANNERL CHECK APPLICABLE ITEMS i/ NEW SYSTEM NIAILINr2 ADUPE35: ate•' ,DA MEPXO NE, REPNRSYSTEM VV l X %%5 21P: MAINTENMICE REVIEW ') CITY: BI.— 'a f ZY. SINGLE FAMILY RO n OTHER /�+•^�/•a.e PP l L+j K. f J' /� i✓ SP 6 PIINPIE WELL SPECIFIC DIRECnON4 FOR LOCATING SDE: COMMUNTYWEWPUNICSVBR6.1 iU L - / SYSTEM WflY 7y c I G / l LJ & 2 a SYSIEMNMIE L i Lth i IN- P A 1'1 1 0 I f" Name OfT Ld D a.�4 n wluxG Ess.,r: I fLr , QS N Iroblbr J[ r.f rhw FULLIPINIGNE r Ii-Ir .r w 3�I^ Nemec 'T' u s TD 1 r /)il1^ DaMpe, y M rl JL` I Bea99tl16 r PLOT PLAN I -O Drew a amenebrlel Pbl Plan, / @ ir¢luarlp: IQ L p Precise IarsEon Of teal ..rwwirlB 1 ❑Entry roe0;dnar roeM. w a aNeYnYc NOTE: DD NOT DRAW IN I I It SYSTEM DESIGN ``I(I OFFICIALUSE O LY.DO NOT WRrFE BELOW DOUBLE LINE. WwvuM MTCn "I W 801E 1A08 TMrM%.E 2 TC37/dL� m 0 C9 6 0-1P rr Fla(4y"t) ,2 mc. r) /-uA FYLG ("ant)' eerrlrN/ekuNT[r a YO- 39 -4rNysWri�nc 27'86/-7sA.*7 x7-t-�fi.-/ carat.) FNeeM for-tev2 34-45wk•MEX yL-IirfwMfK 31;_4p^ _Ki TiSfIbCEW sl y,Lreanc Yc Yv/ts -lieru>< p n tl 9C � p PYLC !v/Is //LN11///} k Fla : ta�P Auxu l 92 eR f hw I/a S� otlsrWA'1 `Yafi/G DESIGNER DESIGNATION SCORES MINIMUM SYS)TTEM REQUIREMENTS q- tom. Designer Level'. DO— 6Twlo�,� Soil TYgs �d -J_ L�r^_Jg,'.�.�v"/' y 1p/lsMEfq�wCIM uYT^p;'^PY_Y"v'IMfi S H CePM n �,JL Nl4tLwhhwy Pr�PtlS M:P' 1xo Gal. R Fhxy } GPo SbGa ^Y3(eL= TvdPAt APNrA1 nfiM Ma.)' Percnl9irs -�yys Tiere r g GPG/R' Area FT' Mq�K� DislYice to entlrelire/ ,-..� Twl I^s Dale f GOMMENTS/CONDITIONS FOR APPROVAL fm'I/..+ T we ♦ aM/f Ttl /eACC awN L/An05 61NL{( fII% sra is TIL///f�'y`LPT L (B -n"(Qa d 9/s5l�vc�a q v •Atl oR weewege ryNama must he eusignae bve Masm cwrcY CarePeCem4r- - Irw�wwMw a6m- 9raM' �s..r al oa+lre eewego av�+ema meal ee mardlae ora MaaM coaaN ceNII.aIMela,ws® MP.Nea lwa � I obwN><v�iM• In cum w�a Polimmary omane marries earwa.rr naann eHeraned Men w manmr.wra.r w rwPNM. .Onaire eexege sysrwn sago eppw&eoea nN rmplY aN'a huiMaq ab rpuYammb(l.e.RLc.wela be9wsYl nose Eeee mat. .MY tlrarrge hom'Ira zpsiliM rW of M PrWarIY a erry sOatlWatlNr eflading Or9 Walarr EsaNn rrwy YrMMYe tlia pinnl. Finis germnerplres2years hdn Ne Celadsnarwiew.OMNIdtlIL9 me rM Ce tlw XaeM OIb.V WMJr 10 OlCaeai CaN_ DESIGN REVIEW AW.d pNd APPb 11NMO OW AR,,. SffESiENEw. I I!Q`• DATE 111(aI TD BY TE'-7 / t DATE'M / ,1I TOP:HMSINh Dept COPY MIDDLE Des errs PY BOTTOM:Appllc t COPY MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 (360) 427--%70 FAX 427--7798 APPLICATION FOR RE-INSPECTION - ON-SITE SEWAGE PROGRAM- DIRECTIONS i. Coiplete Part 1-3 and supait to the Director of Health services. PO Box 1666, Shelton, MA 98584. 2. The on-site lead will Hake a deternanatlan in Part 4 4wther a re-inspection is justified. Men a re- inspection is wide, the findings of the second Envirgmcntal Health Specialist are written in Part 5. A final determination by the lead is recorded in Part 6. 3. Applicants are billed at the current adopted fee schedule vanes a re-inspection is required and are ex- pected to pay for any necessary laboratory costs associated with soil tests. unless prior arrangeaents are wide with the health department. 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 RE-INSPECTION Applicant's Name: CQS-,e! kJVgr Address: • 0 . 6 J lick mi v I_.AA. tly,,i¢ Telephone: ( ) ..-IS - S40d II ; 3 2 l ( -� 0 \ -1 U KSseswr s ParcerAuiier — Subdivision Plane, and Lotr Health Department finding being disputed by applicant: n n Mticipated deptli of watertable u Soil type/application rate u Depth or presenre of mottlirg n n u New drainfield area to eval wte u Other (please specify) PART 2: AUTHORIZATION 6EP pp n APPLICANT 0� Abq / P A(n., 1i- DATE S- (` -Sg H:DM-SITBRE-EV&.M Revised 12/18/97 3-4 PART 3: PLOT PLAN Use this space to draw a detailed plot plan. or attach do, to this application. A detailed plot plan is one Mat shows the precise location of the test holes, existing septic systems, dimensions of the p'opertY. and location of any Bells, roads. or other buildings on the property. PART 4: DETERMINATION OF LEAD ❑ Re-inspection is justified. 0 Re-inspection is not justified, for the following reason(s): On-Site Lead Date x:um-SITME-EVAL.N Revised 09/03/96 PART 5: RE-INSPECTION FINDINGS SOIL LOGS TEST HOLE #1t1 - TEST HOLE #3 42B,- °Id e'a 1w 4� Sv.l -vAmbk, +ia'- k,J_k4 �;i- • !. cqW pp+ ,Pid1+1k- QM+ p.l'l' " 6, S+W ✓�.�. S"�d jrdA S+V-V 3 w.e i -A" .wl yvy.+1 -12 co-ync+;w, , cawu�-kl 1� V mw.leer M Am$ -lax r+a SA.a Aid YA"A -F° toms S+ltl 'M OS+w 41" y iave� DESIGNER DESIGNATION SCORES Depth from original grade to restrictive layer: 12 Parameter Finding Score T"ti Soil Type pe ° +Ib= ds+�•ee,� 0«4.,snw Usable Soil Depth to in. IOP� 1a S+v Slope Parcel Size 1.0 Ac. o-Lb w i, ,-q,.a ,+,..d 3n 1 Distance to Shoreline +121 ft Total: 8 CSNI+c J'A W MINIMUM SYSTEM REQUIREMENTS Parameter Requirement Designer Level 2 Septic Tank Capacity + llev&gal. Daily Flaw ` 6A' QPd Application Rate B g;r,2 Infiltrative Area •daq ut OTHER �p�ENTS NpSr ilaa anv 'fo 0.e'1P/v.-mac. h41l EWv W o'd TNP 1 AW T01 M4iM4w4 9� L SN- 19 Environmental Health Specialist Date PART 6: RE-INSPECTION DETERMINATION Accos3 N a F d a lbw s9� sa; 1 tk '03 awt 7R r y On-Site Lead Date S Billing Amount Receipt Number H-M-SITBRE-EVAL.M Revised 09/03/% MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 (360) 427-9670 FAX 427--7798 APPLICATION FOR RE-INSPECTION - ON-SITE SEWAGE PROGRAM- DIRECTIONS 1. Corylete Part 1-3 and submit to the Director o1 Health Services, PO Box 1666, Shelton. WA 98584. 2. The on-site lead will Mike a detemination in Part 4 Mether a re-inspection is justified. When a re- inspection is mde, the findings of the second Environnental Health Specialist are written in Part 5. A final determination by the lead is recorded in Part 6. 3. Applicants are billed at the current adopted fee schedule when a re-inspection is required and are ex- pected to pay for any necessary laboratory costs associated with soil tests, unless Prior arran"ents are mde with the health deparbrent. 4. Findings and deteminations of the lead my be appealed to the Hason Canty Health Officer at the ad- dress listed above. PART 1: REQUEST FOR RE-INSPECTION CC ; Barjows Applicant's Name: jIIGL `)OH►sON Address: " Telephone: ' 3 6 1 '075 5,4w 44izq � as W -g1 -6872 pameTr Subdivisi o Health Department finding being disputed by applicant: n ^ u Anticipated depth of watertable Soil type/application rate u Depth or presenre of rattling n u New drainfield area to evaluate, u Other (please specify) PART 2: AUTHORIZATION APPLICANT DATE © H'N-SITBRE-EVAL.W Revised 12/18/97 S-4 PART 3: PLOT PLAN use this space to draw a detailed plot plan. or attach one to this application. P detailed plot plan is one that shprs the precise location of the test toles. existing septic systeas, dimensions of the property. and location of any Hells. roads. or other Duildiigs on the property. z a 1 FILE F1Lr pL� ? 1" -- 2i�9 jai jW aop.eti:�.. � Fiu te' __. a feu In i��as "vyr PART 4: DETERMINATION OF LEAD ❑ Re-inspection is justified. Re-inspection is not justified, for the following reason(s): On-Site Lead Date OH:OWSV EW-EVR.L.V Revised 091031% MASON COUNTY PERMIT ASSISTANCE CENTER Macwi County tea.III 4M W.Cesar P.O.Box IN BM1911en,WA 995Bi (")427-WO Selfair(360)2754467 Elmo(M)482-5269 SeaMe (206)464-6988 DATE: 3 /15 TO: ,�Itce Jo/Frosal11B00 10N£5 FROM: c 64,2(I47ff p6 3oa 5 SUEIECT: QelSXnan/ APPLICANT: SWG# PARCEL# 123?9 '4/- 06 130 AST Hatz 0 1 15T A&Lp 0 a O's4�Lofi»l 520 W/fh 0 �2fo'I .6GP'-D/ t0?m/LOrIM/ ecg lc. 068615 Iowa 111/Ot6AfV/LS -F/CL Gray Fue-wows &KZ 26- S2e Boor mI T lotgowICS/ snags) toe»ty.srM/tl /M07TLED eVLOAK 21-.► drarvrlly fo/r+irY54 32 '6A " 7/Lc , IRL6bIVlItG 60YNDJV/ do /JFONGr AOtCeMfWfrct, 601i ge lar Arr g/! iI � d. JEST UOLCM 3 'I0Ir hbl.6 N a 0-15e FILL •LonoTsbVD p-lI°LDA")y V"y F/M sMtD ril nv e2ana/►twm AcAel5 PILL '6-4 �,fp fg Illy 40MY p-t3'r �avr/lJI tOArity s+nvp 5nv �ioyrl/ smvay LOAML eon 24-Sq ° yeeYwer/SOT9e#If� 23-3/" //lNY sAvo uN/U�xoLID'ric» wo'ty x u l d0 Mt e< 5R-59' NYlffl' 3y•5n" COn+iAttt?7 SE✓� l�jrK�/�Ca� sa-s6 " w ?�/Z(n�QQ� aN -sljE EY/fLu/t7/ON PIDEC aL50 MZ 1//6149 a. -S/TE EYIhlIA�/Oljj ur,TE3 kzy MASON COUNTY PERMIT ASSISTANCE CENTER Meeoe COI,"Bldg.III 1 W.Ceder P.O.60a lee Sh lDim NA i141W (3B0)427.8670 Seftr(360)275-4467 Elma(360)482-6269 Seattle (206)464-6988 DATE: 4S a8 TO: FROM: SUBJECT: -^ bF 5 APPLICANT: PARCEL4 mug-Al W 13G FOL./Nal>OV XErlC. AM /!/fY[l'gM ge/IS~S R Wd/kPL �I.�![IIAA�Mf' — ON �II�,)g8 � drovr d�T�'/GSr�E � lNvoeur�tl '(4� t7fDT/15 �fO ylolGC !N 7hC /6LE5 / - s)S5Ao q3 "DEL7� Yz 3S"4U o7 ��A!If �3 - 31 "Tor4at ►/ AW> 3 ORLOTRAtrN For u5l�z4tG saw oL�o7/� sastn �o s taoaJ 4NGG 6F IA6 ST!}7E qON 42 : aa&A fz' o��cnr 41 N><f (dNCL/61A�1 �l Mgt of ?X157/N6 Ft" IHA IeIAL. UaLfIdALE FDle mg.6 ,k,NLtntt , bbEST !/Uu /'dJV Tt?CT LL �L7/F/Ez� SG/L _ MASON COUNTY PERMIT ASSISTANCE CENTER ueeoncamy buy.ill�W.Ca4ar PA.Box IN elnaan.WA Nw (360)427-9670 Bellair(360)275.4467 Elms(360)482-5269 Seattle (206)464-69M DATE: 9D TO: FROM: SUBJECT: APPLICANT: SWG# PARCEL# jXJ�3O CcItwil5T 7a Evw( i/kTc 17tz SITE I Tbz Al HV2 ' ,THf- 54lTA8VTXOF TN-E FILL- - S CONO OP/NloN Neeyia ol(- ("Sf lvaLwa1Z 570911 M ky[rauUG CO DAWTiVITV/ 4) EA) U79QAJ M2VIAL /J'AI T& WItL l2G3PKT�Gn1T/ Atr T-r#e Fz v/I`7tl 31► m m The E45a4mT OFT ClWv OPiN/ON SECOND ooiN/DAl CONFI ZWS 2'LI/ E!/ La1A7/orY 0'F 7Hf FILL lleN &O"ZC Ralew ��oc �La cumc c WA/vER 01 p �Ayr iod Awg,* +c-rionJ pst�n gl i e rtnr c��s�rt�us a►c ccneuur�s 4211 ® YZI-Oval &XT 2� y gI 5]•' � � A� t ga• 3 �• � � -.cW v�9 x3� a. C w 1oSL � x A 3 ? o a a g g 3 T W a a 9. �I� os�� A �� � xss�p.9 ¢�' �? ESL, a .E�. $ •3 S3i2 P aG $ � '� s� si a �•� asi � �w s s' g g•� d F'a_ 4yA �yE dg = 3 �$ & pail y ` gay 'a � E s ! q � • a MASON COUNTY DEPARTMENT of HEALTH SERVICES 6netton,Wcanhgton 9666e (206)427-9670•Be6dr:276d467 PERSONAL HEALTH WATER OIIAIM ENVIRONMENTAL HEALTH {N.FOURTH P.O.BOX 1666 P.O.BOX 1656 MEMORNIWUM FROM: �Ft(•�•� LLv.IW� RE: Design for Lq_%4gr parcel A 1 23201, - 0090 J Your design for the above referenced parcel has been reviewed and is APPROVED. Your design for the above referenced lot is NOT APPROVED. it does not meet Elthe requirements or needs additional information. ®RKyded )ESIGN FORM - PAGE ONE A design will be: reviewed when 3 aooies of each of the following items ao eubaitted, Completed design fora that has been signed and dated completed Completed design f Lends and Critical Areas ndChecklist a IIILrY7 U U Scaled plot plan, including all applicable items on cha Scaled layout sketch, including all applicable items on kliat Cross-section sketch, including all applicable items on cheekl'An O 5 is CoMMf.I[.LN4L PARCEL IDENTIFICATION {yMMW gK H SFe1C1Lu'ES I�ffV.C2a 97-0892 Designer-. Name Bud TonA]?L?RCl�)L7111 Permit Number p� Tester Krueger prop. Owners Name same (N(ia)s f LY II Applicant's Name n n^ Trig Mailing Address Mailing Address Assessor's Parcel No. 12329_9�T Iva-41-0 Am0eYT' Subdivision GLE/JI�OI ) DESIGN PARAMETERS 81C - L7E.e M-31 u ✓ / / Designed II r-L, Vertical U U U U U U separation II mound subsurface Pressure Gravity Bed Trench f2. in S optic Tank/Drainfield Spabification ❑ Yes I}XJ NO M .n e .. .� No. Bealiebme AM' 0 ,Aa V -5Z Lxk- assure DistributiOaT . ... .:::^ .. u.: (If Daily Flow H O sod yes, proceed...) ii.................Septic Tank Capacity l2m cal Receiving Soil Type (1-6) -3 Receiving Soil Rate �t Lsterale Trench/Bed Bottom om Area rea echedul Class Trench/Bed Width Length Trench/Bed Length t Diameter Elevation Measurements Number Original Drainfield Area Slope ,3+- t Separation Drainfield Area Slope if Altered a Orifices - Total Number of ifices Depth of Bottom of Trench/Bed 1JB _ in Diameter in from Original Grade W�I1P� Spacing ,Gp 1^ Mani o d I TROPs Schedule/Claae ft II Length Infiltrator Used? D yea C No Diameter �^ V Tr sport P e pumpRequired? CE yes No Schedule/Clare I Length I ..................i i (If yes, proceed. . .) :M.H...........................:..... .......%......... . Diameter ^ II Pump/siphon Specifications osing and Pump Cismb r N Difference in Blevation Between pump Shutoff 8 Doses/D I and Uppermost Orifice io ft Dose 0u tity Chambe Capacity u Uppermost Orifice is 2higher, lower than Pump Shutoff �� Che the following components if they rain d Capacity a Tot. Pros. Head gli Nr1o`hdP b wean doses: u Calculated Tot. Pres. Head -<c me aD ft ❑ G� (Attach Pump Curve) Laterals Manifold C Transport DESIGN FORM - PAGE TWO "'"" ° WWI, DESIGN CR :C ISTS c'.1 d Y�-t Plan a^^l d L vout Sketch -8 tl ek t-h © Ref arena. depth from -rig- J lu Test hole location- Drainfield orientation i++�nal grad., III and layout ILl Septic tank lid and wY Property lines Q Trench/bed dimensions and drainfield cover depth I I Existing end proposed critical distances within I wells within 100 ft layout Reference depth from orig• u of property lines I inal grade and restrictive d ® D-BOX/eT'/'L• locations strata+ II Critical distance chamber ® Lataralc, trench/bad measurements to cute, ❑x Septic tankly%mg top and bottom banks, surface water location u h d II Location and orientation ® Otiearvatioa port location Curtain drain collector Q of curtain drain and all I Cleaaout location Sand augmentation II absorption area components a Manifold placement No external reference asaded+ Location and dimension II of primary system and Orifice placement Obearvatiow ports and II cleanouta reserve area Lateral placement, with I � Buildings distencne to edge of bed Additional mooed Satommtioa,N II Direction of slope ® Audible/visual alarm ® fillowidthd downslope u II indicator raferenced u I u waterlines I Scale of drawing Shown Settled cap depth at II II on scale bar center and edge of bad �j Roads/easements/ driveways/parking Additional Mound Iaformatlon+ ® Sidewall elope u Critical resource lands ® Eadslope width ® Op/downelope bed slavat. /if applicable) ® r 1 ted Resource Land$ and I overall fill dimensions III North arrow and scale ofti 1 A se Checklist drawing shown on bar Mason Count D 11 y APPROMEi1__ II nasxcN Annaovw iniiieia it a II ' The undersigned designer ©does, does not, waive the regirement to be notified by the installer of the installation and given 48 hours to perform a final Snapactlon prior to & - /- 9� ® S'-al"pg}tYRI[gP�--DSCS The undersigned has revieeeda and this design on behalf of Mason County of Health ul Services. sea CAPTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIONS+ III ✓ THE DESION IS STAMPED -APPROVED` BY MASON COUNTY DE➢TARTMENT OF HEALTH SERVICES I ✓ THE ON-SITE SEWAGE PERMIT HAS NOT EXPIREDI EXPIRATION OF SAID PERNIT IS BASED ON II THE DATE OF INITIAL SITE INSPECTION, NOT ON THE DATE OF DESIGN APPROVAL III ✓ THE SYSTEM IS INSTALLED BY A CERTIFIED INSTALLER, UNLESS PRIOR AUTHORIZATION IS OBTAINED PROM MASON COUNTY DEPARTMENT OF HEALTH SERVICES I L ' j �♦ Hy A.: t. 1. ! f � AM A N' �' 1 r ., � ♦ ' Yt Ftcr".l6, a t (• �4 P it h Cr�r � L JY I r t �. � :t � - t `i fa +J i: r'i i c^ } rf r! ktrj t,;� S \�`R�tl !r d• i?! > . '�?>^, , -• �'. ., ! rr.ti�t ,thl•7''�S. r�•l _'� ..�` � r 1 as er L'a.�`r tt 5;1r f 7L>;� }�b� sr• �'dr. oSK ,3 �i r l 'ti t t.t • J l N } , iK , ! 'c ; iy 41'� " t•S 4 �.{ 3• .. �,� ) i ' ,r1d '-i��ti yWr✓ O Y i y; !! f9YcaMa v t :tt/' 4'r` + (•6 r� '[' O 7 L,p'. T�� t;, � ,� . .. 6.. -w �♦ s.t trl• _+�e1�tn �aa h A Y�r'y �.^'ll� �tr, o b r' T,�• r 'i. ! 'Rpa} In n W. I SY,�• 1. 1 r rl Y•ns a`'!r�r �'F f� ,' !1 i• ' a> iItt a�..h.' Ki 5�T 'u a°..^ fit,• �f} ti rtiYT,r ! a t ! �� 1 l'n t C • r ml`t � lvlrya r 1�R , • ' Wi 4d",CtM1 � Jc� ^i t ` i r �. � ° t�4 r4 � v J d'�� r � t('i' t+; 8t �• � ..(+++MMM t ! ..i3 �. . ron! Ip pr ♦ }. �s-, `! L c { 4 by .; . ' tl I Jr y �.v N .:,il J4 »a,..'i,�}:lri�'• It4 Fs� �;i rti ���:i'�L•u:'rlwa�A.�t..' :Y,7+ Y,.•� ` 'Nq'10 .- J ` a 1 a t i . . •r. .1 •) `,.tit • •'OV:60 46. £Z AM led SZS S3SIddtl31N3 tOSErW OMZ-5LZ-W gx ©air d � Y . p IR r OH 2 z0 0 L _ to rr 0 date �If d5�'ry 5 F � s & 6i 00 � 7 �u Ox Rig o r "11 ® -" � � `17 BioFilter Design Guidelines Model M31 , 120 GPD 0% to 5% Slope Type 3 Soil Rim Absorption Area "Foot" Width 10 r so" Ceunfy Cept, Cross Section APP7?0 vEi� Length laltah_ 141 Date GPD minimums for all calculation of each M31 unit 120 GPD Loading Rate = 2 x Soil Loading Rate O.8 x 2- 1.6 volume loading w/o media (of per GPD capacity) 2.2 Rim Length=L (in feet) g Rim Width=W (in feet) 6 Basal Rim Depth=D (in feet) 5 Internal Volume (D x L x W) = IV 270 cf Internal Loading = (IV/2.2) (cf per GPD) (min. = 120) 270 2.2 123 Perimeter Rim Length = (21- + 2W) = PRL (in feet) 30 Perimeter Rim Loading = 1 foot per 4 GPO = (PRL x 4) 120 GPD Absorption Width = AW (in feet) 10 Absorption Length = P.L (in feet) 14 Basal or Absorption Area Available = (AW x AL)-(Basin) 86 sf Basal or Absorption Area Required 75 sf PROPRIETARY SYSTEM TOP VIEW NO SCALL I I MODEL 1+131 G'LWDwJ Mood-4t. .✓ ) 4 ' tQ I (ALL r., M 019 1Rs .sic-A--Y) '(j •, bo I � � • I ,Crzoss s�.�rl�l� PROVED Na B .LAL 10itiBls _ (� — I �dtB MoOr-L M-11 CLENDenI Mo--LAP . \ \ V / / FocY ARFA FaoY AREA \ ml - ALL Fodt MODULES DOUL 'WE SAME wAY '. :i /7T117!/771-07177/A,eA A OL/6idI AlGESS oP.,GINgL SoILs ol¢IG.�uwL Se,La MODvLAC L�NFZ SPECIFIC-CONSTRUCTION NOTES FOR THIS-SITE It the site is too et to prepare, proceed properly *dry. Installation in wet soils can reduce the infiltration rates. s for rage of cavated * not areas, lumberapackages,in field aoraanythingothat will ydisturb or destroy park- ing destroy the areas. roped the *The din fild sites,aprioreto and eduring tthe e setting of�the rmobile protection or the construc- tion of the home. his system shall onform to *Construction regulationsnandd materials requirementsoOftthe County HealthcDepartment. latest *Topography, benchmark, stub-out and invert elevations are based on assumed data. *Ascertain locations of underground utilities before gsing. '00*Encroachment of the home and/or driveways into drain f ' �g_1*bM$errce, area may render the site unusable, requiring a redesig (.� r 4b costs, or even totally unusable. Initials *This septic system is not intended for a garbage disposagafeUse of such may cause system failure. is ic t a filter *ins the outletan ue of sidesof thehsepticttankymaymcancelu located any warrantyex- pressed or implied. *This system requires a proper degree of maintenance. Certification of the design and installation does not insure trouble free service. *Keep the septic components a minimum of 10' from any water line under pressure, unless sleeving of water line is provided, per codes. *A curtain drain is not required at this time, but the option must remain open if unforeseen problems occur in the future. *The property owner is responsible for the locating of all utility lines(water, sewer, power, phone, gas, and etc. ) *As needed, install check valves in pump outlet so as to prevent the system from draining back into pump chamber. Check valves, if re- quired, must be accessible for 0&M personnel. *No curtain drains allowed within ten feet of the up-slope edge of the Glendon Bio-Filter foot area. No curtain drains allowed within thirty feet of the down slope side of the Glendon Bio-Filter absorp- tion area. *Influent waste water characteristics must be typical household sewage. i. SPECIFIC CONSTRUCTION NOTES-FOR THIS-SITE *Only those installers certified by the Glendon Bio-Filter Corp. , are allowed to install this system. *The designer uses property lines that are identified by the property owner. The property owner becomes responsible for the final place- ment of the system, in respect to the property lines. *Operation and Maintenance is required, and must be accomplished by those that are certified for this procedure. *Since the Mason County Health Department has established the absorp- tion properties of the soil, the designer assumes no responsibility for the systems longevity or failure. This system design meets State and County design standards. *The current site has very shallow soil depths and extra caution must be taken to prevent the destruction of the site. *The designer has established approximate contours apd location of the system. Actual layout of the system will be don11W C" &W%,JA3ervices at time of system installation. AilRO�}i� *Electrical controls must include provision for timed dogq&�to on Y allow a maximum of the daily designed flow into the Glendon BTO -- Filter. Automatic high water over-rides must be eliminate. aiaL water alarms must be shut off manually. Dose counter will be rage red. All floats must be installed on a separate mast. Do not attach floats to the screen basket or the pump discharge line. Electrical control equipment must be installed near the pump tank and accessible to 08M personnel. *All roof gutter downspouts must be tight lined away from the septic system area. *All traffic must be directed away from the Bio-Filter area, The area of the Bio-Filter must be fenced off from any livestock exposure. *The designed location of the septic tank and pump tank may be changed to fit the final location of the home, decks, walkways, or etc. The absorption area cannot be changed without the expressed approval of County Health Department and the designer. *When final grades are established, elevation differences must be check- ed and coordinated with pump selection, *This Glendon Bio-Filter must be installed and maintained per the specifications of the Glendon Bio-Filter Company. *A 1 /8" mesh in line effluent filter with no less than 12 sq. ft. area shall be installed on the septic tank outlet. An Orenco Systems Model 842 or equivalent filter is recommended. $PECfFIC CONSTRUCTION NOTES-FOR THIS SITE *QUALIFIED INSTALLERS: The following contractors are licensed by Mason County Department of Environmental Health to install septic systems in Mason County and are also approved by the Glendon Bio- Filter Technologies to install the Glendon Bio-Filter. The Glendon Bio-Filter is a proprietary and patented device. Pioneer Digging E. 3083 Mason Benson Road Grapeview, Wa. 98546 Phone 360-426-1803 Highland Excavation E 200 Arellem Road Nsson County Dept, Health Services Union, Wa, Phone 360-898-3773 APPROVED Initidjl ` Date SEE ALL ATTACHED CONSTRUCTION NOTES. REMOVE NO TOPSON DURING SUL rnb. OWNER TO PUNT GRASS OVER SYSTEM AND MAINTAIN GROWTH. DIMENSIONS ARE CRITICAL. DO NOT DEVIATE FROM DESIGN. USE EXTREME CARE IN SITE PREP. This septic system is designed for a peak flow of YBogals. per day. 1s� SEPTIC SYSTEM DESIGN ONLVI WAO�FIJ APEF wv./ ASlfihn THIS B.S.A.SUBJECT TO OTHER k�NNi.4 >wea�.v r. AGENCY'S APPROVAL] THIS IS NOTA SURVEY] (�EFyTiy( Oft I I 1 1 1 I I I I ~ K y Y z t SEE ALL ATTACHED CONSTRUCTION NOTES. REMOVE NV 10PSOH,WIRING Sift rau. OWNER TO FLAW GRASS OVER SYSE[W APO MAINTAIN GROWTH. DIMENSIONS ARE CRITICAL. DO NOT DEVIATE FROM DESIGN. USE EXTREME CARE IN SITE PREP. This septic system Is designed for a peak flow of±90gals.per day. " 1 LCA00b 0 AtAO WIN A A9➢%Hn 1MIS6SASUT BJECCTTTOOTFfl Rwr./xb v.Np e,v,r. AGENCY'SAPPROVALI THIS IS NOTA SURVEYI r�(,Valiae.C Ann 0°O Nearh, { Initials PA DaNlei �~4f i 1, S ° Ira & A,1✓ a -mac 2 Y 3 B. J.'s Septic Design 14174 NW Holly Road #133 Bremerton, Washington 98312 360-830-5056 IItN '9 i'12,l 6-26-98 Pam Denton Mason County Health Department P.O. Box 1666 Shelton, Wa. 98584 RE: Lester Krueger, Parcel #12329-41-00130. Permit number 97-OB92 Pam, The 15 gallons per person that I used for my calculations came from the E.P.A. manual. These same figures I have used in other design work. The proposed building will house only office space and will not be for any type of manufacturing, doctors offices, cooking establish- ments, or any other type of business that will generate anything other than normal human waste. The building will be rated at a maximum of 32 people at any one time and for only a 8 hour period during each day. If you have any further questions, then feel free to contact me at my office. Sincerely, Bud Jones -- - Certified designer in Kltsap and Mason Counties. Certified Operation and Maintenance Specialist. AS-Hfmr Ow-srrr lf'wary rweo ^-. ! -- _____. tl A.0 02 OD U7: 46a Bob 6 Patty Pay3se 360-427-2353 P. 2 ON-SITE SEWAGE INSTALLATION FINAL INSPECTION cam t F.. d7-779Y M. DAn CALLED Dc TDAE: Y� llwll=: All, APPLICAN7YOWNER: CALLER: p PHONE OF CALLER: SWG N: --o R � -2 �l ( PARCELNUMBER: 1oC3o7 / / "0 (90o SUBDIVISION: Dir. Lat SYSTEM TYPE(CHECK ONE): ❑ _cT^�✓�^^" PRESSURE GEAVRY NSPECTION SCHEDULE(CHECK ONE): cl ❑ APPODrrmwr PLUOIN AS-BUMS ON-50E(CHECK ONE): ❑ '�' ❑ YES NO STAFF D[ : 77,77 7.777FJ(A'TA}'€I7RE`QNL' .-�c-` „ _'c'a '>� ... ✓:&4 :. APPOINTMENT DATE: TIME: COM.M�.YTS: ii. Rub 02 00 07' 46a Bob L Patty Patdsse 360-427-2353 P. 3 LS-BUILT FORM a<rf.<dF<aw n :vn PA➢CEL 131EWIFICATION AppIk4M's Nmpe 1�7„� y( - O D 13Y7 Assmor's Pfccl a P-1 Nunbc cwr•Q 7 . R R 1 C we v umh� WsWIQ•a NunG Oes.,o's Nunc � I maa m IRaTALLF3 Cu"YA UT WA Ta. Prkrb ca piatkn 1. Sarttc TAylK t/ A) >S h. Fora fmodatim7 ................................. — B >50 n bam well rood aulfac<cud' am �- �- C3 Blde blba¢baplc taak�duocm If ea 12%T ..................... �- D B.msdYp aad'olmt .._.._.........I................. ...... E Dividing ............................. F) Rlam iucsR ..... ......... ...../� ..r '. ./ -4sc- — G) Tmk Sim:l zoo gal.; MaWAfictive: 0 D-Idoa Lwrded wbh sla3er lattdla)sped kvcle(off ame is usd(atrrJa) ILL 011412ats4a A >IO 6 Eum fmodYlm and n A(wa PnPc7 liam1 ................... B >IOO n mom wwa�1�WW P "ar brfaca wmm9 ......... ...................... — >IOitOmm ;MM t T"— 0 Labab bW t� wwisa and ape pe"Jaor bopdt......�........ — E) (:volt-�a�.vdliad4 . _.... . e this'. ...................... Fl S)a l iiaw•ima spa aaba as�Gawv m' dcupst ................... G) Gnvd aiad.and PaDr ditht ........................ 1))) MtlASSTe Cd)t ....••... -- — :a Basle ieG6¢" : mY Ocad — pacYgmR..................... _ A MwmG: 4Wa-Sham L.It. emu by WAI?............. — owaaF �alleseltlr sad mwaGad q ......... . Iv. A) FdmD'4 t. Pump Model D 3) Cb sbfws k01229 gal. MmIdlama c - " C) Fkight ofp®p el4amo o(PumP cbfabf 1 .7� wrae D) Pmp cbambf'dnimsp I:_. Ssd°os Pc ua }) Pump IfoWt0'Idi9 B Od I�r a kraa.d) e) sacra e.eka lJ rs§�(6.1.me)Manuel? FO RisR iatallad m F ....••....................... . . .......... 1) AWm uwll.C7. ............................... ..__ . . . e ._ ,.. . .. -.-._..,. 71 . . -.::x,..._._.....' . ..� .:-� :,='�4iE�•rl'F(�akibnoF4ucSPku�ofY � .: iq Installer Check a box hom Aow"A"and"B",sign and date the enilpcea A. / 1 cR.iry ram!il:suflca the system without any ^- I eeniFy•Am al:derotlons tram the deign smn:pd deviation host the design 312111ped'APPIOVEd`by WPnOVM"by V,CDRS m:shown A.w. MCDRS G. ❑ 1 mr4(y list 1 carts,:ed he destg r and left:he afa not emLa the dvsi"aet poor h final cover Onerv:e 'Osten open far kspeeuon oP m xd hrs priano / desipntt waived s.e aati�a4an rcquVemcaL GGYR. I further mniFy that all in:ornuien contained an Nu fora is te-watc. l undmmnd=a:IFIhe Iniarnxion wruined berth: sec. saumea,there will hejc%""a let hansceiate suspe^,sien of av,ns:al El Ei r.. , 'vim/R}/f,E m1.o:Lnl er a I <undc:vgned acprare:hL•iruislla:ier on beha:fsf Mason.Ceurly Diet:", ee _.antf cea. 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