HomeMy WebLinkAboutSWG2019-00112 - SWG As-Built - 1/6/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALT „-
APPLICANT/ PERMIT INFORMATION :<
Permit Number SWG "s„tJ 1 g — I(2 Parcel# 22212-50-03017 1 N
Applicant Name JAG Construction Subdivision (Name/Div/Block/Lot) a
Applicant Address PO Box 476 Lakewood Plat A Blk 3 Lots 17-20
City, State, Zip Manchester, WA 98353 Installer Name Tom Weaver V
Site Address 130 E. Cedar St; Belfair 98528 Designer Name Tom Weaver 1C`
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only El Drainfield Only ❑ Repair ®OtherTank Baffles replaced
System Type Gravity Pretreatment Type D-Box Retro + Access
>5 ft.from foundation? - - El N/A tn YES ❑ NO
>50 ft. from wells? - - ❑ I] ❑
Z >50 ft. from surface water? - - ❑ g] ❑
H Cleanout between building and tank? - - CI CI
✓ Tank baffles present? - - ❑ In ❑
d24"access risers over each compartment?- - CI CI
rW Effluent filter installed?- - CI ID
Septic tank size 1 ,150 gal Manufacturer Original concrete tank Cast outlet waffle
0 D-box water level and speed levelers used? - - El N/A ] YES ❑ NO
XO Manifold/D-box accessible from surface?- - CI E CI
OOZ Check valves installed? - - ❑ ❑ ❑
oQ 3034
E Transport Line Size 4 Schedule/Class
Bedrooms installed (check one) K] 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation? - - El N/A ® YES ❑ No
c >100 ft.from wells?- - ❑ IN ❑
W >100 ft.from surface water? - - El ® CI
LL >10 ft. from potable water lines?- - CI ® CIZ > 5 ft.from property lines and easements?- - El ® ❑
4.7
02 > 30 ft. from downgradient curtain/foundation drains?- - ® ❑ L l
Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or UI Clean gravel used? (check one)Existing drain field and D-Box 3/1976
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistant with septic tank?- - g N/A ❑ YES ❑ NO
Pump tank size gal Manufacturer
< 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑
H
a Alarm or Control Panel Installed? - - CI CI CI
2 Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑
m
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
2 Pump Make/Model ❑ Floats or ❑ Transducer
d Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/2112018
Reserve Soil Log
0-18" Loamy Med Sand
18" Compact
For Oscar II if needed
t`
O(n
O O
N .go
11
U N
� 1 ON
Y 'N
iL. Cedar St
Water Meter
-Tel
100' 0 o'el
Existing D/W
14'x 65' 3 28' ti
`Q bedroom �o 3
\., 35'X3' Mobile
\ 1 ,
.to remove '
l Co
\ New 4"Vne ---
New two bedroom
E;
Existin Home ,-10' —
U T Mo
D Box
o \
\ 34'
o
Lea \\ /,
8y
100% Resery
Oscar II
p )* 22'x4 St 0 #� I•
-17'el -12el'
0
{
510U'i3
p.TF1gR4as E.wEavER'\ .
EXP7:,ptl25I.Z `,
22212-50-03017
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES NI NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - p YES 0 NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record
Drawings contam: Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings location of wells,waterlines.
wells.observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
See Attached Photos and original As-Built
The original septic tank was retrofitted with new inlet and outlet baffles
i
[X Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I certify that!installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this ;MrthafilegliMML «rwrr wAire,
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
12/12/2022
Signature of Installer Date 4
o / /
Tom Weave • ':1 �
ro •.ow
Printed Name of Signee �r ��yrr�, •• �1�1
sal•.• 'Y a, ^I
MASON COUNTY PUBLIC HEALTH ��r: ;'G �'`:III
The undersigned approves this Installation Report and ,; 5100333 '".••
e THOMAS E.WEAVER'•, h
Record Drawing on behalf of Mason County Public •' i e -I04 Fr u.
Healthn Ey-in Di1251
--tA) ezio,,,
Signa rei
ronmental Healt Specialist Date (stamp, signature and date)
Updated antrzota
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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' THURSTON-MASON HEALTH DISTRICT . .
529 W. 4TH PHONE 753-8073 P.O. BOX 746 110 VIA"K.;ST. PHONE 426.4407
OLYMp1A,WA 98501 aa� j.a.' - go • cy3,3.1...-i-2SHELTON, W4 98584 -
- • RECORD OF FINAL INSPECTIyON OF YOUR.SEWAGE DISPOSAL SYSTEM
OWNER _ _ n . TOWNSHIP RANGE • SEC.
'THIS RECORD IS NOT A GUAR TEE OF PERFORMANCE. • NAME OF LOT
• A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER' PLAT O ]� „� - NO. / r4F-/5-to
1 WITH PROPER MAINTENANCE AND CAREFUL USE 'OF SOIL n� •T .
WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE.SER- • COMMENTS 7�.0
VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SITE / AERATI FIELD X
BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH NO. 6a5i' Oj SIZE
AND PLASTIC MATERIALS DOWN THE DRAIN,OR BY LARGE DEPTH TO. • ' !MONTH �,I GARBAGE 8 YES
AMOUNTS OF WATER FROM LEAKY FAUCETS OR FAULTY WATER TABLE ,' OF YEAR DISPOSAL NO.
FIXTURES. INSTALLEq�
THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY j
TWO OR THREE YEARS DEPENDING ON THE HABITS OF'THE SIZE • /?
FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND SEPTIC TANK IS) O?/z) g P. 2
THE AMOUNT THAT A GARBAGE DISPOSAL IS USED, DRAINFIELD' , F. J TOTAL FEET
CLEANING AT'THE RIGHT TIME WILL AVOID THE RISK OF LENGTH, 3/0 _ . -
• INJURING OR DESTROYING THE DRAINFIELD DUE TO TRENCH AREA • TOTAL SQ.FT.
•SOLIDS CARRYING OVER INTO THE DRAINFIELD. CALL THE �d J Z��U
THURSTON•MASON HEALTH DISTRICT FOR A LIST OF LIC TILE r �J
ENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE CLEAN. DEPTH /��a� CORRUGATED rl SOLID ❑CEMENT•
ER CAN SERVE YOU BEST IF YOU SHOW HIM THIS RECORD ROCK _ 1�
WHEN HE COMES. CU. YDS.:� t 3U` �.t1J7).� '" DEPTH L..._ INCHES
HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER ;BE SPACE RESERVED FOR
DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS REPLACEMENT DISTRIBUTION FIELD: SQ. FT.
' RECORD IN CASE ANY BUILDINGS, DRIVEWAYS, SWIM I " I t
MING POOLS, OR EXTENSIVE GRADING OR FILLING ARE "NORTH`__. a. I'
- LATER CONTEMPLATED. ' • �0 c-LL4)a�. -- ._'. •• .: --... ...— . ,. .. • -: .,
• . SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO . ••. , . . •.. • . • ; .
THE SEPTIC TANK AS THEY WOULD INTERFERE WITH • !t �r . .. : . _ .. ,. , . • : • ' 7
, CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE' • -
i 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 DRAIN- .. ••- ' • •• .
FIELD. ANY SETTLING OF THE GROUND OVER THE TREN. :' • • I :' ' .
CHES SHOULD BE FILLED IN WITH SOIL DO NOT EXCES• �F d . .
SIVELY WATER THE LAWN IN THE DRAINFIELD AREA. , ' • =r -. . M bl f! ( • . '
WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT. 3' 9R-� • • ____I -' ' • . -
EQUAL TO ONE HALF INCH OF RAIN PER DAY. -
_ 1 r" —.__ •
' FOOTING DRAINAGE, DOWNSPOUTS AND WATER : - x �'"X; I •• • _
SOFTENER RECHARGE WATER SHOULD NOT BE CONNECTED • • • .
INTO THE SEPTIC SYSTEM OR DISCHARGED INTO THE DRAIN- ' .. J: .. • ' • %I . :
FIELD AREA. i. I s. `� . . , — . , a 4 y 73 . (`!
THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE i •- I -- • - `3 'k . : . - , , 4r a
ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD • - - .
YEAST OR OTHER STARTERS'TO A SYSTEM. THE USE OF RE• " . "'• - • •., T3 •�' ' � •
JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK • • 4 • _ r - 4 , • .1 O•
,�•! O '
HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY .. ......_._ __. .. ? .l y
BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR • • - • e. •-' * ' • .._• : •• ._
BY CHANGING THE CHARACTERISTICS OF THE SOIL THE I - • .- "" _ .- '.-' - '• - -. .
NORMAL USE OF BOWL CLEANERS OR CLEANING COM- �� �-•.� S'IA .. 'SOUTH IV
POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW
' DOWN THE OPERATION OF THE SEPTIC TANK.
ii.----2 - 76 Mar3-
DATE I.j7VED BYTHIS IS AN IMPORTANT DOCUMENT 3 _ �_ -76 Q '
. KEEP IT WITH DEED OR OTHER DATE ZERTIRED BY
ESSENTIAL PAPERS.
O.,
.I
TANK PUMPING REPORT
Sib Num
130 E CEDAR ST Service Company:
Betiair
Tax ID:222125003017 KITSAP SEPTIC PUMPING
u«: 5201 E.Hliaest Dr.
Port Orchard,WA 98366
380.871.5258
Serviced:11/02/2022 by:Trenton Miller Submitted 11/04/2022 by:Darren Miller
D..n.Local ie.:BIO-Recycsrp Jurisdiction ID:222125003017
COMMENTS
Owner we replace Inlet battle
TAM:Septic Tank-2 Compartment
Tank Pumped: YES
Tank Size(Gallons)(Number only,no text): 1150
Effluent level within operational limits(If NO explain In comments): YES
Total Gallons pumped from tank(Number only,no text): 1000
Effluent returning back into tank after pump&ng: NO
Tank depth below grade(inches): 8
Access Risers installed to grade(N/A if not present): N/A
Tank Construction Material: _ Concrete
Tank Condition Good: YES
Baffles in good condition(N/A If not present): WA
Effluent screen cleaned(N/A if not present): N/A
Effluent surfacing around site components(N/A If not checked): NO
Tank abandoned after pumping: NO
Were repairs made to the Tank or Tank Components?(If YES explain In comments): NO
Compartment 1 Scum accumulation(Inches,If other specify): 3
Compartment 1 Sludge accumulation(Inches,If other specify): 10
Compartment 2 Scum accumulation(Inches.if other specify): 0
Compartment 2 Sludge accumulation(Inches,If other spedfy): 4
Sc,Awe ateo.mo.rt.na..e.wm oleo orw.armor.meant rrn.Mom o/rut.I,no wy,A ea sport.p..' of opnolmonwka, WAY....
ReportlD:621882 View pump reports online at www.oNmemne.00m Page 1 of 1
1
Mason County Pumping Report 12'122022
AAA S pflc Punpons
PROPERTY INFORMATION
Location:130 E CEDAR ST
Bettair
Tax ID:222125003017
WI To Jag Construction Llc
130 E CEDAR ST Use:.
Berfair.WA
GENERAL SYSTEM TYPE:Conventional (Non-Pressurized)
ON ID.:222125003017
County Area:Hood Canal MRA(w/In 1100 ft)
Fold ON-SITE WASTEWATER TREATMENT SYSTEM PUMPING REPORT FPO
W.. Inspected:0905/2007-Inspection Type:Pumping-Correction Status: wn
Company Submitted 11/14/2007 by.
MA Septic Pumpers Mane Seymour
COMMENTS&GENERAL INSPECTION NOTES
System Status:ii..
INLET BAFFLE NEEDS REPAIR.
Component(Serviced?):Conventional (Non-Pressurized)(Yes)
Repairs Needed:
Repair Comments:
Septic Subtotal:1000
Gallons Pumped:1000
Gallons Disposed:1000
Disposal Date:09/05/2007
Disposal Location:Bio-Cycle
Waste Type:Septic Waste
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ReporUD:39617 View inspection repots online at www.ontinerme.corn Pepe I of I
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