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HomeMy WebLinkAboutSWG2022-00325 - SWG As-Built - 1/4/2023 Mason County QSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number • SWG 2022-00325 Parcel # 42209-51-00096 Applicant Name Mike Mortenson Subdivision (Name/Div/Block/Lot) Applicant Address 3001 Monte vista St. SE City, State, Zip Olyu,Wa 98501 Installer Name Spear Const Site Address XXX N.View Drive Designer Name Bob Paysse INSTALLATION CHECKLIST NH Full System Installation ❑Tank(s)Oniy 0 Drainfield Only ❑Repair ❑Other System Type Sand auq. pressure Pretreatment Type >5 ft.from foundation? - •- © N/A ❑YES Ei NO >50 ft. from wells? - ❑ a ❑ Z >50 ft. from surface water? - - 0 II • Cleanout between building and tank? - - ill ❑ 0 ✓ Tank baffles present? - - ❑ ■ 0 d24"access risers over each compartment?- - El El ill Effluent filter installed?- - 0 ■ ❑ Septic tank capacity(working) 1200 gal Manufacturer House Bros. CI D-box water level and speed levelers used? - - II N/A El YES El No oO Manifold/D-box accessible from surface?- - 0 le 0 GQCheck valves installed? - . 0 III 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ® 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- N/A ❑ YES ❑ NO CI >100 ft.from wells?- - 0 I ❑ --1 >100 ft.from surface water? - 0 IN ❑ W 11 Z >10 ft.from potable water lines?- - 0 3 >5 ft,from property lines and easements?- - 0 II ❑ > 30 ft. from downgradient curtain/foundation drains? I ❑ ❑ Drainfield level and observation ports present - - 0 0 ❑ 0 Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 IN 0 Pump tank setbacks consistent with septic tank?- - 0 N/A ® YES ❑ NO • Pump tank capacity (flood) 1200 gal Manufacturer House Bros II Z < 24"access riser(s)and accessible from surface?- - ❑ a ❑ a Alarm or Control Panel Installed? - - ❑ I 0 • Control Panel equipped with Timer/ETM/Counter- - 0 I ❑ a. Pump installed in In Bucket or ❑ On Block or ❑ Other a- Pump Make/Model Liberty 290 I Floats or m 0 Transducer a Tank draw down TBD in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd / Updated 8/212018 4_ Mason County OSS Installation Report pg. 2 Parcel# 42209-51-00096 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? 0 YES [, 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 developmenL Typical Record Drawings contain: Grainfield&manifold onentaton&layoat,Septicipump tank locabon,North arrow,reserve orainfierd,existing and proposed buildings.lccalion of wells,waterlines. wells,observaton ports,eloanouts,and other maintenance access points. Incomplete Record Drawings may create additional detays in Rnal installation approval and related permits. il Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 I further certify that all information contained on this formattached iecord Drawing is accurate. form and attached Record Drawing is accurate. f (6/Z(�Ld -Z inat e of Instal-r Date L1 ga n. )2 ea r Printod ame o Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 0)44. , Record Drawing on behalf of Mason County Public o POP Einzi PiY66E • Health: EXPIRES \Q-1-1\b0/4(6AA1) 14 1Z-5 Signature of Environmental tfealth Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated turtrzcta e 14,11) /..n / 44,4'4.14 p,%CQ'4 6y / , p'! � f . . , vED �O Q•• POL347 H3" 4 J 1 .......... /. ***7 ., V N 04 20 EXP,Re'S / ' 1 Q / MASON COU 3 f '' I ti ERE;°NMENTAL HA Ti 1 c I 1 I � � I 1 1 I WATERLINE: 1 \ \ MAINTAIN 10FT TO • ill - A I SEPTIC COMPONENTS ' ...** I Ili' -- - AND LINES 1111 \ \ ,�, A 1 J di III - ' ,--V„ , iiiii,„. „ „ l • AC/O ,� . a PROPOSED \ N. �•• 2 BEDROOM \ T._ DRAINFIELD v� • \ 0 O / APPROX. FUTURE O' • HOME LOCATION \ PROPOSED SEPTIC & PUMP TANK LOCATION \.,..v • AN ASBUILT/INSTALL SIGNOFF FEE WILL BE CHARGED AT TIME OF INSTALLATION PIONEER_ DIGGING INC. `.11ST MER.: .\'IKE. OKTENSON TLI IK`U is TEST 110LE'_- TGMTIk'LC3: s I'.1I .EL ff -1 09-51-00096 055 C,I_ 0-55(.LJ 0-55 GLS SEPTIC DESIGNS ADDRESS: XXX N VIEW DRIVE R�`�`T 55 ROOTS55 •RC�`T5 55 30tti E.\I&SCN HLNSON R.D. C:R1PF1/4I1:I\,ll0.V$4ts DE.SIGNE ROBERT I f.f.AYSSE °'K'ti""M'Mawr A MM.a/CMACts ncuue AiArwLCpxrr FROMn llATI Ca tUR VI MO UCOSAttWNTt MO(WAY WS.DIUCN t{TINOtO KW an,r• �'I-FIC'!:-360-i2bkiO3 F.\\•360427•2 453 P. O$cs 04.V. P O OMo ot+uoM.Oo7 - it twee ,o o,w. sl IEEE: PL' C PL'\\ xALL. r..20' r *, s ti++W.VIswna ACT atsrO+SEFC tarmacs w,rnnoTO RrTIC CCwm.0.4Nri,