HomeMy WebLinkAboutSWG2022-00263 - SWG As-Built - 2/2/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00263 Parcel# 32008-75-90108
Applicant Name Don Robbins Subdivision (Name/Div/Block/Lot)
Applicant Address 181 SE Morgan Rd
City, State, Zip Shelton, Wa 98584 Installer Name Spear Const.
Site Address 828 E. Hiawatha Blvd. Designer Name Bob Paysse
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Shallow standard pressure Pretreatment Type
>5 ft.from foundation? - 0 N/A Ng YES ❑ NO
>50 ft. from wells? - - ❑ e ❑
Z• >50 ft.from surface water? - - ❑ ® CI
Q Cleanout between building and tank? - - 0 ® CI
U Tank baffles present? - - ❑ It ❑
d 24" access risers over each compartment?• - ❑ I ❑
N Effluent filter installed?- - CI I. CI
Septic tank capacity(working) 1500 gal Manufacturer House Bros
o D-box water level and speed levelers used? - - Ng N/A 0 YES ❑ NO
00 Manifold/D-box accessible from surface?. - 0 ® CI
00 z Check valves installed? - - 0 I ❑
0<
E Transport Line Size 2 in. Schedule/Class 40
Bedrooms installed (check one) 0 2 0 3 0 4 0 5 0 6 Commercial/Other
>10 ft. from foundation?- - N/A III YES ❑ NO
0 >100 ft. from wells?- - ❑ I ❑
W >100 ft.from surface water? - - ❑ IN CI
ti >10 ft. from potable water lines?- - ❑ IN El
Z
Q > 5 ft. from property lines and easements?- - ❑ ® ❑
CL > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑
0
Drainfield level and observation ports present - - 0 UI ❑
❑ Graveless chambers or mg Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ It ❑
Pump tank setbacks consistent with septic tank? - - 0 N/A ❑ YES ❑ NO
• Pump tank capacity (flood) 1500 gal Manufacturer House Bros
Z
Q 24" access riser(s)and accessible from surface?- - ❑ IN ❑
1--
Alarm or Control Panel Installed? - - ❑ IR ❑
CL
E Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑
D
d Pump installed in ix Bucket or 0 On Block or ❑ Other
d• Pump Make/Model Liberty 290 ® Floats or 0 Transducer
CL 'Tank draw down 1 in/min Pump capacity 30 gpm Squirt Height 5'+ ft
Pump on time 2 min. 40 sec Pump off time 4 hrs. Daily flow set at 480 gpd
Updated 82112018
Mason County OSS Installation Report pg. 2 Parcel# 32008-75-90108
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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 development. Typ:dal Recort
Drawings contain. Dranfield&manifold onentation&layout,Sept,clpump tank location,North arrow.reserve drarntwlJ,existing and proposed bu ld rgs,location of wells.walnrtinus
woils,observalon ports,clearouts,and other maintenance access ports. incomplete Record Drawings may create additional delays In final installation approval and related pem its.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that l 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 l further certify that all information contained on this
form and attached Record Drawing is accurate.7 form and attached Record Drawing is accurate.
4241.- 1/3e/ 1Z
t:
/ 1 '
ure of Installer Date 9IFN.'
Logan Spear Jet 0*4"
'►";,
Printed Name of Signee . ;
MASON COUNTY PUBLIC HEALTH 4/Dg ROBERT0H p4VC6E wNkk
44
The undersigned approves this Installation Report and EXPIRES
Record Drawing on behalf of Mason County Public
Health:
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updatedei2:2ota
I -
DRIVEWAY/PARKING
APPROX. WAREHOUSE
ACCESS & OFFICE
DRAINFtELD
3067FT
7‹
_ _ _ - _ 603SQFT
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\ 18'
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SEPTIC ♦ ,-'
& PUMP TANK ♦ /yr APPROXIMATE BPA
EASEMENT AREA
♦ (POWER LINES)
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APPROX. PUMP HOUSE PC
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t COMMUNITY WELL
APPROVED (HINTERLAND H20)
FEB 0 2 2023
MASON COUNTY ENVIRONMENTAL HEALTH
ji,ET
CUSTOMER: DON BOBBINS SCALE l:50 I '
PIONEER DI��IN�, INC. PARCFL 32008 75 90108 TEST IIL LE 1: TEST HOLE 2:
SEPTIC DESIGNS ADDRESS: 828 E I IIAWATHA BLVD 0.36 CIS "5 C13
36-55 CMS 35.55 CMS
3083 E.MASON BENSON RD. GRAPEVIEW,WA 98516 DESIGNER: ROBERT H.PAYSSE
.OFFICE-360-426-1803 FAX-360-427-2353 DESIGN PAGE RECORD DRAWING
RECORD DRAWING (continued)
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EXPIRES
APPROVED
FEB 0 2 2023
MASON COUNTY ENVIRONMENTAL HEALfl
RET