HomeMy WebLinkAboutSWG2022-00346 - SWG As-Built - 2/8/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-346 Parcel# 22320-10-60000
Applicant Name Girl Scouts of Western Washington Subdivision (Name/Div/Block/Lot)
Applicant Address 5601-6th Ave. Suite 150
City, State, Zip Seattle, Wa 98108 Installer Name Workman Contracting
Site Address 800 NE Twin Lake Rd Designer Name Bob Paysse
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Standard pressure Pretreatment Type
>5 ft.from foundation? - •- ❑ N/A ®YES ❑ NO
>50 ft.from wells? - - ❑ I 0
z >50 ft.from surface water? - - El ® 0
HCleanout between building and tank? - - 0 In 0
U Tank baffles present? - - ❑ ® ❑
a24"access risers over each compartment?- - ❑ II ❑
tW Effluent filter installed?- - El !I ❑
Septic tank capacity(working) 2250 gal Manufacturer Sound Placement
0 D-box water level and speed levelers used? - - IllN/A ❑YES 0 NO
DO Manifold/D-box accessible from surface?- - 0 I El
m. Check valves installed? -
p Q - ❑ El
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 El 6 El Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
>100 ft.from wells?- - ❑ ® ❑
W >100 ft.from surface water? - - El MI CI
u. >10 ft.from potable water lines?- - ® ❑ ❑
Z > 5 ft.from property lines and easements?- 0 0 ❑
Q
cc >30 ft.from downgradient curtain/foundation drains?- - IN ❑ ❑
Drainfield level and observation ports present - - ❑ 0 0
El Graveless chambers or • Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® El
Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO
`.L Pump tank capacity(flood) 2700 gal Manufacturer Sound Placement
Z
Q 24"access riser(s)and accessible from surface?- - ❑ U 0
dAlarm or Control Panel Installed? - - 0 I 0
E Control Panel equipped with Timer/ETM/Counter- - 0 0 0
m
LI' Pump installed in ® Bucket or 0 On Block or El Other
E Pump Make/Model Liberty FL 100 ® Floats or El Transducer
C Tank draw down 1.5 in/min Pump capacity 70 gpm Squirt Height 24+ ft
Pump on time 2 min Pump off time 4 hrs Daily flow set at 810 qpd
Updated 8/21/2018
S
Mason County OSS Installation Report pg. 2 Parcel# - )o - 6 00 0v
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - wi YES NO
If yes, please describe: ) uL - �c ,� f,,e,„f b y '
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - OLYES El 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
Drawirgs contain: Drainfield 8 manifold orientation F.layout,Septiclpcmp tanx location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines.
wells.observation ports,cleanot.ts,and other maintenance access points. Incomplete Record Drawings may create additional delays.n final installation approval and related permits.
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
/certify that I installed the system in accordance with /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
1 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
d
Signature of Installer Date ky�L
r We If tfn to 'M .
Printed Name of Signee y
MASON COUNTY PUBLIC HEALTH / .41t u 2
The undersigned approves this Installation Report and ,f. rtoes r°H''MyasE T;
Record Drawing on behalf of Mason County Public �. - - - •
Heal ExriREs
Signature of Environmental Health Specialist Data (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
\ 1
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DRAINFIELD INSTALLED \\
AS PER DESIGN
`\ \\ EXISTING
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c... ♦ I NEW 2"SCH. 40 TRANSPORT LINE
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♦♦ ) ../— EXISTING CULVERT FOR SEASONAL DRAINAGE
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C/O °- - NEW SEPTIC AND PUMP TANK
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DES:GN NOTES: INSTALLATION DESIGNER SIGNOFF/ASBUILT FEE WILL BE CHARGED AT TIME OF INSTALLATION. ANY PROPOSED STRUCTURES ARE SUBJECT TO
OTHER DEPARTMENT REVIEWS,DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.
CUSTOMER: GIRL.SCOUTS... SCALE I:30 I
PIONEER DIGGING, INC. PARCEL=:22320 I0-60000 TEST HOLE C TEST HOLE 2 TEST HOLE 3:
SEPTIC DESIGNS ADDRE:: 800 NE TWIN LAKE RD 0'37 GLS 0.37 GIS o-37 GIS
37+TILL 37+TILL 37+TILL
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE
OFFICE•360'4261803 FAN-360-427-2353 DESIGN PAGE: RECORD DRAWING