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HomeMy WebLinkAboutSWG2021-00563 - SWG As-Built - 3/30/2023 Mason County OSS Installation Report pg. 1 C . C, MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION 1 Permit Number SWG 2021-00563 Parcel# 51901-52-02008 Applicant Name JOEY MANEMAN Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 144 City, State, Zip RYMOND,WA 98577 Installer Name ANDREW SPEAR CONST Site Address 58 W LOST LAKE VIEW DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ®Tank(s)Only 0 Drainfield Only 0 Repair 0 Other System Type Pretreatment Type >5 ft. from foundation? - - ❑ NIA ❑YES ❑ NO >50 ft.from wells? - ❑ ❑ S 0 >50 ft. from surface water? - �' Z' Q-.__ ❑ 0 Z ❑ • Cleanout between building and tank? - - - -11 g��� _ 0 ❑ ❑ V Tank baffles present? 11_�1[�R - 0 0 P.: 24°access risers over each compartment?-- -- _ 0 W Effluent fitter installed?-CO 0 Septic tank size gal Manufacturer 0 0-box water level and speed levelers used? - - El N/A ❑ YES 0 NO o0 Manifold/D-box accessible from surface?- - El El El mZ Check valves installed? - ❑ 0 ❑ ETransport Line Size Schedule/Class Bedrooms installed (check one) 0 2 0 3 0 4 0 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ NIA ❑ YES ❑ NO i l0 >100 ft. from wells?- ._ - - - ❑ ❑ ❑ W >100 ft. from surface water? ElEl ❑ Ii. >10 ft.from potable water lines?- ._ ❑ ❑ ❑ az >5 ft. from property lines and easements?- - ❑ ❑ if >30 ft. from downgradient curtain/foundation drains? El Drainfield level and observation ports present - - El ❑ ❑ • 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- --_ - _.. -- - -- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?- ❑ NIA 17i'YES ❑ NO a.c.. Y Pump tank size Son gal Manufacturer R.Oft? z < 24"access riser(s) and accessible from surface?- - ❑ ® ❑ I— a. Alarm or Control Panel Installed? - - El P ❑ Control Panel equipped with Timer/ETM/Counter- - ❑ 0 0 a Pump installed in ❑ Bucket or 0 On Block or i1'f Other sole /244 a 2 Pump Make/Model L`b,crfy L E 5I AA_ 1g'Floats or El Transducer Tank draw down in/min Pumpcapacity 11' Q- P Ygpm Squirt heightf< Pump on time Pump off time Daily flow set at gpd �f Updated 8/21/2018 (�0'C I��rgt4 tiZ l"'Y �7(1 r?'1Q t Mason County OSS Installation Report pg. 2 Parcel# 51901-52-02008 ABANDONMENT RECORD Were existing septic components aban oned as part f his roject? - - 0 YES NO 1 If yes, please describe: t �Y1,,1 upiir Were all components pumped out and properly abandoned per WAC246-272A-030 ? - - 0 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 contain! Drainllleld&manifold orientation&layout,Seplicrpump tank location,North arrow,reserve drainfietd,oxisting and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. i • / r Y 1 d q if : O N�Jlr�{7/ 1 r! hr S p tirrn$ bcp A 7 1-P SO'?,--y2 d Y✓ S 1 470! -S2-- G l C,/d 0 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 form d attache ecord Drawing is accurate. form and attached Record Dr wing is accurate. 3/!?/�3 gna/ re of Ins JfLfrJL Date P� ,441 1, . VA1 74/ Printed lme of Signee ',�A,,t a �� • MASON COUNTY PUBLIC HEALTH ys 004 t.. • The undersigned approves this Installation Report and tJ LICCNSED DESIGNER Record Drawing on behalf of Mason County Public Health: E.,0,04t5 05,10, 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 Updated 112018 PP .� v E D 1. Proposed garage/RV site 2. Audio/visual alarm MA' 30 2023 .4 1200 3. 1200 4. gallon concrete septic tank MA N COUN ENVIRONMENTAL HEAL gallon pump tank with two risers RET 5. Transport line 6. Valve Box 7. Primary drainfield 8. Reserve Drainfield Iv 9 Soil Log 0.43" loa �''� 10.Soil Logmy sand 0-39" loam 4 11. Clean outT Y sand • iA Wji \ \,..... ../ 1 j i:�:� Los/tt I . \ _,I ,._,-- 1 1.4i vrrw ‘ ''''' ''gA '.. , '`^' /01 1 1 MoleLICENSED DEVS�Fq t \' MoleU I \ ko LTJ ,/ V), r ya, V sew 1,1‘ 0 0 , sittlon ' ,u Zo ' d ,' , `'' ,�.z"�a.�� py 1. • f 1 "Yu �. �� .xe�-r I i ,71 la t- ,...57 . . . .- otolt, , . . 1/47.1 1-n.,11 iii..ke 61, A,4. .re i -....._._ I 1 Z-65.1 C-4 ke _.............. ; sl , P p ko I , A4,4 ' IQ Vet) iff4304/,,, 0 , Ou'" ONlye , ( 23 0 C't.::<sf;141 1....,411 .r.,..f.. r YeNT4 /4.7 c.3f"Vivo itirrIclit.4' . tr..• (37.) , . '''' ..„,..:„..........„__, :560 Tvigew jiiie '4 #1. eicie4ii„t,,.„i ol • ..,.......„..„1 , or f 47, it I • I 0 ce .....• I - p ( )''k C?:::4) to44 .- J 4 itAtyk r.,„,,f, ore, 41 t • co t , Ait oc-ti0.9, 14.1t: ,uvdd . . / vp 3 i or*. .14. g tP 04 ei ....„4. r• `•„t id, 1\'‘-i, \71/ 4.4.1— 411,...* 5s1004 18 y t ti 4 . it t CINDtE WAITE LICENSE \\.‘1‘ UESIGNER to 1 i lioloomb. itmootoot... ma yokitook. 4 07 LxPiRis 0.,.,,10, i I I i .57 q Oi- V--4400 • 3—P ki Lox./ Z.,,,te. I/res." nt,_ 1 . , 1 ...., t • • P-• r , .t,-,i p 1 .„... i 4 VI la , i__j_:(e2:___.I__ 4.0 A ... _ _I ..„ ..._ .1 St,..p .._ --...... -.... ...... ....4_ 1 4,2022 .i-%,_;: 24:;) - • .t..'j"...7. ,-- , • • I 1 Mason County WA GIS Web Map <30 W LOST LAKE VIEW DR 33 W LOST LAKE VIEW DR 1 32 W LOST LAKE VIEW DR 0 34 W LOSTLAKE VIEW DR o 50 W LOST LAKE VIEW DR 51 W LOST LAKE VIEW DR o Pp, � V F� ,5,., -,4R 3 Q c. cps yrr�� 0 2�?3 Llith�R FNTA �T l yEgLT 58 W LOST LAKE yIEW DR 54W LOSTLAKE VIEW DR I 0 1127 W LOST LAKE RD .- ___- Q 1125W LOST LAKE RD o 62 W LOST LAKE VIEW DR 1123 W L[3oTLAKE RD 0 131 W LOST LAKE VIEW DR 0 6/12/2022, 3:40:15 PM 1:769 L� County Boundary �'Pe C�a'3''> y o o.o1 0.01 0.02 mi No Filled o 0.01 0.02 0.04 km 11 f Site Address (Zoom in to 1:3,000 .r3\ 9 ) Tax Parcels (Zoom in to 1:30,000) Ear HERE. Gannit, (c) OpenStreeWap cvntruutors. end the GIS user community I to ,,.__.. .. Mason Cnunh.wn coo .._... Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00563 Parcel# 51901 -5".2—O(4,0 Applicant Name JOEY MANEMAN Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 144 City, State, Zip RAYMOND,WA. 98577 Installer Name ANDREW SPEAR CONSTRUCTIO Site Address 51 W LOST LAKE VIEW DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other System Type PRESSURE DIST Pretreatment Type >5 ft. from foundation? - >50 ft.from wells? - - ❑ N/A ®YES ❑ NO Z >50 ft.from surface water? - - 0 III 0 ❑ ® ElH Cleanout between building and tank? --- - - - ._ - V Tank baffles present? - - El El � d 24"access risers over each compartment?- - ❑ ® ❑ co Effluent filter installed?- -_ __ - - - 0- © 0 Septic tank size 1200gal � Al ❑ Manufacturer HOUSE BROTHERS ® D-box water level and speed levelers used? - - No N/A ❑ YES ❑ NO 4000 Manifold/D-box accessible from surface?- Qz Check valves installed? - - d I CI El a Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) 0 2 0 3 0 4 0 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ® >100 ft. from wells? ® N/A ❑ YES ❑ No - W >100 ft. from surface water? - ❑ ill 0 it ❑ iZ >10 ft. from potable water lines?- -. - II 0 > 5 ft. from property lines and easements?- - ❑IN IEl d Ela > 30 ft.from downgradient curtain/foundation drains?- - - -- El- ❑ Drainfield level and observation ports present 0 0 0 Graveless chambers or ® Clean gravel used? (check one) ❑ El Proper cover installed over drainfield?- - ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES 0 NO Z Pump tank size 1200 gal Manufacturer HOUSE BROTHERS a 24" access riser(s)and accessible from surface?- - --- __ _ - 0 IIL•- Alarm or Control Panel Installed? - ill El Control Panel equipped with Timer/ETM/Counter- -. - _ _ . ❑ Pump installed in 0 Bucket or El On Block or 0 0 �- a ❑ Other Pump Make/Model L b 2 53 Y ..Floats or 0 Transducer tl, Tank draw down 1 7/8" in/min Pump capacity gpm Squirt Height 24 ft Pump on time 2:Z54 IA_ Pump off time 1 ICY Daily flow set at 360 gpd Updated 8212018 t -51 cia-.5Z UZcr o $ Mason County OSS Installation Report pg. 2 parcel# 51901-52.-b/ fey t U ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - u YES IN, NO If yes, please describe: Were all components pumped out and properly abandoned per WAC248-272A-0300? - - 01 YES lig 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 contain: Drainfield&manifold orientation&layout,Septictpump tank location,North arrow.reserve drainfreld,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. ® 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 • I 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 DA. g is accurate. jed/2- 3/ 7/ 3 .' t t�� ign ure of Installer Date ��+! L.ecida-5,eai �4. 1) ri.�1�i etay. •�'of Printed Name of Signee •Ire " s�1.\,L�� i 1t i MASON COUNTY PUBLIC HEALTH .-6e 1 Sv E4 AITE i LIC NSED DESIGNER il l The undersigned approves this Installation Report and m.�.�������"„"` `�"`�, 1 Record Drawing on behalf of Mason County Public Exp+ems o ,o Health: ' ' sla1 31-o1 —5 Signature of Environm@ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121r2ot8