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HomeMy WebLinkAboutSWG2020-00114 - SWG As-Built - 9/28/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00114 Parcel # 32130-11-00000 Applicant Name Charles Olin Subdivision (Name/Div/Block/Lot) Applicant Address 4780 E. Mcreavy Road City, State, Zip Shelton, Wa 98584 Installer Name Charles Olin Site Address 47XX Mcreavy Rd Designer Name Bob Paysse INSTALLATION CHECKLIST Q Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? - •- ❑ N/A 'EYES ❑ NO >50 ft.from wells? - - ❑ ® 0 Z >50 ft.from surface water? - - 0 MI HCleanout between building and tank? - - 0 li 0 V Tank baffles present? - - 0 t 0 d24" access risers over each compartment?- - 0 NO tW Effluent filter installed?- - 0 Ili Septic tank capacity (working) 1200 gal Manufacturer j-3- j#j f.' -'-yam PrL '� o D-box water level and speed levelers used? - - ❑ N/A E YES ❑ NO XJ O Manifold/D-box accessible from surface?- - El o?Z Check valves installed? - •- ® 0 ❑ ClQ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) © 2 ❑3 ❑4 ❑ 5 0 6 0 Commercial/Other >10 ft. from foundation?- •- ❑ N/A ® YES ❑ NO CI >100 ft.from wells? - - 0 ® ❑ W >100 ft.from surface water? - - 0 IN 0 u. >10 ft.from potable water lines?- " 0 It 0 Z > 5 ft.from property lines and easements?- - ❑ UI ❑ 02 > 30 ft.from downgradient curtain/foundation drains? - - UI 0 ❑ Drainfield level and observation ports present - - ❑ III 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - 0 NIA ❑ YES ❑ NO Pump tank capacity (flood) gal Manufacturer < 24" access riser(s) and accessible from surface?- - 0 0 0 H C. Alarm or Control Panel Installed? - - El El 2 Control Panel equipped with Timer/ ETM/Counter- - El 0 0 M Cl- Pump installed in 0 Bucket or ❑ On Block or ❑ Other a' Pump Make/Model 0 Floats or El Transducer d Tank draw down in/min Pump capacity qpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 I Mason County OSS Installation Report pg. 2 Parcel# 32130-11-00000 ABANDONMENT RECORD • Were existing septic components abandoned as part of this project? - - 0 YES ® NO If yea, please describe: Were all components pumped out and properly abandoned per WAC246.272A-0300? - - ❑ YES 0 NO RECORD DRAWING Ths is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future dwNopmenL Typical Record Drawings contain: Dralnlleld&manifold orientation&feyouL Septic/pump tank location,North arrow,reserve drainheld,existing end proposed buildings,location of wails,waterlines, web,observation ports,c4anoW,and other melnarofoe access points. Incomplete Record Drawings may create additional delays In Mal Instakatan approval and related permits. ® 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 end 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. /.0/L-,,. ,' 4--)Lai,,,,,, f. .. Signature of Installer Date `tt 's A. Charles Olin Printed Name of Signee / / „.a '�*�y , . MASON COUNTY PUBLIC HEALTH t`}, t� ' r The undersigned approves this Installation Report and ��;`; q�a� }`+'IPTA�asE ' Record Drawing on behalf of Mason County Public �s%�%i��' • EX PrR SS Health: - ,..t_TSQSP(N ..fi Ct h-LCD1-1-7..— Signature of Environmental i'fealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Vpd00id amn°'a EXIST. DRIVEWAY AND ACCESS EXIST. 7�- SHOP - _ '-7/ F.- - _ //_____' _ _172-_--.--;---.------ ' /// // APPROX. PROPOSED J • / I •r�---- ADU LOCATION / / F On.)w -1-r,..1� /// Lv�:-vZrv.- WELL IS 100'+ may i_-- ,) FROM DF PROPOSED 2BED /// I C-: c \___ SYSTEM /EXISTING HOME \__ EXISTING DRAINFIELD ..- I / O // tsn / APPROX. WETLAND / BOUNDARY PER GIS // 500'+/- FROM DF i. I 4. / /1Nii // i'' w: / • / 6 d"'^ tip.- / AN APPROVED ;r.-�OF' HPAYSSE �\ •! 0. E••,1. . ,..-.. SEP 2 $ 2022 EXPIRES MASON COUNTY ENVIRONMENTAL HEARL__ RET - - - - - - - - - - - - - - - - - I 1330' INSTALLATION DESIGNER SIGNOFF/ASBUILT FEE WILL BE CHARGED AT TIME OF INSTALLATION CUSTOMER: CI IARLES OLIN scnLe I:200 PIONEER DIGGING, INC. PARCEL#:32130-11-00000 TEST HOLE I. 0-30TEST GIjOSLE2 SEPTIC DESIGNS ADDRESS 4780 E MCREAVY RD 30-60 GMS 30-63 GMS 3083 E MASON BENSON R.D. GRAPEVIEW TWA 98546 DESIGNER: ROBERT PAYSSE <n nr.;onn r•v v.n �