HomeMy WebLinkAboutSWG2023-00127 - SWG As-Built - 5/10/2023 s mow '
Mason County OSS Installation Report pg. 1 '\ MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00129 Parcel # 22223-51-03009
Applicant Name Sean and Jamie Caudle Subdivision (Name/Div/Block/Lot)
Applicant Address 4991 Rasor Rd.
City, State, Zip Belfair,Wa 98528 Installer Name Weathertight Constuction
Site Address same Designer Name Bob Paysse
INSTALLATION CHECKLIST
In Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type ATU -pressure Pretreatment Type NuWater BNR 500
>5 ft.from foundation? - •- ❑ N/A 1.1 YES ❑ NO
>50 ft. from wells? - - ❑ MI ❑
Y >50 ft. from surface water? - - ® ❑ ❑
Z
H Cleanout between building and tank? - - ❑ III 0
U Tank baffles present? - ❑ ® ❑
P 24" access risers over each compartment?- - ❑ ® ❑
a
W Effluent filter installed?- ❑ Ill 0
cn
Septic tank capacity (working) 1 050 gal Manufacturer
Sound Placement
Ca D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO
�OJ Manifold/D-box accessible from surface?- - ❑ MI ID
ME Check valves installed? - - ❑ ® ❑
6Q 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ® N/A ❑ YES ❑ NO
>100 ft. from wells? ❑ IN ❑
J >100 ft. from surface water? - - ❑ 0 El
W LL >10 ft. from potable water lines?- - El El ❑
Q > 5 ft. from property lines and easements?- - ❑ IN El
w > 30 ft. from downgradient curtain/foundation drains? - 0 Cl ❑
CI
Drainfield level and observation ports present - - ❑ II ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
• Pump tank capacity (flood) 1500 gal Manufacturer Sound Placement
Z
< 24" access riser(s) and accessible from surface? ❑ . ❑
H
a Alarm or Control Panel Installed? - - El
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ II ❑
m
a Pump installed in ® Bucket or ❑ On Block or ❑ Other
a Pump Make/Model Liberty 280 I Floats or ❑ Transducer
in/min Pumpcapacitygpm Squirt Height ft
R. Tank draw down
Pump on time Pump off time Daily flow set at gpd
Updated 8121'20'-8
Mason County OSS Installation Report pg. 2 Parcel # 22223-51-03009
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - Q YES 0 NO
If yes, please describe:Pumped and filled in Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q■ YES 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
D,awing5 contain: Dralnfield&manifold orientation&layout.Septicipump tank location,North arrow.reserve drainfield,existing and proposed buildings,location of wells.waterlines.
wells,observation ports,cieanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
J
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 and attached Record Drawing is acc form and attached Record Drawing is accurate.
n
Signature of Installe Date
3ct v\KSL ,-) �L
ti
Printed Name of Signee a
MASON COUNTY PUBLIC HEALTH 1►.f ?. �•.,-,..
The undersigned approves this Installation Report and t► •
Record Drawing on behalf of Mason County Public ,�'Q� ROBERTprypgyg "
Health: s: .ice` •e.r: `
CliCl7- EXPIRES
cPZ-VriC4\\fiC.1"\
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 e.n'.2018
F I
n F.' , NOTE: LOCATION FOR EXISTING
JEDCOMPONENTS DO NOT APPEAR TO
I MAY 10��2023 MATCH COUNTY RECORDS.
i
, MASON COUNTY EN ONMENIA L HEALTH fl
N EXISTING FAILED DRAINFIELD
,� �p 1j TO BE ABANDONED
8
3„ PROPOSED ATV
& PUMP TANK
` ELECTRICAL METER
\�.� ~ _\
0. \ EXIST. TANKS TO
/ S
1 BE PUMPED &
k ABANDONED
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, #4". •
'..._,,, .. 22-------...„,,,...//
....—
/ / ` ' CONNECT TO
IS4pP6- do + — EXIST. STUBOVT
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41
s A i i/4-% .7 % EXISTING��� HOME
Iai A,,______ ,.,, ./
...
EXISTING GARAGE
. ,
/ PROPOSED DRAINFIELD" ../......, /
i
SEE DOWNSPOUT NOTE'
EXISTING TRANSPORT LINE
TO BE ABANDONED
04.
EXISTING WATERLINE �� �g {ia`
' SOUTHWEST DOWNSPOUT
;I >_
MUST BE HARD-PIPED AWAY y� `"''''.>
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t
FROM DRAINFIELD AREA.
f !cry R��F ">.:..£<
" CLOSE ATTENTION MUST BE GIVEN TO ORIGINAL �:..6:2., .,4:�n�
GROUND CONTOURS, NEW SYSTEM MUST BE ^``
Rzs
INSTALLED 6"- 8" INTO ORIGINAL SOILS / AN ASBUILTI INSTALL SIGNOFF FEE WILL
/ BE CHARGED AT TIME OF INSTALLATION
\` / TEST HOLE I: TEST HOLE 2:
INC. CUSTOMER: JAMIE CAUDLE 0}22 OLD`III 0-28 GI S
PIONEER DIGG NG, I C• PARCEL :?7��3 5103009 22•48 GIS 1120 @ 28
SEPTIC DESIGNS ADDRESS: 4991 E RASOR RD W NO RLST.1Al FR ROOTS @ 20
DESIGNER: ROBERT H.PAYSSE D1°TS OR S TM"is NOT A SURVEY.REFERENCES iNCI WE DES.O APPLICANT/COUNTY COUNTY PROVIDED
3083 E MASON BENSJN RD. CRAPEVIEW,WA 98546 PUTS OR SURVEYS.FIELD SURVEY.REF AND COUNTY D DESGNNT/CO INTENDED FOR SEPTIC
30' Pl,'RPOSES ONLY PROPOSED DEVELOPMENT MAY BE SUB:ECT TO OTHER
JFFICE•36l}4261803 FAX 36l}427 2353 SHEET: SITE PLAN SCALE 1'= DEPARTMENT/AGENCY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS