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Home My WebLink AboutSWG2023-00107 - SWG As-Built - 5/17/2023 Mason County OSS Installation Report pg. 1 �. .. MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00107 Parcel # 22221-32-00400 Applicant Name Audrey Schaeffer Subdivision (Name/Div/Block/Lot) Applicant Address 131 E. Mountainview Lane City, State, Zip Belfair, Wa. 98528 Installer Name Spear Construction Site Address Same Designer Name Bob Paysse il INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 11 Other System Type ATU - Drip Pretreatment Type Nu Water BNR 500 >5 ft.from foundation? ❑ N/A ® YES ❑ NO >50 ft. from wells? 0 IN Y >50 ft. from surface water? ❑ z ❑ I ❑ Cleanout between building and tank? - 0 111 ❑ U Tank baffles present? - 0 ® 0 d24"access risers over each compartment?- - ❑ IN ❑ W Effluent filter installed? ® ❑ ❑ V) Septic tank capacity (working) 1150 gal Manufacturer Sond Placement 0 D-box water level and speed levelers used? - ® N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface? ❑ PE mZ Check valves installed? - ❑ I ❑ pQ E Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft. from wells?- ❑ II ❑ Ill >100 ft. from surface water? - ❑ II ❑ LL >10 ft. from potable water lines?- Mg ❑ ❑ - > 5 ft.from property lines and easements?- - ❑ ce > 30 ft. from downgradient curtain/foundation drains? - 0 El ❑ Drainfield level and observation ports present - - 0 ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ MI ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A NO YES ❑ NO Pump tank capacity (flood) 1200 gal Manufacturer Sound Placement Z Q 24"access riser(s)and accessible from surface?- - ❑ NI ❑ ~ Alarm or Control Panel Installed? ❑ IN ❑ a 2 Control Panel equipped with Timer/ETM/Counter ❑ II ❑ 0 a- Pump installed in ❑ Bucket or ® On Block or ❑ Other 2 Pump Make/Model 1/2 hp turbine ® Floats or ❑ Transducer a Tank draw down in/min Pump capacity 3.15 gpm Squirt Height N/A ft Pump on time 6.5 min. Pump off time 2 hrs. Daily flow set at 240 gpd Updated 8/21,20/8 Mason County OSS Installation Report pg. 2 Parcel # 22221-32-00400 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Q YES El NO If yes, please describe:pumped and filled in with pea (ravel 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 Drawings contain Drainf:eld&manifold orientation&layout,Septicipump tank location.North arrow,reserve drainfielo,existing and proposed buildings.location of wells.waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays n final installation approval and related permits. ,,, 14 /1 , „e, .,,,, 1 L---1- - ‘"s\- 0 NO ��c� 3 I 'i'5 IL 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 nd attached Record Drawing is accurate. form and attached Record Drawing is accurate. f5/9/23 Sign'Ill- f Instal er Date Logan Spear Printed Name of Signee t MASON COUNTY PUBLIC HEALTH Q". it . The undersigned approves this Installation Report and r?' Record Drawing on behalf of Mason County Public 0 ROBERTrF AGYSSr H�a EXPIRES r i l t'Uk' S(gridtu f 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 8121/2018 ■r► Mason County OSS Installation Report pg. 2 Parcel# 22221-32-00400 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 111 NO If yes, please describe:pumped and filled in with pea gravel Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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 containi Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,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. t\I`t•4 teI. - 3 .0 �1 ti��P�� so �'°�� \\p i 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 t. and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Godes. State and Mason County Codes 1 further certify that all information contained on this I further certify that all information contained on this form d attached Record Drawing is accurate. form and attached Record Drawing is accurate. 5/g/23 ignat e of Insta)&24e4 Date `� Loden Spear ,,►� L ��y Printed Name of Signee . ►�'+;, = i MASON COUNTY PUBLIC HEALTH $$'. rt; iii 1. z„,,,,,, The undersigned approves this Installation Report and ��](�C, m„5,o `0: ROBERT H Ft4Y8SE Record Drawing on behalf of Mason County Public �t ; ;, ,' �Ailr... a �6� EXPIRES v� ;1 = r7��grfar/u' f Environmental Health Specialist Date (stamp, signature and date) l / � THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated8/2112018 'EXISTING DRAINFIELD HAS FAILED AND IS NO LONGER ACCEPTING EFFLUENT. 80I 7 1 1 1 ,,AAPPOVE MAY 1 7 2023 Sf3N CQUNTY ENVIRONMENTAL HEALTH I JI3 VI/ EXISTING HOME I I I 1 EXISTING TANK& DF TO 0 EXISTING WATERLINE BE PUMPED & I TO BE DOUBLE-SLEEVED ABANDONED I / IiiD • • PROPOSED DRAINFIEL� Pg. } 15X45 - 675 SOFT I Q I LI., I g WATERBOX 0 , 11 • • y {` \ MOUNTAIN VIEW LANE : ssk . _ A MM T (-2 ‘,..,.. ,t,,,, N •—de, EXF.;:cS AN ASBUILTI INSTALL SIGNOFF FEE WILL BE CHARGED AT TIME OF INSTALLATION C UST��,�IE.R: AIIDREY S( {I\EI"fF.R HI, I I��Lc I: Tb1 I IDLE.z PIONEER DIGGING INC. 0-29 `}''�`" PARCEL k:22221-32-00400 , r I I LL I: v+ :� ;s5�.v lilt\nu,l I. SEPTIC DESIGNS ,\DDRESS: 131At0IINFAIN VW DR R. .'Iac, 2,1 RCi IS(u 23 .3t23 I.\t 1S.\RI N' N R ) (,R 1I\II\\•\I\985 Eb D[SIG.[R: RL`LERf I I.I \YSSE oscUUrERE ITN II NOT SURVEY R .ES INCLIEX U C& • vOEO PLATSR V. WOOS PNO COUNT, IS ENSIGN INTENDED TORWmc wRRCaEB CA., BA0a3SEO cxvE.O.AEA, . BE SOME- •0 -• N-IICI -3(�o-426"I8o3 IA\''360 F27-2353 SIIEET: SI I E PL.A\ sC'\LL I"=20' OEi ETUE � DEWIER DEIER NOT RESPONSIBLE KRSETGLS UNRELATED TO