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HomeMy WebLinkAboutSWG2020-00654 - SWG As-Built - 6/23/2023 1 Mason County OSS Installation Report pg. 1 QC. MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-0 0b5 y Parcel # 32335-50-00980 Applicant Name Bill Beisley Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 2355 City, State, Zip Belfair, WA 98528 Installer Name South Shore Const. Site Address 561 Tee Lake Dr Designer Name Bob Paysse INSTALLATION CHECKLIST © Full System Installation El Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type atu -pressure Pretreatment Type NuWater >5 ft. from foundation? - - ■❑ N/A ❑ YES ❑ NO >50 ft. from wells? - - El IN 0 Z• >50 ft. from surface water? - - 0 ® ❑ Q Cleanout between building and tank? - - ❑ IN El • Tank baffles present? - - 0 ® El a24"access risers over each compartment?- - ❑ ® El W Effluent filter installed?- - ® El ❑ fn Septic tank size 1060 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - pi N/A ❑ YES ❑ NO p0 Manifold/D-box accessible from surface?- - 0 It El mZ Check valves installed? - El U ❑ 0 Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 El 4 ❑ 5 ❑6 El Commercial/Other >10 ft. from foundation?- - 0 N/A ❑ YES El NO >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water? - - El III El E. >10 ft. from potable water lines?- - El In ❑ Z > 5 ft. from property lines and easements?- - El ® 0 cc > 30 ft. from downgradient curtain/foundation drains? - - PI ❑ ❑ Drainfield level and observation ports present - - ❑ © ❑ El Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - El ❑ Nil Pump tank setbacks consistant with septic tank? - - 0 N/A ® YES El NO • Pump tank size 1500 gal Manufacturer Infiltrator Q 24" access riser(s) and accessible from surface?- • El ® El ~ Alarm or Control Panel Installed? - - El 0 El a 2 Control Panel equipped with Timer/ETM /Counter- - ❑ IR El 0 d Pump installed in Q Bucket or ❑ On Block or ❑ Other n'• Pump Make/Model Liberty FL 100 © Floats or El Transducer a Tank draw down 1-1/4" in/min Pump capacity__ 30 _gpm Squirt Height 60" ft Pump on time 2 min. Pump off time 4 hrs Daily flow set at 360 gpd Updated 821,2018 immosimomimmomw Mason County OSS Installation Report pg. 2 Parcel# 32335-50-00980 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ■❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ 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: Drainfeld&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wets,waterlines, wells,observation ports,cieanouls.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 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 att ched Re- d Drawing is accurate. form and attached Record Drawing is accurate. iyA 1 4 e 7/7/21 Signature of Installer Date Richard Moore ��� *. Printed Name of Signee f coo u. v MASON COUNTY PUBLIC HEALTH j,��.. ` ii4 The undersigned approves this Installation Report and o. ROBERT M p4vsSE Record Drawing on behalf of Mason County Public �!�% % 'i "" EXPIRES Health: Oir,,INvlocci/1ref 3 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 8/2t!2018 I.. c� 2" TRANSPORT LINE ORIFICES 36" OC PER DESIGN I MAN I FOLD I I I_ i 3, ._..__.—/,.//:*0 5,..4 izE,//////,' — • t 20' PRIMARY OBRT I // /ler/ 40 0` / 1YP. 20' PRI-MARY I I I /1/// //7 0 4)(fa//// 20' PRIMARY I /Ai/ //2fr/ /��4. O 20' PRIMARY �� ; . I /%/ '/0 '*'//i VET S s A.y\ li�^O UN P . I ?l J ,,��,`" 0 26' PRIMARY NCOUN.ryEN� 20?3 ,�.'$ R�: • PAYSSf , ,\ `!1 . ..:,. :•::,,. „�, / /yam/ GW/r/ RE i A E4cr� EXPtIR lei/7: / /J I I v 20' PRIMARY DRIVEWAY I •••-• ..... ..............\ PIONEER DIGGING INC. \STONER: BILL,BEISLEY ALE IO , I ARCEL 32335-50.00980 SEPTIC DESIGNS ADDRESS: 561 TEE LAKE ROAD 3083 E.MASON BENS)N RD. GRAPEVIEW,WA 985 K, DESIGNER: ROBERT PAYSSE OFFICE•360 426-1803 FAX•360"427-2353 DESIGN PAGE RECORD DRAWING APPROVED JUN 2 6 2023 — MASON COUNTY ENVIRONMENTAL HEALTH — _ _ RET 1 0 ---_ 1 0 --_ PLASTIC INFILTRATOR I I i IM-1060 / NVWATER All/ I r 5' -1 I O j=` 1 NEIGHBORING O I I 54'1- I WELL 1 0 1 CONCRETE COATED I I"DNS 500 GAL. TRASH TANK LINE I I 1 45 } I I 1 \I PLASTIC INFILTRATOR I IM-153O / PUMP TANK I I 11 ,..-, ��� y 16' -I I ��� DECK/ PATIO IoPZ; Ij `� FOBEs H WIYSSE '�',. 1 `7.s.. .... _ I EXPIRES HOME 1 I I PIONEER DIGGING INC. L.0 ioam .R: B3ILL B ut9LY E I:I0 PARCEL# 32335 50-00980 SEPTIC DESIGNS ADDRESS: 561 TEE LAKE ROAD 3083 F.M'sSON BENSON RD. GRSPEVIEW,WA 98546 DESIGNER. ROBERT PAYSSE OFFICF.-360-426-I803 F.A\-360-427-2353 DESIGN PAGE: RECORD DRAWING