HomeMy WebLinkAboutSWG2022-00467 - SWG As-Built - 6/28/2023 Mason County OSS Installation Report pg. 1
�t, MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2022-00467
Parcel# 22131-44-00060
Applicant Name Grace Deffinbaugh Subdivision (Name/Div/Block/Lot)
Installer Name Spear Construction
Applicant Address 1510 Spencer Lake Road
City, State, Zip Shelton,Wa. 98584
Site Address Same Designer Name Bob Paysse
it
INSTALLATION CHECKLIST
lip Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑❑Repair Other
System Type Pressure Pretreatment Type
>5 ft.from foundation? -
-
>50 ft.from wells? - ❑ N/A II YES 0 NO
Y >50 ft. from surface water? - _ 0 IN ❑
fill
Cleanout between building and tank? -- 0 e
o Tank baffles present? - 0 NE ❑
a24"access risers over each compartment?- 0 ❑
Ill Effluent filter installed?- e C
Cl, 0 IN
Septic tank capacity(working) 2250 gal Manufacturer Sound Placement
o D-box water level and speed levelers used?
�-1 N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- 0 Ill El o92 Check valves installed? - 0
e 0
a Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) 0 2 0 3 ❑4 0 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- - 0 N/A El YES 0 NO
G >100 ft.from wells?- - 0 U ❑
W
>100 ft.from surface water? - 0
ni LLL. >10 ft.from potable water lines?- 0 U 0
z >5 ft. from property lines and easements?-
CL > 30 ft.from downgradient curtain/foundation drains?- - 0 El
o
Drainfield level and observation ports present - - ❑ UJ 0
0 Graveless chambers or 111 Clean gravel used? (check one)
Proper cover installed over drainfield?- _ 0 ® 0
Pump tank setbacks consistent with septic tank?- - 0 N/A Q YES ❑ NO
`1 Pump tank capacity(flood) 2700 gal Manufacturer Sound Placement
Z
< 24"access riser(s)and accessible from surface?- - 0 U ❑
~ Alarm or Control Panel Installed? 0 I 0
a
E Control Panel equipped with Timer/ETM/Counter- 0 0 ❑
m
a Pump installed in IN Bucket or ❑ On Block or ❑ Othera.
Pump Make/Model
❑ Floats or 0 Transducer
Tank draw down 1 in/min Pum ca aci 45 a p p ty qpm Squirt Height 24" ft
Pump on time 2 min. 15 sec Pump off time 3 hrs 57 min Daily flow set at 600 gpd
- Updated 821/2018
Mason County OSS Installation Report pg. 2 Parcel# 22131-44-00060
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? • - El YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? r3 YES NO
RECORD DRAWING
This Is a permanent record and must be accurate and descrrptive enough to re-locate In the need of malMenance activities and future development. Typical Record
Drawings cbrrtam Drains eld d mani'uto onentaaon 8 layout,Septic/pump lark location North arrow,reserve drainlreld•existing and proposed buildngs location of wells.wutedines,
wells observaton ports.devout:.and other maintenance access points. Incomplete Record Drawings may crea:e additional delays in final installation approval and related perms.
III 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
L C/6-1Z 3
Siinat of Installer Date
Loaan Spear ,t�t,Q"•,
Printed Name of Signee
'
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and Roe7.H,A� .,s_t• >.
Record Drawing on behalf of Mason County Public
Health:
Exp;REs
g-n-\9.,\X\V--041 (z- / T3
, Signature of 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 Updated e21:2016
�NG�M,EKE RoPQ
SP , --- a."-7\r.
APPROXIMATE
EXISTING DRIVEWAY
AND ROADS
PROPOSED `. APPROVED
DRAINFIELD JUN 2$ 2023
="% '
EXISTING WELL MASON COUNTY ENVIRONMENTAL HEAL".H
- a.
RbT 7
MAINTAIN 10F1-SETBACK _ '1
FROM WATERL;NES TO i `'AP..11
SEPTIC COMPONENTS // \ \\ I
� —1 J ^t` ". \\ 1
- 1' / • \` %O_ —'\
t, �„cpaseoI
— f .
Lr�, 1 1 !HOME`!
."� \` ,' // / // ! PROPOSED
• \-- •-� / /�i — ; t- SEPTIC 6'r PUMP
_�� i r --- , - TANKS :
EXIST. %�, i/ /
TANK � _ i i /
& DF
COI* �� EXISTING TANK())
\`��- EXISTING TANK
— - & DRAINFIELD
I
HOME AND OFFICE CURRENTLY SHARE EXISTING 4 BEDROOM SYSTEM.
PROPOSAL IS TO INSTALLA NEW 6 BEDROOM SYSTEM FOR HOME, I
i I INCREASING THE HOMES CAPACITY, EXISTING 4 BEDROOM SYSTEM I
WOULD REMAIN IN USE BY OFFICE ONLY.. _ ..... !
,,
- - - 4 - - - -
.
n.
N
wnflF�•.,H'rJJf
EXPIRES NFU;
AN ASBUILTI INSTALL SIGNOFF FEE WILL
INC. CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, 1 V PAR CUSTOMER.:
r .: GRACE
1-NBAUGH TEST`111I LF j ;(H,�IE_
SEPTIC DESIGNS ADDRE.': 1512 SPENCER LAKE RD
1 3083 L!YI&tiYv BE\�'N RD. GR.ME\'(m.v%A 0546 DESIGNER: ROBERT H.rAYSSE w asap L.„7, ,1°,1"W 143.5.7.2 1N`Of u-11.«i Y! e_•-- ':',i
OFFICE•30K)42(ism FA\ 3( 427 2353 S Dt + •CV os..cw.otiai vr° ' .4:�,.i.•-4:�I
HFFI: SITE r1 A\ SUIE 1"=100 a,ccorONEWS 1