HomeMy WebLinkAboutSWG2022-00392 - SWG As-Built - 3/13/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2022-00392 Parcel # 22020-75-90092
Applicant Name Mellinger Living Trust Subdivision (Name/Div/Block/Lot)
Applicant Address 7801 25th Ave. E.
City, State, Zip Tacoma,Wa 98404 Installer Name Spear Construction
Site Address 241f Big Skookum Rd. Designer Name Bob Paysse
INSTALLATION CHECKLIST
•i Full System Installation ❑Tank(s)Only ❑ Orainfeld Only ❑Repair ❑Other
System Type Standard Pressure Pretreatment Type
>5 ft.from foundation? - - ❑NIA •YES ❑ NO
>50 ft.from wells? 0 MI ❑
Z >50 ft.from surface water? - - 0 M 0
✓ Cleanout between building and tank? - 0 0
U Tank baffles present? - - 0 II 0
1 24"access risers over each compartment? 0 III
m Effluent filter installed?- - 0 II
Septic tank capacity(working) 1500 gal Manufacturer House Bros.
O D-box water level and speed levelers used? - I. NIA ❑ YES ❑ NO
QO Manifold/D-box accessible from surface? 0 e 0
a.
a?Z Check valves installed? - - 0 IN 0
04
E Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) 0 2 a 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - 0 N/A In YES ❑ NO
O >100 ft. from wells?- - 0 ® 0
W >100 ft.from surface water? - - 0 III
L >10 ft. from potable water lines? 0 El
Q > 5 ft.from property lines and easements?- - ❑ e 0
K > 30 ft. from downgradient curtain/foundation drains? MI 0 0
Drainfield level and observation ports present - 0 0 0
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ INI 0
Pump tank setbacks consistent with septic tank? 0 N/A . YES ❑ NO
• Pump tank capacity(flood) 1500 gal Manufacturer House Bros.
4 24"access riser(s)and accessible from surface? 0 ■ 0
I—
a. Alarm or Control Panel Installed? - ❑ 0 0
a
• Control Panel equipped with Timer/ETM /Counter- - 0 ® 0
a Pump installed in I. Bucket or 0 On Block or 0 Other
fPump Make/Model Liberty 290 ® Floats or ❑ Transducer
a Tank draw down TBD in/min Pump capacity gpm Squirt Height ft
Pump on time TBD Pump off time Daily flow set at gpd
Updated 8/21/201e
Mason County OSS Installation Report pg. 2 Parcel# 22020-75-90092
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ❑ YES Q 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
ent record and must be accurate and descriptive enough to re-lre-locateoc. In the need of maintenance activities and future development. Typical Record
Drawings contain- Drelnlield&manoola onentaton n lyout.Repo/pump lank location.Not arrow reserve dainreld,existing and proposed bwNmss,location of wells,waterlines.
wells observat.on pods.cleanouts,end other maintenance access points. incomplete Record Drawings may create additional delays in anal installation approval and related W'mils.
,,
k APR 1 2 2023a a
J SW
® 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 1 further certify that all information contained on this
for end attach d Record Drawing is accurate. form and attached Record Drawing is accurate.
oat eof In r ate efIL
cf.
Logan Spear r
Printed Name of Signee '//� I Q et; A.-1 .4;
MASON COUNTY PUBLIC HEALTH U 'f�'ri1
The undersigned approves this Installation Report and t4s `
`
Record Drawing on behalf of Mason County Public u•- 1 .f Ia
EXPIRES
Health:
/ L .f _(3 2
tit/
I -nvironmental Health Specialist Date (stamp, signature and date)
Sign'/ updated erzvzme
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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-� BIG 1�
I ' y/ SKOOKUM
I i �- ROAD
A
DRIVEWAY I ' I �
PROPOSED 3 BED. I / / =J s
DRAINFIELD I l / ��f ii 0 r E g 5',
114 I APR 1 2 2023
,` III \N�__ 1N ,� Jain
- I 'E N
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1 I TRANSPORT LINE
p 1 I I I APPROX.
Ir I I PROPOSED HOME
PROPOSED WELL: I____I
MAINTAIN 100' FROM t I I PROPOSED SEPTIC & PUMP
PROPOSED DRAINFIELD r1� TANK LOCATION
50' FROM TANKS & LINES I PT�� �'1//
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EXPIRES
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I APPROX. SHORELINE
HAMMERSLEY INLET AN ASBUILT/INSTALL SIGNORE FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, NCQLSTOMER LISA MELLINGER TEST Hf l F L TEST HOLE 2 TEST HOLE 3:
rARCEL PI22020ae 90092 6+COMP 64 TN
SEPTIC DESIGNS ADDRESS: XXX E BIG SKOOKUM RD MED.SAW MED, SAND
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER ROBERT FL PAYS¢ Y°1rr-rflur
OFFICE-360-261803 FM-360427-2353 SHEET: SITE PLAN SC AI F. 1'=60' DEPPlirarridtirMCV wawa erw�wrRS 4=41 TO A