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Home My WebLink AboutSWG94-00196 ABANDONMENT RECORD - SWG As-Built - 10/13/2023 A or ii pno Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG `j Li, 0 0 Vi (0 Parcel# 31932-24-00010 Applicant Name Brittany Smotherman Subdivision (Name/Div/Block/Lot) Applicant Address 3620 49th Ave. SW. City, State, Zip Olympia, WA 98512 Installer Name Site Address 730 W. Old Olympic Hwy. Shelton Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ❑ Tank(s)Only ❑ Drainfield Only El Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? - ❑ N/A ❑ YES ❑ NO >50 ft.from wells? - ❑ ❑ ❑ Z >50 ft.from surface water? ❑ ❑ ❑ F Cleanout between building and tank? - ❑ ❑ U Tank baffles present? - ❑ ❑ ❑ a24"access risers over each compartment?- ❑ ❑ ❑ W Effluent filter installed?- ❑ ❑ ❑ CO Septic tank capacity(working) gal Manufacturer D-box water level and speed levelers used? ❑ N/A ❑ YES ❑ NO DO u. Manifold/D-box accessible from surface? / ❑ ❑ ❑ 19 Check valves installed? - - ❑ ❑ ❑ 05 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 [X4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? // ❑ N/A ❑ YES ElNO a >100 ft. from wells?- / ❑ ❑ ❑ W- >100 ft. from surface water? y ❑ 0 0 CC >10 ft. from potable water lines? ❑ ❑ ❑ Z- > 5 ft.from property lines and ease -nts?- ❑ El a W > 30 ft. from downgradient curtai oundation drains? ❑ ❑ ❑ CI Drainfield level and observatio- ports present - ❑ ❑ ❑ ❑ Graveless chambers . ❑ Clean gravel used? (check one) Proper cover installed o -r drainfield? ❑ ❑ ❑ Pump tank setback- consistent with septic tank? ❑ N/A ❑ YES ❑ NO • Pump tank cap- ity (flood) gal Manufacturer < 24"access ri -r(s) and accessible from surface? ❑ ❑ ❑ ~0. Alarm or C trol Panel Installed? ❑ 0 ❑ 2 Control P. el equipped with Timer/ETM I Counter- ❑ 0 ❑ m a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a 7 Pump Make/Model ❑ Floats or ElTransducer a_ a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8rz11201e Mason County OSS Installation Report pg. 2 Parcel# 31932-24-00010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? Q YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? 0 YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need or maintenance activities and future development. Typical Record Drawings contain' Dralnneld&manifold onenlation&layout.septic/pump tank location,North arrow.reserve drain,iela.existing and proposed buildings,location of wells.waterlines, wells.observation ports.cleonoms,and other maintenance access points- Incomplete Record Drawings may create additional delays in final installation approval and relaled 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 1 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. Signature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: -i„,f\fci,m 10I 13Iz-S 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 Updated9612018 • '''. _ Goebel Septic Tank Service, Inc. .wr 4411 ' 171 Big Hanaford Road INVOICE # Centralia, WA 98531 fill-. (360) 736-2167 Date I' L'Th -\ - i�J Olt t PO# • Bill To: ! � 7 ?�" ' Service Site: �C� /1�(�%� C G�i•t fr. <li ?p/7 SEPTIC TANKfl GREASE TRAP) HOLDING TANKS CHARGES Tank exposed for inspection: Yes L. No .� Tank Cleaning 4 r�` _ s 5' G Tank size �'V !WI/Gallons ix:- Mileage /1:.-<, � $--- Bottom/Sides satisfactory condition(no cracks or holes) les V No _ Labor/Digging $ Type of tank:Concrete' Plastic_Metal Other Risers: Yes_ No/ Tank Dg/pth: L, Inches Difficulty Charge S Scum Levels: 1st compartment 5{� brd comp)artment`: Inspection S Sludge Levels: lst compartment U 1b/d,�c'onipartmcntL Electronic Locator _. — $ Tank abandoned after pumping: Yes 4/No i Materials—. .. 5 BAFFLES v / Afisc. S Condition of inlet b fe: Satisfactory 1/ Needs repair Condition of outlet baf ee: Satisfactory_✓ Needs repair_ County Fees S Effluent Filter: NA i66 Cleaned Subtotal S / J��/ Check#_._ Tax s (25,9(7) FLUID LEVELS vL�' o Fluid levels normal in first compartment: Yes 1/ Nn__ __i Total Due S b L`/4'� .—. arip VISA Fluid levels normal in second compartment: Yes 1/ No lii THIS IS YOUR BILL Effluent running back from drainfield? Yes No Evidence ofsurfacin seu n e in the yard? Yes .No We recommend you make a sketch of your septic system in Ihi. space and keep and cops of this invoice for your home files SANDFILTERJ NA ti" Fluid levels:Satisfactory. High Low_ Pump: Working Not working Alarm: Working Not working_ ^r. PUMP CHAMBER' NAJ / ar r - • Pump chber exposed for inspection: s1/ No Tank size�V GnR ilk ('' � , Ye Type of tank:Concrete'Plas c Filter Clea-ed:.-Yes No_NA Risers: Yea,/No Tank Depth: . (Inches Pump 'Tank"pumped out? Yeses Sa_ _ Comments:Pump"Tank""Tank"in good condition? Yes No Conditin of pump: Working-Not+vorA'g4L Alarm working? Yes Not: NA_ • Scum Levels: , - Sludge Levels. ,h > r y f KOWner or Authorized Representative /h -/ C Drier 1, n�� N safe==a'" 730 OLD OLYMPIC HWY NW OLYMPIA Service Company: Shelton Tax ID: 319322400010 Goebel Septic Tank Service Inc u:.. 171 Big Hanaford Rd I Centralia.WA 98531 360-736-2167 Serviced:09/25/2023 by: Brian Orr Submitted 10/13/2023 by:Leslie Erwin nnmo.ncat or.BioRecycling-Centralia Jurisdiction ID:319322400010 COMMENTS Tank Pumped- YES Tank Size(Gallons)(Number only,no text): 1200 Effluent level within operational limits(if NO explain in comments). YES Total Gallons pumped from tank(Number only,no text): 1200 Ef0uent returning back into tank after pumping: NO Tank depth below grade(inches): 6 Access Risers installed to grade(N/A if not present): N/A Tank Construction Material: Concrete Tank Condition Good: YES Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present)'. N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches, if other specify): 3 Compartment 1 Sludge accumulation(Inches,if other specify): 10 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 4 Tank Pumped: YES Tank Size(Gallons)(Number only,no text): B00 Effluent level within operational limits(if NO explain in comments): YES Total Gallons pumped from tank(Number only,no text): 600 Tank depth below grade(inches): 12 Access Risers installed to grade(N/A if not present): YES Tank Construction Material: Concrete Tank Condition Good'. YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Pump operating as intended. YES Controls operating as Intended: YES Alarm working as intended: YES Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify). 3 Ths report teciteates cenarn chamcemrcx of the on nu sewage system at the nm of WN.Iono way s Ns scam 9,acante of operelion or roOffe performance. ReportlD:684857 View pump reports online al www.onlinerme.com Page 1 of 1 Rhonda Thompson From: Brittany Smotherman <aei-brittany2@comcast.net> Sent Friday, October 13, 2023 3:50 PM To: Rhonda Thompson Subject: RE: Septic Caution: External Email Warning!This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SOI Instead, report the incident. There is not currently a house sitting on this property. the mobile home that was sitting on that property has now been moved off the property that's the reasoning for abandoning the septic system. & no I don't have photos. Brittany Smotherman,Office Manager Advance Environmental,Inc. P:(360)-357-5666 F:(360)-357-5665 3620 49th Ave.SW. Olympia,WA 98512 On 10/13/2023 3:42 PM PDT Rhonda Thompson<rthompson@masoncountywa.gov>wrote: Thanks Brittany. Can you give me more of a backstory on this one? I finally got the OnlineRME report to attach from the pumper. It still looks like there is a house here. Is the house to be demoed?What is your reason for abandoning the septic. Do you have photos? Rhonda Thompson, RS Senior Environmental Health Specialist Mason County Public Health 415 N 6'h St. Shelton, WA 98584 360-427-9670 ext. 581 Rthompson@masoncountywa.gov From: Brittany Smotherman <aei-brittany2@comcast.net> Sent:Wednesday, September 27, 2023 10:07 AM To: Rhonda Thompson<RThompson@masoncountywa.gov> Subject: RE: Septic 1