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Home My WebLink AboutSWG2023-00284 - SWG As-Built - 10/13/2023 Mason County OSS Installation Report pg. 1 i OCT- I202 AEON COUNTY PUBLIC HEALTH — APPLICANT/ P9RMITRE ATIO 1 Permit Number SWG 2023-00284 Parcel # 22104-52-00001 Applicant Name KEITH BLOSSOM Subdivision (Name/Div/Block/Lot) Applicant Address 21 E BOUNDARY ROAD City, State, Zip GRAPEVIEW, WA 98546 Installer Name LOGAN SPEARS Site Address SAME AS MAILING Designer Name ROBERT H. PAYSSE INSTALLATION CHECKLIST • Full System Installation ❑Tank(s) Only ❑ Drainfield Only El Repair ❑Other System Type SAND LINED PRESSURE DIST. Pretreatment Type SAND LINED >5 ft. from foundation? ❑ N/A Q YES ❑ NO >50 ft. from wells? - - . ❑ IF ❑ • >50 ft. from surface water? - -- - - ❑ ❑� ❑ HCleanout between building and tank? - - t., 0 ❑ ✓ Tank baffles present? - -- ❑ II ❑ d 24"access risers over each compartment?-.- - - `. ❑ It ❑ W Effluent filter installed?- \�- - -- '- .' ❑ 0 ❑ (n Septic tank capacity (working) 1500 ".-gat'-- Manufacturer SOUND PLACEMENT SERVICES O D-box water level and speed levelers used? ❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- ❑ II ❑ c?Z Check valves installed? ❑ ❑� ❑ Oct ▪ Transport Line Size 2" Schedule/Class SCH.40 Bedrooms installed (check one) ❑ 2 ❑3 I]4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A Q YES ❑ NO O >100 ft. from wells? - ❑ ❑� ❑ W >100 ft. from surface water? - El ❑� ❑ LT. >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ 4 ix > 30 ft. from downgradient curtain/foundation drains? - - ❑ II ❑ • Drainfield level and observation ports present - ❑ Iff ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- ❑ MI ❑ Pump tank setbacks consistent with septic tank? ❑ N/A MI YES ❑ NO Z Pump tank capacity(flood) 1500 gal Manufacturer SOUND PLACEMENT SERVICES Q 24"access riser(s) and accessible from surface? ❑ I] ❑ 0- a Alarm or Control Panel Installed? - ❑ 0 ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ El ❑ m &, .,Pump installed in ❑ Bucket or i] On Block or ❑ Other 2 PumpMakelModpl LIBERTY 280 1/2 HP I] Floats or ❑ Transducer OCTank draw down 1.5 in/min Pump capacity 42 gpm Squirt Height 6 ft / 3 -- . Pump Hrz.ilme 1.9 MIN Pump off time 4 HRS Daily flow set at 480 gpd Updasd Bj2l/2Ol Mason County OSS Installation Report pg. 2 Parcel # 22104-52-00001 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - Q YES 0 NO If yes, please describe. Were all components pumped out and properly abandoned per WAC246-272A-0300? - Q YES 0 NO RECORD DRAWING This Is a permanent record end must be accurate and descriptive enough to re-locate In he need of maintenance activities and future development. Typical Rorurd Drawings contain DalnM1em s manitoxforxxgation a dyne: Seot npump m^x location.North annw.res r x.i datnf.eld meting and proposed lmad.nps location of wells.waterlines wells.oserva.lon ports deanmds.aM other maintenance access points. Incomplete Record Drawings may create dddnwna,delays in final installation approval lam related permits. • Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with 1 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. Jpea"/t_ 4/75/a3 Sign is of Installer Date r'Y��a� C "`Y Printed Name of Signee y ` 's MASON COUNTY PUBLIC HEALTH a" /� The undersigned approves this Installation Reparta�l„-.s ( C Record Drawing on behalf of Mason County Public Se - Health�� • r OCT 't-- < !..✓_2r:t Signature of Environmental Heall Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 0131/201P M-,sON �kFD _ — \ RF�sr � 1,1jI1 \ \ Z y I I \AI • 4BEPROOM p Oalles / DRAINFIELP _ ___ 0 / AS PER DESIGN -- C/O G • I / ,-' NEW SEPTIC /,- & PUMP TANK I EXISTING / /1 �j HOME I 0 / OCi13 3 FI �trH I / RECORD DRAWING / / \ / 1317 • jEXISTING WELL AN ASBUILCHARGEDN ML SIOF OFF INSTALLATION FEE WILL BE CHARGED AT TIME OF li I `Vql R_ KM III IN�`o�.'V4 IL-1 IIJLL L II I MOLL PIONEER DIGGING, INC PvIUiI �1LII o_'011OVI In NO[9 Id AL ' AF OAIl vlV1FA( lpA' ',FP I IC DESIGNS vela> , ➢ I ROE2u2151 RD ROOI>U 55 ItOor- 5 51 .,U 31 NA cJ�9F\-R N Ka C.RnPt\1FN.Ica 0%9 RI DF9G\FR: RORCRT H.P..\153C 541111] -S6O-2(5-180i 11V-3GMP-L351 L//I III I AtiRU >C 11 I I"-20 P54505 5 5155 550505ED SEV 44515,55T PIA4 LIE sum T TO 045ER 541555115455,145 551 1 I 511 A J54145155555 EE+.5 TEA( AEJ,TEcu