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HomeMy WebLinkAboutSWG2023-00488 - SWG As-Built - 1/4/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00488 Parcel# 22104-12-90101 Applicant Name Robert H. Paysse Subdivision (Name/Div/Block/Lot) Applicant Address 3083 E. Mason Benson Rd City, State, Zip Grapeview, Wa 98546 Installer Name Pioneer Digging Inc Site Address 3279 Mason Benson Rd. Grapeviev Designer Name Bob Paysse INSTALLATION CHECKLIST II Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other System Type Gravity Pretreatment Type >5 ft.from foundation? - •- ❑ NIA ®YES 0 NO >50 ft.from wells? - - ❑ II ❑ Z >50 ft.from surface water? - - ❑ VI Cleanout between building and tank? - ❑ MI ❑ U Tank baffles present? - - ❑ II ❑ F'- 24"access risers over each compartment?- ❑ ® ❑ a III Effluent filter installed?- El WE 0 Cl) - Septic tank capacity(working) 1200 gal Manufacturer Sound Placement CI D-box water level and speed levelers used? - - ❑ N/A MI YES ❑ NO cO Manifold/D-box accessible from surface?- - ❑ II ❑ i. oil Check valves installed? - •- II 0 ❑ GQ 2 Transport Line Size 4" Schedule/Class ASTM 3034 Bedrooms installed (check one) ij 2 ❑3 0 4 ❑ 5 El 6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ® YES ❑ NO >100 ft.from wells?- - ❑ ® ❑ W >100 ft.from surface water? - - ❑ IL ❑ li >10 ft.from potable water lines?- - ❑ ® ❑ Z >5 ft.from property lines and easements? CI ® ❑ 12 >30 ft.from downgradient curtain/foundation drains?- - ❑ © ❑ Drainfield level and observation ports present - - ❑ II ❑ El Graveless chambers or Ng Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © ❑ Pump tank setbacks consistent with septic tank?- - ® N/A ❑ YES ❑ NO ZPump tank capacity(flood) gal Manufacturer H24"access riser(s)and accessible from surface?- - ❑ 0 ❑ a Alarm or Control Panel Installed? - - ❑ ❑ 0 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑ n- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n' Pump Make/Model ❑ Floats or ❑ Transducer 2 aTank draw down in/min Pump capacity qpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 821/2018 Mason County OSS Installation Report pg. 2 Parcel# 22104-12-90101 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES J 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: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval end 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. IV.„ C O.L- 1/2/24 Signature of Installer Date f i f i' jf Robert H. Paysse • Printed Name of Signeeof �l MASON COUNTY PUBLIC HEALTH • The undersigned approves this Installation Report and r;itno V.� Record Drawing on behalf of Mason County Public J' AL EX L°us pl►tssta _ eh } - 1 Health: ew,N[s 16y\iii1/\()VI/1r\ (/Li Z Signature of Environmental Health Specialist Date p (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 I I I I I I / / I 1 �'�0 // O / i . \1/4_,_ i� I I I I - — -- --- — _______ _._ ______ IA I I I i 1 1 gI INSTALLED DRAINFIELD W/ RESERVE BETWEEN I 1 t' 8, I i �r) II I I I II11I `I I 1 < III ,,.f, III �Ij` - I I .1III. }'` II' -: III ,/ III illI I,II� . 1411) Ip- I D _ nI HOME �, I D—BOX D 0 o CLEANOUT 1 g INSTALLED ,.4 „`wun;, ' _� SEPTIC TANK S N(T2oo GAL)MAOCPGUNJ pATY VE RN M0O420V2E3N EtAI III�ttH��oE „,is,o i ',-I 4 1 FEriiES — — — - - - RET- - - - - - CORD a3AWN0 PIONEER DIGGING, INC CUSTOMER: ROBEItT H.PAYSSE PARCEL#: TEST HOLE I: TEST HOLE 2 TEST HOLE 3: 221Q412 90101 0 6t►<;L\l5 0-60(L'0S two GL\%S IUX)IS 60 ROOFS-60 ROOTS-60 SEPTIC DESIGNS ADDRESS: XXX MASON BENSON RD 3083 E.MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE PP'°,AC,SORBURVEYS.Ff DM NOT A EURVEY.REFERENCES EASUREMENTSANDCOUNTYGIS DDEES`GN INTENDEDF RSESE�C li OFFICE 3G0 426 k 03 FAX 3(x►427 2353 SHEET: ASBUILT SCALE 1 A=30 M >.]tP05ES OM1ly PROPOSED DEVELOPMENT RE MAY BE SUBJECT TO TED TO 1 CFPRETMEnt onkr v IMAM PROPOSED SED NOT EESPON MAY FOE SETBACKS UNTO OTHER TO SEPTIC COMPONENTS