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Home My WebLink AboutSWG2024-00030 TANK ONLY - SWG Application / Design / As-Built - 1/29/2024 • OFFICIAL USE ONLY MASON COUNTY DB I _ c) CciCA COMMUNITY SERVICESDATE RECEIVED. NTT/ s a, al , 1� > t CO CO J/) O y Public Health(Community Health/Environmental Health) G m Z a; ON-SITE SEWAGE TANK ONLY APPLICATION > z APPLICANT PHONE m 0 m WILLIAM MORRISON 1206-849-2294 z MAILING ADDRESS-STREET CITY STATE.ZIP CODE C 3 51 E PIRATES DR. GRAPEVIEW, WA. 98546 m m SITE ADDRESS-STREET CITY.ZIP CODE - A 260 E LOMBARD RD S, GRAPEVIEW, WA. 98546 I —' NAME OF DESIGNER •PHONE CINDY WAITE 360-701-0205 ro NAME OF INSTALLER PHONE SELF FYPE OF WORK/SeleR one) DRINKING WATER SOURCE (7)_ ❑ NEW CONSTRUCTION/UPGRADES EPAIR I REPLACEMENT RIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL 0 Z V PUBLIC WATER SYSTEM COMPONENT!S)TO BE REPLACED/ `_j,/'_'EPTIC TANK PUMP TANK ❑ RV HOLDING TANKn eEDROCMS �-) I OTSIZE `' / I ❑ OTHER N) �y CD OTHER DETAILS(select all Thal apply) TANKISI SETBACK CHECKLIST r I/ae 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE ® 100FT+PUBLIC!COMMUNITY WELLS 0 I ISUBMITTALS • SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS RIVERS E PLOT PLAN(REQUIRED) ❑ TANK CROSS SECTION(REQUIRED) a 10FTa DRINKING WATER SUPPLY LINES I El PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) • SFT+PROPERTY/EASEMENT LINES.FOUNDATIONS.FOOTINGS PLOT PLAN CHECKLIST 6 I c F PROPERTY LINESAND EASEMENTS ® EXISTING/PROPOSED STRUCTURES • EXISTING/PROPOSED OSS COMPONENTSAND LINES . 1 0 WELLS WITHIN 100FT ■WATER SUPPLY LINES • DRIVEWAYS/PARKING • SURFACE WATERS,STREAMS,RIVERS,ETC I ND • DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS • NORTH ARROW • SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS (es locked Bare/ I O GO OUT HIGHWAY 3, TURN LEFT ON GRAPEVIEW LOOP, GO RIGHT ONTO LOMBARD ROAD, DRIVEWAY IS ON THE LEFT SIDE OF LOMBARD. OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE por report ng purposes 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE COMPLAINT 0OTHER. COMMENTS/CONDITIONS Lot•-11 C '1 CrE \ Etl�\(2) . �lS 2v SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIRE EQUIPPED WITH RISERS AND LIDS TO SURFACE AND INCLUDE AN EFFLUENT FILTER IIF APPLICABLE/ RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 7E'( 1 IIS ( WI zll lay THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED I VY/Zm5 Cindy Waite 80 E Pickering Lane Shelton, Wa. 98584 360-701-0205 cindyewaitefa msn.cpm January 15, 2024 RE: 260 E Lombard Rd S 12107-44-01020 I did a site inspection on December 30, 2023, Drainfield was installed as per design. Observation ports are visible. I took effluent measurements on the septic tank and returned on 1/1/2024 to check. Tank effluent had not changed. This told me that the tanks were not leaking or taking on water. System is not in use at this time. Current owner moved his own tanks, installed risers and effluent filter. He tied into the existing transport line and did not change anything in the drainfield. Tanks were moved about 3' to the west. The original install had the tanks about 6-12" out of the original soil. Could not get enough slope to use the tanks. SWG92-0821 was installed in 1995 by Mason County Septic, Otto Field. Approved design and approved record drawing are on file with Mason County Health. Respectfully submitted; Cod (,) , Cindy Waite w • YKeutovs c7 4oi i p� .L A 5. t or z Now a t /69 ' t3� ' ♦A' S `/9f , ° of Aotc SE:-1 5j flint, f 3X G 9 TH a% I 1 Wore ` 1,RP'sPn d' • //Dare T!TL< / S I '3,'« ii Coa7rletrie% 8av-erd,44 j7acr«. A "-e AdS vs r.H.Pn f I 3 r 1I i t s Pie 8L A ' 93- /? L rS-e., do ' Sail J` 77" a r J rot, /oT 44ST /d�/ ", ( fRcvio✓sl.i Lots i4 a) ,off_o. s� /I IZ /aT �/9-o/oza • Au.20' —7 Z —rf Sca1eo Pin fL4+7- bCoA CPR.11-o+s ' SEAVFY) ` /✓ew 4.a7, Sic/ 6h lc,R qt.ee 1� L4 FRf$Nti6 PRa cos,o� .7a_ aide </UY se At f4fl) ' '6•( 5y9 h! �� 2a Elr♦. yoo .�` EL`I . -'a3e eny' y o a d ` "Mason County Dept. Health Services rn.113 c_auc'JG PAei APPR• ED „ - .S 1�-"� Initials i Date SI. Masan County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00030 Parcel # 12107-49-01020 Applicant Name WILLIAM MORRISON Subdivision (Name/Div/Block/Lot) Applicant Address 57 E PIRATES DR City, State, Zip GRAPEVIEW,WA. 98546 Installer Name SELF Site Address 260 E LOMBARD RD S,GRAPEVII Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation Q Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? ❑ N/A Q YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - El ill H Cleanout between building and tank? ❑ 5 ❑ a Tank baffles present? ❑ ❑ ❑ d24" access risers over each compartment? - ❑ NI ❑ W Effluent filter installed? - NI ❑ ❑ U) NOIT KNOWN Septic tank size 1150 gal Manufacturer o D-box water level and speed levelers used? ID NIA IDYES ❑ No DJ O Manifoltl/D-box accessible from surface? - 0 0 ailCheck valves installed? - ❑ ❑ ❑ Oct Schedule/Class 2 Transport Line Size Bedrooms installed (check one) 2 24 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - ❑ N/A _ YES ❑ NO CI >100 ft. from wells?- ❑ ❑ W >100 ft. from surface water? - - ❑ ❑ it >10 ft. from potable water lines?- ❑ -J ❑ ? > 5 ft. from property lines and easements?- - 0 ❑ d > 30 ft. from downgradient curtain/foundation drains? - . _ ❑ ❑ o Drainfield level and observation ports present - ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? ❑ ® 0 Pump tank setbacks consistent with septic tank? ❑ N/A 0 YES ❑ NO 2 Pump tank size 300 gal Manufacturer LIGHT BULB FIBERGLAS Q 24" access riser(s) and accessible from surface? ❑ 17 ❑ ~ Alarmar-CeeffelParek+ftste1ed? - - ❑ Pi ❑ CI.7 Control Panel equipped with Timer/ETM /Counter- li ❑ CIs Pump installed in ❑ Bucket or ❑ On Block or 0 Other g Pump Make/Model NOT KNOWN 5 Floats or 0 Transducer EL a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd Updated 812J201e Mason County OSS Installation Report pg. 2 Parcel# 12107-49-01020 ABANDONMENT RECORD NO Were existing septic components abandoned as part of this project? - - YES— If yes, please describe: E YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? 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'. Drxinfield&manifold orientation&layout.Septicipump tank location.North arrow,reserve draintield,existing and proposed buildings,location of wells,waterlines, wells.observation parts,Geanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. a C✓N,e4 rvlaLCOJ e- rr/,.f 4aar Ad (714e4,1 ben.`! fic 4 pttm, A Yr mom .t abut Tr 1...n asup,.,al Tda.i SI la Iry fAl'hay.4 41). S/an/t.G 1 so ? 47 Q.wf1 No } bt q,ca.r7a} G1J. • 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 and Mason aso Countyouty Public Health and meet all and Mason County Codes. I further certify that all information contained on this 1 further certify that all information contained on this form andfn mo attached Drawing is accurate. form and attached Record Drawing is accurate. The-- of Installer Tr t1 Date k ( U,v )V3, �4- ' A Printed Name of Signee rtri. b� 2 MASON COUNTY PUBLIC HEALTH LP n.CL% The undersigned approves this Installation Report and h 5t 5 is, 77/ re CINDY CCCC wAITVA Record Drawing on behalf of Mason County Public LICENSED DESIG Health: tAPiRLS ',ls 10, Signature of Environmentalealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018 . W nee uloos a , �o, Oct/ AS, / er z 4 a Ntowrs 3� 4 East /61 ' • t' tH 1�fl. G o4 o • 3, 3x . f7 11 I �yLr + _ • rpw I 3Y Lie 1 L Roi aiw J/ -Theiti 1 S[74� - y, �to < /I /2 /o7- 99-0/020 / Yip zee —�►sr- 03 �� r Q: \SIGb. bu 11ia' I (l',_,. - ' . PA 27 ' ii.. vrii'd: .4 "Y..< O< CI Y N EeR \ _ _`\ Y\ �n C�ey ze i ea T Zd el 6aleM enr TO4a , : 1--, cc a.J PE-kw; r _ - - ' ` "Mason County Dept. Health Services ' APPR' ED -t/J)IC �C14� a"N� Initials 4 w pu .r.p T4,,,* rhs ved Data St • Bamford septic Repa!r,LLC 301E Wallace Kneeland Blvd STE#224-332 13607902364 Shelton, WA 98584 —PROPERTY INFORMATION Location:260 E LOMBARD RD SOUTH Grapeview Tax ID: 121074401020 mad To: James Morrison Use: GENERAL SYSTEM TYPE:Conventional (Pressurized) ON ID: 121074401020 County Area:Case Inlet Fold rfT ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT uere Inspected:02/01/2024 - Inspection Type:ROUTINE - Correction Status:No corrections needed Company. Work Performed By Submitted 02/05/2024 by: Bamford septic Repair,LLC Thaddeus Bamford Thaddeus Bamford COMMENTS S GENERAL INSPECTION NOTES No Deficiencies Noted No observed problems. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected _ Components accessible for service:pgien YES Srequired se c ' eflu e perf co('poo t c u omitted inspection_ notes): YES Surfacing effluent from any compone (including mound seepage): NO Componentspp enEewalenii-povioual leaks. YES Improperencroacemfatnduros/(structures/impervious surfaces) NO Alt riser e securely fastened upon departure: YES Electrical repairs If YES describein comments: NO Inspected conpn ts appear to be in oodes l con YES Root int dra any compo eY . If YES d ribe in comments: NO Settingproblems observed If YES describecomments: NO The house/structure was tor ueetl infrequently,assessment of the dra n(eltl was not possible. _ NO ONSITE SEWAGE SYSTEM INSPECTION DETAIL This component was ventrally inspected Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Compartment I Scum accumulation(Inches,if other specify). Compartment 1 Sludge accumulation(Inches,if other specify). Compartment 2 Scum accumulation(Inches.if other specify)'. Compartment 2 Sludge accumulation(Inches,if other specify): Pumping recommended: NC This component was' Fully Inspected Compartment 1 Scum accumulation(Inches,if other specify): Compartment 1 Sludge accumulation(Inches,if other specify). Pumping recommended: Ne This component was: Fully Inspected Lateral ines flushed YES Average squirt height(if performed)(feet.if other specify): Pending present?If YES explain in comments. NO P This component was: Fully Inspected Controls functioning: YES Tested gallons per minute flow: ReportiD:1256551 View inspection reports online at www.onlinerme.com Page 1 of 2