HomeMy WebLinkAboutSWG2023-00119 - SWG As-Built - 1/19/2024 tt
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Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00119 Parcel # 22320-10-60000
Applicant Name Totem Girl Scout Council Subdivision (Name/Div/Block/Lot)
Applicant Address 5601-6th Ave. S. Suite 150 ` ' (A.-\C_6 (M
City, State, Zip Seattle, Wa Installer Name Workman Contracting
Site Address 800 NE Twin Lakes Rd Designer Name Bob Paysse
INSTALLATION CHECKLIST
Ill Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Standard Pressure Pretreatment Type
>5 ft.from foundation? - •- ❑ N/A ®YES ❑ No
>50 ft.from wells? - - ❑ III ❑
Z >50 ft.from surface water? - - ❑ ® El
HCleanout between building and tank? - - ❑ II 0
V Tank baffles present? - - ❑ IA 0
a24"access risers over each compartment?- - 0 IN
`W Effluent filter installed?- - 0 II El
Septic tank capacity(working) 2250 gal Manufacturer Sound Placement
0 D-box water level and speed levelers used? - - I N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?- - ❑ II
c92QQ Check valves installed? - - El ® ❑
2 Transport Line Size 2.5 Schedule/Class 40
Bedrooms installed (check one) 0 2 ❑3 ❑4 0 5 0 6 ❑■ Commercial/Other
>10 ft. from foundation?- - 0 N/A ® YES ❑ NO
C3 >100 ft.from wells?- - ❑ ® ❑
W >100 ft.from surface water? - - ❑ MI 0
u. >10 ft.from potable water lines?- - ❑ I ❑
cr.Z > 5 ft.from property lines and easements?- ElOM ❑
d > 30 ft.from downgradient curtain/foundation drains? - - I 0 ❑
ca
Drainfield level and observation ports present - - 0 I 0
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO
Pump tank capacity(flood) 2700 gal Manufacturer Sound Placement
Z
Q 24" access riser(s)and accessible from surface?- - ❑ IN 0
aAlarm or Control Panel Installed? - - ❑ IN 0
2 Control Panel equipped with Timer/ETM/Counter- - 0 0 ❑
m
a- Pump installed in In Bucket or ❑ On Block or ❑ Other
a' Pump Make/Model Liberty FL 100 HI Floats or� ❑ Transducer
a Tank draw down 2 in/min Pump capacity 90 gpm Squirt Height 4.5 ft
Pump on time 1.5 minutes Pump off time 4 hrs. Daily flow set at 700 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 22320-10-60000
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES El NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q 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,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
0 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.
- 1/9/24
S g ture of Installer Date ,��
N.
Jamie Workman �I A .
Printed Name of Signee $0 �< ti''Ilk
MASON COUNTY PUBLIC HEALTH �e IF .
The undersigned approves this Installation Report and rd./ ROBE H' VSSE •"
Record Drawing on behalf of Mason County Public / r s a �' ;."
EXPIRES
Health:
RPQYY\pTh � ,tq(2_1-f
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 Updated entnote
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_____I --- INSTALLED SEPTIC
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100'± TO WELL & PUMP TANK
CUSTOMER GIRL SCOUTS... SCALE 1:30
PIONEER DIGGING, INC. PARCEL# �9320 0-60000 TEST HOLE I: TEST HOLE 2 OTHER TEST HOLES
SEPTIC DESIGNS ADDR.FSS: 800 NE IWIN LAKE RI) 0-40 GLS 0.39 GLS SHOWED SIMILAR
40+TILL 39+11LL SOIL TYPES AND
3083 E MASON BENSON R.D. CRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE ROOTS @ 40 ROOTS @ 39 DEPTHS
ONCE-360-426-I803 FAX-360-427-2353 DESIGN PAGE RECORD DRAWING