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HomeMy WebLinkAboutSWG2020-00485 - SWG As-Built - 12/4/2023 iPi rEP fisgwerr ri/'ilzX Mason County OSS Installation Report pg. 1 MASON COU!Viz HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00485 Parcel # 22018-52-00032 Applicant Name GLEN STOLLMEYER Subdivision (Name/Div/Block/Lot) Applicant Address 490 POWELL RD City, State, Zip CASTLE ROCK,WA. 98611 Installer Name HANSON EXCAVATING Site Address 151 E MCLANE DR Designer Name CINDY WAITE INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Y' IL t1/416,Ai- Pretreatment Type >5 ft. from foundation? - - 0 N/A ❑YES ❑ No >50 ft. from wells? 4 Z >50 ft. from surface water? l� - - 0 ❑ ❑ Cleanout between building and tank? 1 �t� - - - X ❑ ❑ U Tank baffles present? - t - - - -1.-fr l- - - ❑ El ❑ d24" access risers over each compartm ,� ' - - ❑ El ❑ W Effluent filter installed?- ��' - 0 ❑ ❑ N By ENVIRO FLO Septic tank size BNR500 gal Y anufacturer 0 D-box water level and speed levelers used? - - 4 NIA ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ II ❑ m 2 Check valves installed? - - ❑ 0 ❑ CI 4(2 Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - 0 N/A ❑ YES ❑ NO 0 >100 ft. from wells? 111 ❑ ❑ W ❑■ ❑ >100 ft. from surface water? - - ❑ a.. >10 ft. from potable water lines?- - El ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ El ❑ d > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑ cl Drainfield level and observation ports present - - © ❑ ❑ ❑ Graveless chambers or ET/Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ' ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A Q YES ❑ NO Y Pump tank size f.)So gal Manufacturer COLA p l4 CQ ft1P/1 f- 24" access riser(s) and accessible from surface?- - ❑ © El H a Alarm or Control Panel Installed? - - ❑ CI 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑ m a- Pump installed in ❑ Bucket or On Block or ❑ Other 2 Pump Make/Model /_.;bp..01 Y 6 E, Floats or ❑ Transducer a.a Tank draw down a in/min Pump capacity Li`-t gpm Squirt Height -3.-6 ft Pump on time Pump off time Daily flow set at gpd n, Updated 8/21/2018 `\ Mason County OSS Installation Report pg. 2 Parcel# 22018-52-00032 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - -- - ❑ YES ❑■ 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 drainfield,existing and proposed buildings,location of wells.waterlines, wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. G o eaba-� .0,/ ktio w 2107 tit APPROVED DEC 0 4 2023 MASON COUNTY ENV1ROlhYENTAL HEALTH RET NI Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER l 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 ached ec rawing is accurate. form and attached Record D;, ing is accurate. s�,l h yboo)(t . Si ature of lnstalle ( Date 0 PQ' ,er 1!, �/) Sc��'P c� ITS 1 S i ~ �t�o""���11 + V • Printed Name of Signee N�: :° '`tP. Q 4111/ at MASON COUNTY PUBLIC HEALTH i LICENSED DE AITE . ' .,41 i"1 The undersigned approves this Installation Report and ✓_ DESIGNER I• *\ • Record Drawing on behalf of Mason County Public E • $5/10i Health: ‘74 112,1; ePcii se ) .71-) - VA-14.,( -6\tvk 41,44a4rfitotThp-• 4)- 5 Signature of Environ ntel Health Specialist Date (stamp, signature and ate) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIE I • ••' •. • i • B SITE Updated 8121/2018 t ,1 p 1 0- `l v/ ,i� >.. Tµ I o - 11 " 1.- , ,' .2/is, wes-heddio, 0 T-i-41 1 6n22" 1., , 22 if 1PpROV OEC 0 4 2023 MASON COUNTY ENVIRONMENTALHEAU�� !cve • dEe%�°i RET �$` 1 3 U' or%A 1 _ h r r� "«`.1 ti dc.-1,10 ZiA',,4, ,(v) • pirr. c_v4s.s.;,01. 41/ tii N Y E.WAITE I N4A or LICENSED DESIGNER 1t r ■ .... I. .. .v1 1frl „ .����.. ���..� .a , . m,. _ _ _ ExHiHES 05;,p 1ii ,\61—' 1. , Residence NO tcs,Je,,,. I 41 ® 2. BNR 500 Unit in concrete tank p LD •Q - - - . 3. 1200 concrete pump tank 04. Transport line ! 04) (a----" 5. Valve Box 1 I - . 6. Drainfield (3x44" laterals) 157 e „, ,..tea., 04. 7. Reserve (3 4-1s laterals) 8. Clean out between residence 2a Ot '—.rz— O1,o32- and BNR 9. Audio/visual alarm 10. Water line 11. Soil log #1 12. Soil log #2 1. 2a' —I._ kiG 1 4° ' .� 13. Soil log#3 14. Very large tree, when removed, J l� ��- Zp� stump hole must be filled with C-33 sand if Glead o6 -/0 is 0,4