HomeMy WebLinkAboutSWG2022-00488 - SWG As-Built - 5/1/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00488 Parcel # 22104-51-00009
Applicant Name Phil Oliver Subdivision (Name/Div/Block/Lot)
Applicant Address 1441 Mason Lk. Dr. E.
City, State, Zip Grapeview,WA 98546 Installer Name Spear Construction
Site Address Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drammield Only ❑Repair ❑Other
System Type ATU-Drip Pretreatment Type
>5ft.from foundation? -- -- --- -- ------- --- -- -- --- - ❑NIA ■YES ❑ NO
>50 ft.from wells? -- - - - - - - --- - -- - - - - - -- - ------ - ❑ e ❑
Z >50 ft.from surface water? - - -- - -- -- - - - - - -- - - - - - - -- ❑ ® ❑
F Cleanout between building and tank? ---- - ❑ e ❑
U Tank baffles present? - - -- ❑ ❑
tL24"access risers over each compartment?-- --- -- - - - - - - --- ❑ IN ❑
W Effluent filter installed?-- --- - - - -- - - - - - - - - - - - - - - - - - ❑ ❑
to
Septic tank capacity(working) 1050 pal Manufacturer Sound Placement
0 D-box water level and speed levelers used? - -- - --- ------- - 0NIA El YES NO
00 Manifold/D-box accessible from surface?---------- - - - - -- - ❑ ® ❑
p?Z Check valves installed? - - - - --- -- - - -- - --------- - - - ❑ ❑
02 Transport Line Size 1" Schedule/Class 40
Bedrooms installed (check one) m 2 ❑3 ❑4 ❑ 5 ❑6 ❑CommercialJOther
>10 ft.from foundation?- - - --- ---- ----- - ❑ NIA YES ❑ NO
0 >100 ft.from wells?-- -- - ------- - - ❑ ❑
W >100 ft.from surface water? -- - ------ - - -- - - - --- ----- ❑ ® ❑
LL >10ft.from potable water lines?-- - - - --------------- -- ❑ ❑
Z >5ft.from property lines and easements?-- --- -- - -- ----- - ❑ ❑
>30 ft.from downgradient curtainifoundation drains?-- - -- -- - -- N ❑ ❑
0 Drainfield level and observation ports present -- - - - - ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-- --- - - -- -- -- -- --- - ❑ ❑
Pump tank setbacks consistent with septic tank?-------- -- -- - ❑ NIA YES ❑ NO
Y Pump tank capacity(flood) 1500 at Manufacturer Sound Placement
Z
r24"access riser(s)and accessible from surface?---- -- ------ - ❑ ❑
IL Alarm or Control Panel Installed? - ---- - - - - - - - - - ------ - ❑ ❑
Control Panel equipped with Timer/ETM/Counter-- - - ❑ ® ❑
0- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Flow inducer
IL Pump Make/Mcdel Orenco Turbine E Floats or ❑ Transducer
f
:3 Tank draw down in/min Pump capacity 3.5 on Squirt Height N/A ft
a
Pump on time 3 min. Pump off flme 57 min. Daily flow set at 240 gpd
uomi.a erzvm+e
Mason County OSS Installation Report pg. 2 Parcel# 22104-51-00009
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? - - - - - - - - - - ---- - Q YES ❑ NO
If yes, please describe.
Were all components pumped out and properly abandoned per WAC246-272A-03007 - - - - - -- - X YES NO
RECORD DRAWING
Tnb I..pnm.marl reeord am.main In.aeeurase..a cm engH..oeuen to—Ii In the need or maintenance acumas and Iran eewbgNm. TYpmn aecon
orawmys cmlal¢ Dumneld If m.m6N omen n ii.a NroN.s.pudwmo II Iwenon tJmm anmv.......malnneld,enaang and p,00mad mitten.hc.non M wane,wmemnes.
wena.odx.anrwn pone.uaenons,am oma manrenanc..uas.oolms. mcomple�e Reao,a orawmga m.v Deere aaamona aney<m fine n.wlarm.opm..I.m ramae permits.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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
formI attached Record Drawing is accumte. form and attached Record Drawing is accurate.
Signature ollns[aller' a Date
Logan Spear
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health: EYFRES
- P`�w'
Signature if Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE instincts, d
MA50N APPROVED
LAKE . APPROXIMATE t'AY 01 2024
EDGE OF LAKE "SON C2J T'ESvIRCNYENTAL HEALTH
RET
APPROXIMATE EXI5TING
\ DRAINFIELD & TANK
n
\ TO BE PUMPED &ABANDONED
Exlsr. �
HOME
PROPOSED
\ 30'O _aRGE TREE
NUWATER ATU
& PUMPTANK \ \
\
TRANSPORT& \
RETURN LINE
WELL
6
PROPOSED 2 BEDROOM \ �� . ExIS1 \j
e ' DRAINFIELD REPAIR t ',CARPO�V \ 50'
tom'
121'
R50 \
EAPIRES
\\ EXIST. \�i
WELL
EX15T. ` I
WELL /
A i
/
l N q<:�rl; nllk'v FnV4RC! c�°.. /i
` / AN ASBRGE INSTALL SOWS AF TI N
� 8E ONAROED AT TIME OF INSTALLATION
PIONEER. DIGGING, INC cusFOMER PHL OLNFK TEST HOLE HOLE
PAR R.CEL 71104-04-51-00009 Dom P3Utl'R.
.
]&i091. 3Jxl tiLL
SEPTIC DESIGNS ADDRESS 1441 E MASON LK DR E ROO RO31<.Ai
3083 E MASON BEN O R.D. cRM'W W,WA 98546 DESIGNER: ROBERT H.PAYSSE
OFFKE-360426-MM FAX-3W427-2353 SHEEP. SIIEPLAI SCALE, P.90' . e �w U