HomeMy WebLinkAboutSWG2024-00021 - SWG As-Built - 7/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUB RC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00021 Parcel# 22021-50-90031
Applicant Name ROXANNE VANDERBERG Subdivision (Name/Div/Block/Lol
Applicant Address 591 E BENSON LOOP AFC&, Z!/
City, State, Zip SHELTON,WA 98584 Installer Name LOGAN SPEAR
Site Address 591 E BENSON LOOP Designer Name ALEX L PAYSSE
INSTALLATION CHECKLIST
Q Full System Installation ❑ Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑Other
System Type CONVENTIONAL GRAVITY Pretreatment Type
>5 ft. from foundation? ------ ---- - -- El WA NYES El No
>50 ft. from wells? ---------------- ------ - ------ ❑ e ❑
Z >50ft.from surface water? -- - --- - -- - -- - - --- ---- --. ❑ ® ❑
FCleanout between building and tank? ------ ---- --------- ❑ ® ❑
O Tank baffles present? - - -- --- - -- ---- ----- ❑
IL 24"access risers over each compartment?---- -- - - - ----- -- ❑
w Effluent fitter installed?---- - - - - - -- - - -- --- - - - - - - --. ❑
Septic tank capacity(working) 1500 gal Manufacturer SOUND PLACEMENT i o Ovy
b
�0 D-box water level and speed levelers used? --------------- ❑ wa ®YES Ni
OO Manifold/D-box accessible from surface?- -- - ------ ❑ ® �'J'
O1Z Check valves installed? - ® ❑ L
OQ
2 Transport Line Size 4 Schedule/Class 3034
Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑5 ❑8 ❑Commercial/Other
>10 ft.from foundation?- --- - - --- - - ---- ❑ NIA YES NO
0 >100 ft.from wells?-- ----------- ---------- ---- - ---- ------- ❑ ® ❑
w >100 ft.from surface water?-- - ---- -- - ----- ❑ 0 ❑
u >10 ft.from potable water lines?--- - - ❑ ❑
Z
a >5 ft.from property lines and easements?---- - - E] ® Cl
0 > 30 ft.from downgradient curtain/foundation drains?--- - --- --- ❑ 0 ❑
Drainfield level and observation ports present - --- - -- - - ---- - ❑ ❑
❑ Graveless chambers or M Clean gravel used? (check one)
Proper cover installed over drainfield?-- - --- - --- ---- -- --- ❑ ® ❑
Pump tank setbacks consistent with septic tank?--- - -- E NIA ❑ YES ❑ NO
ZPump tank capacity(flood) gal Manufacturer
Q 24"access riser(s)and accessible from surface?-- --- - --- -- -- ❑ ❑ ❑
o. Alarm or Control Panel lnstalled7 -------- ----- - - -- -- -- ❑ ❑ ❑
Control Panel equipped with Timer I ETM/Counter- - -- - -- - --- ❑ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or� El Transducer
a Tank draw down in/min Pump capacity gpm Squirt Height N
Pump on time Pump off time Daily flow set at gptl
Wosmo erzirzoia
Mason County OSS Installation Report pg. 2 Parcel u Z7-021 So - 90031
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - -- -- - YES No
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-292A-0300Y
RECORD DRAWING
Tina Is a Permarnnt—core and moat ea scum.ana aactlpavv enough no rHecW M tia rwp W mamtmance anlmtles arM nature d—la,meft Typical RemrE
sewing mntaln. OnanaaaS mallow arenlalbn b Ialtd SeplldWmp lank 1-allon,No111 arrow,ree9rye dreaded,evar,and Propoudd buildups.loudlan ofw s,waleTines
cite oomrva un pods.deanouls,and o0er mamlanance as eaa x nls. Inmmplare Rewrd DgwinPf dqy Geele BdddgNl dMeys in Bndl Incldllfl4M approvA and relalM permu
gs all Sea 41te-eked
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 c/eared/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
1 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.
s fisn �1��/Z
St na reoflnst((la�r� Date ty�
LnnBN $11 b� �Pnnte�/-yS�gnee
MASON COUNTY PUBLIC HEALTH a
The undersigned approves this Installation Report and r
A Lq6 My9¢
Record Drawing on behalf of Mason County Public "l'IE 1
He": n n�
Signature of Errylvoringlintat Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE wed�O3018
PICKERING
APPROXIMATE J PASSAGE
PROPERTY HAS ADDITIONAL OHWM 1
SPACE FOR RESERVE AREA /
FURTH ER TOWARDS BEN50N
LP, BUT SOIL5 MAY CHANGE.
I �
EXISTING HOME
W/ DECK O� 1
\1 V '
SHED /
APPROXIMATE
ADDITIONAL RESERVE AREA LOCATION FOP,
EXISTING 055
FOR EXISTING 055 (300 SF) (pER OWNER)
(MAY REOUIRE 5MALL CHANGE
TO DRIVEWAY AREA&PRE-TREATMENT)
jo -f---------
SHEDS (X2)
5'CUr BANK �/ ; -------------
' N r
i
r ;
RESERVE AREA
INSTALLED PRIMARY % (j
RAINFIELD N ; i EXISTING WELL
D
r $ r (SHARED)
SEPTIC TANK _J 1 `
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I�Rr 1 EXISTINGAPPRI VEt) i WELL
FUNRE'�— ` I
JK-r 1 2024 A n
MASON COU �N
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APPLICANT PLANS
i TO DRILL NEW WELL
0 CORD DRAVMO
CUSTOMER RORANME VANDIXBFRG TEsI I IDLE L TEST HOLE 2 TEST HOLE 3:
PIONEER. DIGGING, NC— PARCEL12(H1
PARCEL 22021-509MI O1-"'I> 818 L n 1 0I9 CAS
�K HELL
SEPTIC DESIGNS ADDRES4 591E BENSON LP lw M5
W83EMASONBENSONRD. GRMEVIEW,WA985* DESIGNER ALEX L PAYSSE
OFFICE 360-Q61803 FAX-3W4272353 SHEET: AWRLT SCALE P=40 cuxnlmxFswxcia[mi usanuxx[u