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Home My WebLink AboutSWG2021-00495 - SWG As-Built - 7/24/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2021-00495 Parcel# 22103-51-00031 Applicant Name Jereme Wilson Subdivision(Name/Div/Block/Lot) Applicant Address 1470 E.Benson Lake Dr. City. State, Zip Grapavlew,WA 98546 installer Name Mikkelsen Septic Site Address 1470 Benson Lake Dr. Designer Name Bob Paysse INSTALLATION CHECKLIST ®full System Installation ❑Tenk(s)Only ❑Oreinfield Only ❑Repair ❑Other System Type ATU-Pressure Pretreatment Type Ni BNR 500 >5 ft.from foundation? -------------------------- - ❑NIA .YE{ ❑ NO >60ft.from wells? ---------------------------- - ❑ E ❑ ZY >50 ft.from surface water? - ❑ . ❑ FCleanout between building and tank? -_________________ - ❑ ❑ Tank baffles present? -__ _ _ ___ __________________- ❑ ❑ 24'access risers over each compartment?---------------- ❑ ■ ❑ W Effluent filter installed?-- -_______ _____ ___________ _ ❑ ❑ Septic tank capacity(working) 1200 NDWatefgal Manufacturer Sound Placement q D-box water level and speed levelers used? --------------- . WA ❑YES NO GManifokl/D-box accessible from sudace?----------------- ❑ Check valves Installed? --- ---------------------- - ❑ ❑ Transport Line Size 2 Schedule/Class 40 Bedrooms installed(check one) ❑2 N 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >10 fL from foundation?------------------------------------ --- - ❑WA E YES ❑ NO es >100 R from wells?-- ---- -- ----- - - ---Lnsil-6 --- --- ❑ 1177 >100 ft.from surface water?---- -----IL >10ft.from potable water lines?-__ _ _>a ft.from property Imes and easements?-- �-n24 - ❑>30ft.from downgradient cudain/foundation ------ ❑ ❑ Drainfield level and observation ports presen ® ❑ ❑ Graveless chambers or S Clean grav Proper cover installed over drainfleld?-- - --------------- - ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ wA AYES NO Pump tank capacity(flood) 1500 gal ManufafAaer, Sound Placement H 24"access risers)and accessible from surface?------------- ❑ ® ❑ Q. Alarm or Control Panel Instilled? --------------------- ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ d Pump installed in a Bucket or ❑ On Block or ❑ other Pump Make/Model Orenco 1/2 he turbine Float, or ❑ Transducer Tank draw down TIED inlmin Pump capacity Wn Squid Height 24- ft Pump on time Pump off time Daily flow set at 360 Opd- upeai wis m Meets Cpeddy OSS In1MIIMIon Repno pq r,,,.,,� �, ))103-51 00031 ABANDONMENTRECORI u ny mnellnn nnpN. ...q,n•.e.A. nh/rMmrM ea Pn9 M p+.[ prrenclY r /q ^ no P,m[ Menen rNefgHf 1",MnMd endl mvpd 1J IMn..nu^n•ry,nrbnk Pvmp!nip•nx n'nn *,Mrs pr WAClaal 17A.n?rmn rg ". MO RECORD DRAWING TM N r rmmanM reaps Syr Tsl M ryYxrpr Vry arµfllrpur TrprOn b w4r[aV b IIb naN!M T,IrMnwrfn rrMryN,and nTin� T. .,�xT, nn�.cos..nw,TT,wrn,srnyn,e.PyxpTnrT,.w+.., v.�.nT.n rTnv,n.+,•n.Y:mr n^°e'^erE rmrv....n ~ ,T HrM Cmm.M MiHM. :✓nn M nN YMh+, lalleMny[rA'pvra MaeurMe TNnY m,l.wnm nenarrw.a irm�f Irrmllin+r..n my nrnM1•npyy.,rr1/n/,ernY,+rYbrTn apprrn[T.r nbr.r y.rny Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I teddy that I installed the system in accordance with I certify Net the system has been installed In accor. the sepb'c 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 cleamolapproved 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 conlamed on this forth and attached Record Drawing is accurate, form and attached Record Drawing is accurate. rBnetureN.iler Data Jam Upson Printed Name of Slgnee c MASON COUNTY PUBLIC HEALTH CBp1iH YfnE The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public EXPIRES Health. ( sgmm.. Spwsrist Data (stamp,signature and date) THIS FORM MAY BE SCWNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SRE ueaa.a aEieurn �' �� -_¢,f . Per eE•ft,� ^---� APPROVED �� ,� ♦ JUL 24 2024 -' M 4;" 0,ON COUNTY ENVIRONMENTAL i ERW GARAGE "` > EXIST. HO,NtE ♦♦\� `�' 'y ♦ ABANDON EX15TING FAILED Ci' � DRAINFIELD ♦ AT ♦ ---- EXIST. WATERLINE ` /^♦ SLEEVE W/IN 1OFT OF SEPTIC COMPONENTS \ \PUMP OUT EXIST. 1♦\ WELL REPLACE EXIST. TANK ♦ / PROPQSED 3 BEDRQBM REPAIIk' t \♦ ' EN15 'WELL DRAINFIELD 75FTT0 PROX. SHORELINE 5HORELINE, 507TO AP 1 \ OWNERS WELL, 75FTTO BOTH NEIGHBORING R751 � �'' ♦\ BE EON WELLS. EXIST. WELL, iI \\ DS<NNOTE4 IMTAALA➢ON DBICNFKVIGNWOASAvlt mF.MU BLU I B DATTIMC Of:%TA:LU ION. ANYPBO"EP57PM. ABE 5mr,T-" JTHER DEDMtME\T iCNE'M,pfTIG\f.0 N(11'UiPON11 VI(IK51 iDALR1 V^..:'.ATED'i-SkPi\CJM1tf JM1tNiS. CISTOMER: IEUME WI SON 5Y'A181:40 PIONEER DIGGNQ Nc- PARCEL A=03-51-OMI TWHOLEL TFE71A, EY SEMC DESIGNS ADURE& 1470 BENSON LK UR 038 W 138 ILL Q 3W3EMAS0NBP60NKD. G8M'EVRWWA98W D6SIGNEP,: ROBERTFLPAYSSE UFFICE 36D426NW FAX-3W4VMM DESIGN PAGE PL AN AN