The URL can be used to link to this page

Home My WebLink AboutSWG2024-00073 - SWG As-Built - 9/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00073 Parcel# 31907-12-00090 Applicant Name Amanda Bumpamer Subdivision (Name/Div/Block/Lot) Applicant Address 301 W. Fredson Rd. City, State, Zip Shelton,We 98584 Installer Name Penninsula Excavation Site Address Same Designer Name Bob Paysse INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Pretreatment Type NIA >5ft.from foundation? -------------------------- - ❑ wA fives I-] NO >50ft.from wells? ----------------- ----------- - ❑ ® ❑ Z >50ft.from surface water? - - ---------------------- ❑ ❑ fClesnout between building and tank? ------------------ - ❑ ❑ V Tank baffles present? - - - -- -- -- -- ---------------- ❑ ❑ Q. 24"access risers over each compartment?---------------- El ❑ W Effluent filter installed?- - - -- - -------------------- - ❑ ❑ to Septic tank capacity(working) 1200 gal Mwukcww Sound Placement traffic rated 0 D-box water level and speed levelers used? -------------- - NwA ❑yes ❑ NO Ou Manifold/D-box accessible from surface?---------------- - ❑ El G� Check valves installed? - - - - - - - - ------------------ ❑ El2 Transport Line Size 2" Schedule/Clew 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑5 ❑8 ❑Commercial/Other >10ft.from foundation?------------------------- - ❑ wA was ❑ No >100 ft.from wells?- ---------------------------- ❑ ❑ W >100 ft.from surface water?------------------------ El ® ❑ jL- >10ft.from potable water lines?---------------------- ❑ ❑ K >5 ft.from property lines and easements?- -------------- - ❑ ❑ >30 ft.from downgradientcurtain/foundation drains?---------- E ❑ ❑ 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 19 Pump tank capacity(flood) 1200 at Manufacturer Sound Placement 24"access nser(s)and accessible from surface?--------- --- - El ® ❑ dAlarm or Control Panel Installed? --------------------- ❑ ❑ Control Panel equipped with TimerIETM/Counter----------• ❑ ❑ a_ Pump installed in ❑ Bucket or ❑ On Block or ❑ OIMr 5'flow Inducer pipe col holes Cr4 18" Pump Make/Model Orenco turbine PF 2005 Floats or ❑Transducer y Tank draw down 3- inlmin Pump capacity 4 Squirt Height Z`f r -- ft Pump on time eZ. 7 IN, Pump off time Daily flow set at l80 apd Mason County OSS Installation Report pg. 2 Parcel a 31907-12-00090 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ----------- -- - Q YES NO If yes, please describe:pumped old tank and filled in with pea gravel. (partially under house) Were all components pumped out and properly abandoned per WAC246-272A-0300? - --- - -- - ® YES ❑ NO RECORD DRAWING Tlle le a pemnirN ncoN aria muN Ye ccuM.na arcrlpW.x,wan w rHee+a In tm rime M malnnnenw acaNaw aria lulus brebpment Typkel RewN er ...mnluln: Omvlfiaq 6menXap oKnbUpn8NypN,SeplirJpump tank bmtlan,NwM encw,reservedmlr?eN,e.iatlrgendpo XXwRiltlirge bcetlonMwalle,xster4ma, wells,aomrve0on pMa,cbenoula,eM dM1pmelnlenenca aazss panb. Imompblc RewN Omnnpf mry oea'B BddilnnN tlelala In flnN inNalladm eppmrel aM relNu!permXa. 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 aecor- 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 Geared/approved by both the designer shown here have been clearedeppmved 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�oJthis--_ I further certify that all information contained on this form attached Record cc'!> ourate. form and attached Record Drawing is accurate. �1zK(Z Signature ofInstaller Date T. Scott Johnson o Printed Name of Signee n MASON COUNTY PUBLIC HEALTH ` The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public EXPIRES Health: C�131zy Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM My BE SCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upmwaataota FREDSON ROAD I i II EXISTING SHARED I[/— DRIVEWAY II APPROVED APPROXIMATE � ' \°t y' I � SEP 03 2024 EXISTING WELL �II 11 �` MASON COUNTY ENVIRONMENTAL HEALTH i NI j R100' — -i RET IL II, I It, {L100 EXISTING WELL i A� ` APPROXIMATE CROSS STREAM AT CULVERT, SEE j r EXISTING WELL BELOW WAIVER REQUIREMENTS. DRY WEATHER CONDITIONS MAY BE REQUIRED FOR PROPER INSTALLATION i SEASONAL / ' DRAINAGE I DRPJNAGE0.0551NGRE05: INSTALL 1. DOUBLE SLEEVE TRANSPORT LINE IN SCH. 'TRANSPORT 40 STEEL WITHIN LOFT ON EA SIDE OF CRO5SING.IN5TALL5KID5. I LINE WITHIN 2. BURY TRANSPORT LINE 3FT BELOW I PROPERTY BOTTOM OF STREAM. BOUNDARIES S. INSTALL TRANSPORT LINE WITHIN 10' I O_ I PERPENDICULAR DIRECTION TO STREAM. 4.PERFORM PRESSURE LEAK TEST PER STATE MITIGATION RM5. I I I I" PROPOSED 2 BEDROOM I "yam DRAINFIELD ¢ •c¢e�ln .ur¢¢e I 1>5" ANA ILTI INSTALL SIGNOFF FEE WILL WO IIIWDAT TIME OF INSTALLATION I CLSTOMER:AMANDA B TEST IkxEL TEST HOLE 2: PIONEER DIGGWG, WG PARCEL x9i907lzaoo90 3613C D 6(l i5.In I. 3a in i. SEPTIC DESIGNS ADDR6C4303WFFLEDS D R Iie�Is®w Ra�Is sa RW E MASJN Be,K3N RD. GRMV4EW,WA US* DESIGNER: ROBERT H.PA155E OFFICE-3G}4Z61&13 FAX-3604Z/7353 SHEET: NLE PLAN SCALE P-iw gym. .w.o�.o�-..woweum.e¢,e.aown.