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Home My WebLink AboutSWG2022-00331 - SWG As-Built - 2/13/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2022-00331 Parcel # 222335100116 Applicant Name Alexander Levin Subdivision (Name/Div/Block/Lot) Applicant Address 11812 167th PI NE City, State, Zip Redmond, WA 98052 Installer Name Mikkelsen Septic-Jerry Upson Site Address 5710 E Mason Lake Or West Designer Name Caliber Septic-Richard Bazzell INSTALLATION CHECKLIST ❑ Full System Installation 0 Tank(s)Only ❑ Drainfleld Only ❑Repair ❑Other System Type Conventional Pump to Gravity Pretreatment Type >5 ft.from foundation? - -- ---- - -- -- -- -- -- - ---- -- --- ®NIA ❑YES ❑ NO >50ft. from wells? -- --- -- - - - - - - - - - - - -- -------- - e ❑ ❑ Z >50ft. from surface water? - - - - - - - - -- -- -- -- - - - - - - -- ❑ ❑ Cleanout between building and tank? - ® ❑ ❑ U Tank baffles present? --- - - - - - - - - -- -- -- -- -- --- - -- ❑ ❑ a24"access risers over each compartment?----- - - - - - - - - - -- ❑ El W Effluent filter installed?-- - -- ------- --- - - - - - - - - - - - - ❑ ❑ Septic tank capacity(working) oat Manufacturer D-box water level and speed levelers used? NIA ❑ YES ❑ NO O0 Manifold/D-box accessible from surface?-- - e ❑ ❑ CQCheck valves installed? El f Transport Line Size 1.5" Schedule/Class 3034140 Bedrooms installed(check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?-- - -- - - - - - - - NIA El YES ❑ NO G >100 ft.from wells?- ❑ ❑ W >100 ft.from surface water? -- - -- e ❑ ❑ ILL >10ft.from potable water lines?- -- - --- ------ - - - - - - - -- ❑ ❑ aZ > 5ft.from property lines and easements?-- - - - - -------- - - ❑ ❑ R' > 30 ft.from downgradient curtain/foundation drains?-- -- -- - - -- ® ❑ ❑ Drainfeld level and observation ports present e ❑ ❑ ❑ Greveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfeld?-- -- -- -- ---- -- ---- - ❑ ❑ Pump tank setbacks consistent with septic tank?--- -- ---- -- - - ❑ N/A ❑ YES 0NO Y Pump tank capacity(flood) 101.5 gal Manufacturer Orenco PVC Pump Basin PB24XX < 24"access riser(s)and accessible from surface?-- -- ----- --- - ❑ ® ❑ ~ Alarm or Control Panel Installed? - -- - - ❑ Q ❑ a Control Panel equipped with Timer/ETM/Counter - ❑ ® ❑ Il Pump installed in ❑ Bucket or a On Block or ❑ Other a Pump Make/Model Goulds 1HP, 230V/Model#HS1012BHF 0 Floats or ❑Transducer f a Tank draw down NA in/min Pump capacity 30 gpm Squirt Height N/A ft Pump on time ON DEMAND Pump off time ON DEMAND Daily flow set at N/A gpd uoal v21vD1e Mason County OSS Installation Report pg. 2 Parcel4 222335100116 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ---- -- ----- -- - - ❑ YES ❑ NO If yes, please describe:Previous Dump basin was a 30 oat metal drum, removed and disposed by Installer Were all components pumped out and properly abandoned per WAC246-272A-0300? ----- -- - ❑ YES ® NO RECORD DRAWING Tnla Is a mmurrant racond and must W accurate and dammi,di anuaelr to Imidna ra In raw n«a or marmmenu activism,and fuWr.development Tyuldel Recurs cram nye roman. orann.id s m.nirom odemalm a mrour.segiummp rank lo®dm,Ram arrow.recmre ammrmu,a:bd,e eras pmwa.a wiairN.,ianamn a.eu...aremn,s. web.o"n,namn pats.aexmum,and oNer mtlmmande eases mans. mcwnpmre RewM D aMnw mayaeam mUradnal delays m nnN inwimoon.W.-Il and reeled Detroit,. E 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 hem have been cleared/appmved by both the designer shown here have been clearedlappmved 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. Y SSE Signature oflEaf (�N 10rU Date 4 Printed Name of Signee vV161 VAI 1W MASON COUNTY PUBLIC HEALTH r s4 The undersigned approves this Installation Report and Tv Record Drawing on behalf of Mason County Public y�acR 21D L BA L Health: LICENRICHSED RD L ESIGNE r�-.� LICENSED DESIGNER bL\R � Z�I 31 z� / u/zs Signature of Environmental Heath Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SUE upd.ma erzumre 165 NW Tupelo Way CA L I B ER SEPWDE&IGN P ulsbo,WA983 0 Feasibility - Near Construction - Repair�r��yr 360.509,7900 ^ n I� � F February 1,2025 �Q �� PRUVE D FF6 MASONCOuhEB 13 2025 Mason County Community Services ��' TYEh Ojoh'4EHTALH Attn: Rhonda Thompson ��(;: REi EALlH 415 N 6th Street Shelton,WA 98584 RE: EXPLANATORY NOTES FOR THE PUMP BASIN INSTALLATION AT 5710 E MASON LAKE DR W, SHELTON,WA 98584(TAX PARCEL#222335100116) To Ms. Rhonda Thompson: The purpose of this correspondence is to provide details regarding the repair/replacement of the pump basin as it relates to SW62022-00331. A site inspection was completed by Caliber Septic Design on January 12,2025 to inspect the installation of a new pump basin and associated components(pump, panel,etc) by Mikkelsen Septic in 2022. Caliber's evaluation of the installation was limited in scope due to lack of notification/communication from the installer,and elapsed time of over three years. Through discussion with the property owner,review of photos,and physical inspection of the components installed by Mikkelsen, it appears the new system components meet code/design requirements with exception to the required setback for pump basins to property lines. Initially, the pump basin was thought to have met the 5' setback until a survey completed by Turnbow Land Surveying, PLLC on September 12,2024 revealed the property line was not where the property owner thought it to be. Given the nature of the repair, no other suitable area for replacement to meet setback requirements, and the overall improvement that the new system components provide, I ask that Mason County Health consider a reduced setback for the pump basin to the property line as detailed in the attached record of construction (as-built). For questions or comments regarding this request, please contact Richard Bazzell at 360-509-7900 or richard@calibersepticdesign.com. Report prepared by: Richard Bazzell Licensed Wastewater Designer A40�F Caliber Septic Design " j � g g o A_o E.MASON LAKE DR.WSOW O ' m � gam'&IOW Imoba' �h d MIA p io i o g � m s DS /l ql I C 92 =1 \\ I I F pz;-0,. 19 z -0' g of Yyn i TOP OF SLOPEIf / BOTIOM OF SLOPE 25 z N O A j 2 m AT y 2 r m � @ m z Fn o z E r i r F - S A O m z v 0 z 0 N m a Z T v 0 'T7 A Z b m 5 w O 2. n .��' m `2 m cNi� < ' a