HomeMy WebLinkAboutSWG2024-00474 - SWG As-Built - 5/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2024-00474 Parcel# 32227-22-00140
Applicant Name Tomas Webb Subdivision (Name/Div/Block/Lot) 4.
Applicant Address PO Box 509 4Zt.
9`
City, State, Zip Tahuya, Wa 98588 Installer Name Spear Const �'�-e `sf
Site Address 14891 NE North Shore Rd. Designer Name Bob Paysse • p
INSTALLATION CHECKLIST
J Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type ATU - Pressure Pretreatment Type NuWater BNR 500
>5 ft.from foundation? - - 0 N/A YES ❑ NO
>50 ft.from wells? - - 0 ® 0
Z >50 ft.from surface water? - - 0 ® El
H Cleanout between building and tank? - - 0 Elf
✓ Tank baffles present? - - 0 ® 0
d24"access risers over each compartment?- - 0 tl 0
tW Effluent filter installed?- - NI ] —
o
Septic tank capacity (working) NUWater qal Manufacturer Sound Placement
0 D-box water level and speed levelers used? - - alN/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - 0 ❑
DQ Check valves installed? - El v
2 Transport Line Size 2" Schedule/Class 40
'i
Bedrooms installed (check one) D 2 0 3 0 4 0 5 ❑6 ❑CommerciaLOther
>10 ft.from foundation? nj N/A YES ❑ NO
G >100 ft.from wells?- - ❑ ,, ❑
W >10o ft.from surface water? - - 0 Li 0
Er_ >10 ft.from potable water lines?- - ❑ __A 0
_ > 5 ft.from property lines and easements?- - 0 0
ii >30 ft.from downgradient curtain/foundation drains? - - 0 i ❑
CI
Drainfield level and observation ports present - - 0 00 i❑
0 Graveless chambers or p Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 „I !!
Pump tank setbacks consistent with septic tank? - - [ N/A 1_ . YES 1: NO
• Pump tank capacity(flood) 1500 gal Manufacturer Sound PIE 3ment
Q 24"access riser(s)and accessi:;a from surface?- - 0 '7 LL
H —
O. Alarm or Control Panel Installed? ❑
2 Control Panel equipped with Timer! ETM/Counter- - ❑
D
a_ Pump installed in D Bucket cr ® On Block or 0 Other
a.
2 Pump Make/Model Liberty 290 ® Floats or D Transducer
d Tank draw down 2.5 in/min Pump capacity 75 qpm Squirt Height 36" ft
Pump on time 50 seconds Pump off time 4 hrs Daily flow set at 36C gpd
Updated 2/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 32227-22-00140
ABANDONMENT RECORD
Were existing septic components aband ned as part of this project? - •
If yes, please describe: 0 YES NO
Were all components pumped out and properly abandoned per WAC24&272A0- 300? - -
® YES 0 NO
RECORD DRAWING
This Is a Permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development Typical Record I
Drawings contain: Draintleld&manifold orientation&layout,Septirlpump tank location,North arrow,reserve drainneld,existing end proposed buildings.location of wells,waterlines
webs,observation Pons,cieanouls,are other maintenance access points. Incomplete Record Drawings may create additional delays in final instsilation approval and related parmhs.
it Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER
DESIGNER/ENGINEER
!certify that 1 installed the system in accordance with'APPROVED'oy Mason 1 certify that the system ha; aeon installed i,; 3ccur
the septic design stamped dance with the septic design stamped'APPIA VELD by
County Public Health and that any devik. kids shown. Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved
and Mason County Public Health and meet all State lthby both •
myself and and Mason County Codes. Mason County Public Health and meet all
I further certify that all information contained on this State and Mason County Codes
1 further certify that all information contained on this
: ;: :RoTd
Drat,rirg;s acule, form and attached Record Drawing is accu;aie.
2
ate
Logan Spear r
Printed Name of Signee —
ec(io'w,
•
MASON COUNTY PUBLIC E ,AL-1 1-1 • e !_r
•
70,ao irospRT
The undersigned approves this Installation Report and Pokt.>
Record Drawing on behalf of Mason County Public
Health: c»>`es
ILS
Signature of Environmente r7ecu4•; Spoviar'ist Jac
...4116111111111 (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOF.PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21l2o18
° PUMP OUT&ABANDON ALL I NORTH SHORE RD
EXISTING COMPONENTS. I °
o MAINTAIN 101+ FROM EXISTING I EXISTING
WATERLINES TO NEW 055 WELL
COMPONENTS I ;� 'T `/
SHOP/ GARAGE
/.%..-%. " N CW/NO FOUNDATION) / , f/
EXISTING 055 / `\ /! Ef
PUMP OUT N. \ /
& ABANDON
♦Its_: ti
REMOVE �.� `y�
SPRUCE TREE I \� ``
NI /
illik
\,../
DBL SLEEVE r';��� � \� /
NEW2 SCH. 40 :\ \��,� / I _____TRNSPT. LINE I �`��\ \\�� PROPOSED / _ �
(10+ EA. DIRECTION) I \\` DRAINFIELD
/
/ \ •
i —_ ,41---ik
NEW 1 ;
`e
SHED TANKS
. ..
° J
---7 APPROXIMATE E •'STING
ABANDON in WATERLINE LOCATION
EXIST. T/LINE `Rr /
APPROVED
EXISTING
PUMP BASIN 1
PUMP OUT& i EXISTING / MAY 0 7 2025
ABANDON HOME MASON COUNTY ENVIRONMENTAL HEALTh
RET
/ i
SHORELINE/ /
BULKHEAD 0.
/ .....r- : ,ut,;,f *�
i HOOD CANAL 'C.'ar 4;
EX�. LL5
/ \ AN ASBUILT!INSTALL SIGNOFF FEE WILL
' BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, INC. CUSTOMER: THO,Mr��'VEBB TEST HOLE I: TEST HOLE 2
PARC Fl # 37227 a2-00140 0-12 LOAM 0-16 LCAM(SEMI COMP.)
12.35 GLS 16-31 GMS
SEPTIC DESIGNS ADDRESS: 14891 NORTH SHORE RD ROOTS @ 35 ROOTS @ 31
3083E MASON BENSON RD. CRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE DISCLAIMISIE 7$NOTA SURVEY."EF�CESINCi,,3E'APPL'GNT000NT'PROVIDED
PLATS
P OR SURVEYS,FIELD MEASUREMENTS AND COUNTY:•s.DESIGN INTENDED FOR SEPTIC
PURPOSES OFFICE-360-F26-1803 FAX•360-427-2353 SI 1EET: SITE PLAN SCALE 1"=30' CY NEvEW DESDESKOON NOT REYDAS,L.FOR 6ETSACK$UMiE:ATED TO
SEPTIC COM ONENT&