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HomeMy WebLinkAboutWEL2025-00031 - WEL Application, Design, Letter - 9/19/2025 (2) MASON COUNTY 415 N 6TH STREET,SWA 98584 SHETREE ,SHELTON, 42 TON, ,EXT 400 584 A BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 09/19/2025 ALLEN IV CLARENDON N 35123 27TH AVE S FEDERAL WAY, WA 98003 RE: WATER SYSTEM PERMIT: TWO-PARTY WEL2025-00031 161 E Island Crest Rd 121087590040 The 2-party water system, Allen/ Phillips Water System (121087590040/121081190061), has been reviewed and is hereby APPROVED for 2 connections. Please continue to follow best management practices with maintaining your water system including regular water analysis, landscaping, keeping wellhead area free of contaminants, and stormwater management around the water source. If you have any questions, please contact me at 360-427-9670 Ext.353 or email at danderson@masoncountywa.gov Sincerely, David Anderson Environmental Health Specialist Mason County Environmental Health ruw 6 2025 J MASON �, NT'Y jam'i��, Date Received: �. =\� COMMU �� ..v,�:....WN Ole o6 2.0z _ Amount Received: �// Received By'1''I,�_��,,i Building.Planning.Enw,ronmental Health Community Health (do `� 415 N.6t'Street,(Bldg 8)—Shelton,WA 98584 VVE L if ��((// 2c _ 3 I Shelton: 360-427-9670 x400 Belfair.360-275-4467 x400 Elma:360-482-5269 x400 TWO-PARTY PRIVATE WATER SYSTEM APPLICATION API'I.IICC`1AANT PHONE J�,,�J �,I M/A'1l1.IN'C ADD TF.SS/-STl F 1L STATE,ZIP ^ ✓ — 36,0 6 v _.F)O t�:7S~ SITE ADDRESS STREET," II CITY,STATE l /V t V 1� 't l//S 'rbl r✓LI 12.6) .l.f—sy(^7' WO "e /g 1(ol E IsIc ZIP, - cqrc Vi(uAJ bu(- 9 gc, V PRIMARY PARCEI.NUN R(WEI.I.SITE) t 2-10Ce 7 Oo ?() SECONDARY PARCEL NUMBER(SAME.AS PRIMARY IF LOCATED ON SAME PARCEL) — 2(vg - ( i -100(01 WATER SOU E. SOURCETYEE PARCEL)LOT SIZE(min I acre) PARCEI,2 LOT SIZE(min I acre) /New _ Existing /Well LI Spring �77J/ PROM' WATE SYSTEM N ME(REQUIRED}'. r� I���) P I c /hdi(Zs wooer Sy s PROJECT D' ION(e.g.,dela ADU,new single-family residence,existing connection,etc.) DIRECTIONS TO SITE/CONDITIONS/GATE CODE/KEY LOCATION/ETC. •i ei lam- e S ci (S/ ETC. Al +a —dp �f-h'(( - 'ram R 4c), ( s t a CvR -- P- . 9O1c) rL ) Site Plan: (may also be attached) (property boundaries,structures,well site w/100'radius,driveways,roads,septic/sewer components and lines,water lines,property easements,etc.) Required Submittals Checklist: (additional information located on the first page of this packet) IQ Satisfactory bacteriological test from within the last year El Well report with well tag number,well tag secured to well casing,and capacity test showing 800 gal per day El Notice to Future Property Owners of Private Two-Party Water System recorded with Mason County Auditor's Office q Septic Records(additional locating requirements may apply if there is a lack of septic records on file) This form may be scanned and made available for public viewing on the Mason County website. Revised:01//2025 Page 1 of 2 Staff Use Only Review Step I: Well Site Inspection: YES NO N/O ❑ ❑ Evidence of existing sources of contamination within a 100-foot radius of the water source?(drainfields, tanks,buildings;indicate distance on plot plan) ❑ K ❑ Are there roads within a 100-foot radius of the water source? Is the road Private,County,or State?(circle one) Distance to the road(s) ki ❑ ❑ Does the ground slope away from the water source site? K] ❑ ❑ Satisfactory well cap? 1I ❑ ❑ Well cap screened and vented? i, ❑ The well casing extends l Y above level ou /concrete slab?(circle one) 0 ❑ ❑ Well tag attached to well casing? Lat: 'i a.a i p Z0 rf ❑ ❑ Evidence of an adequate surface seal? Lon:'l 23,FIR ❑ ❑ Tag:Variance necessary for well site approval? pc Lim Comments: K Pass ❑ Fail Inspector Date ?/ f 7 70 u- Review Step 2: Two-Party Review: YES NO NA t,/ // �t 11 ❑ ❑ Water well report(well log):Date Completed (((( Zo?$ Driller kV� P/I(/4i • t ❑ ❑ Satisfactory capacity test showing a minimum of 800 GPD with full recovery to static levelle withy�24 hours? Capacity test information:Date (I MO l$ Driller/Pump Installer L 0S Nit". "/! . y GPM~(/ Z( "?/O�c Duration(minutes) 510 Total Gal /l7W_ Recovery Time(minutes)to Static 60 ❑ ElSatisfactory bacteriological analysis? Date ffP(ZSTesting Lab f erire? 46/ <tow, ❑ ❑ Signed,notarized,and recorded notice to future property owners?AFN /2—Zz, 4(072:t.., A ❑ ❑ The system appears adequate to serve two connections based on the information provided? ® Comments: �s "00 SFp I ?SS—Approved ❑ Denied Reviewer 7,4 Date ( _✓ Findings in this review reflect observed conditions as they existed on the day of the site inspection. No claim is made,express or implied of the future success or failure of this system. Well site approval does not constitute water system approval All proposed connections to new wells are subject to water adequacy requirements at time of building permit per MCC 6.68. Water usage restrictions and additional fees may apply to all new wells drilled after January 19m, 2018 per ESSB 6091. Revised:07/23/2025 This form may be scanned and made available for public viewing on the Mason County website. Page 2 of 2 -� : DEPARTMENT Or Notice of Intent No. WE58668 WATER WELL REPORT t,.40' ° ECOLOGY Unique Ecology Well ID Tag No. BQC 492 Type of Work: State of Washington O Construction Site Well Name(if more than one well): ❑ Decommission t=; Original installation NOI No. Water Right Permit/Certificate No._ Proposed Use: E Domestic 0 Industrial 0 Municipal Property Owner Name Clad Allen ❑Dewatering ❑Irrigation ❑Test Well 0 Other Well Strut Address 161 E Island Crest Rd Construction Type: Method: City Grapeview County Mason l New well ❑Alteration ❑Driven 0 Jetted [Al Cable Tool ❑Deepening ❑Other 0 Dug ❑Air- El Mud-Rotary Tax Parcel No. 121087590040 Dimensions: Diameter of boring 6 in.,to 130 ft. Was a variance approved for this well? ❑Yes 0 No Depth of completed well 130 ft. If yes,what was the variance for? -- Construction Details: Wall Casing Liner Diameter From To Thickness Steel PVC Welded Thread C■J I ❑ 6 in. +1 120 1/4 in. ❑O I ❑ ❑ I ❑ Location(see instructions on page 2): 0 WWM or❑EWM ❑ 1 ❑ in. in. 0 1 0 0 I ❑ NE h-'h of the NE 'h;Section 8 Township 21N Range 1W ❑ I ❑ in. _ _ in. ❑ 1 ❑ ❑ 1 U 47.329285,-122.825276 ❑ 1 ❑ in. in. ❑ 1 0 ❑ l ❑ Latitude(Example:47.12345) Longitude(Example:-120.12345) Perforations: ❑Yes 0 No Type of perforator used Driller's Log/Construction or Decommission Procedure No.of perforations Size of perforations in.by_in. Formation:Describe by color,character,size of material and structure,and the kind and Perforated from ft.to ft.below ground surface nature of the material in each layer penetrated,with at least one entry for each change of Screens: O Yes ❑No C K-Packer b Depth 117 ft. information. Use additional sheets if necessary. Manufacturer's Name Johnson Material From To Type stainless Model No. T c ft 120 130 — Sandy brown topsoil 0 5 Diameter 5 in. Slot size 12 in.from .to R. Diameter in. Slot size in.from ft.to ft. Clay bound brown sand 5 88 Blue clay 88 113 Sand/Filter pack:0 Yes O No Size of pack tnateriat in. Grey sand and some gravel with water 113 130 Materials placed from ft.to ft. Surface Seal: Al Yes 0 No To what depth? 18 ft. Material used in seal bentonite Did any strata contain unusable water? 0 Yes 0 No Type of water? Depth of strata Method of scaling strata off Pump: Manufacturer's Name Arundfos Type: sub H.P. 1.5 Pump intake depth:120 ft. Designed flow rate: 15 gpm Water Levels: Land-surface elevation above mean sea level ft. Stick-up of top of well casing ft.above ground surface Static water level 22 ft.below top of well casing Date Artesian pressure lbs.per square inch Date Artesian water is controlled by (cap,valve,etc.) Well Tests: — Was a pumping test performed? ❑No ❑Yes ' by whom? Yield gpm with_ft.drawdown after hrs. Yield gpm with • ft.drawdown after hrs. _ Yield gpm with_ft.drawdown after hrs. Recovery data(time-zero when pump is turned off-water level measured from well top to water level) Time Water Level Time Water Level Timc Water Level Date of pumping test Bailer test 13 gpm with 100 ft.drawdown after 2 brs.— Air test gpm with stem set at ft.for hrs. - Date Artesian flow gpm - Temperature of water °F Was a chemical analysis made? 0 Yes C No Start Date 2-1-25 Completed Date 4-1-25 WELL CONSTRUCTION CERTIFICATION: I constructed and/or accept responsibility for construction of this well,and its compliance with all Washington well construction standards.Materials used and the information reported above are true to my best knowledge and belief. O Driller❑Trainee❑PE-Print Name Mike Davis Drilling Company Davis Drilling SignatureInoN/NC. Address 340 NE Davis Farm Rd License No. 0797 City,State,Zip Belfair,WA 98528 IF TRAINEE:Sponsor's License No. Contractor's Sponsor's Signature Registration No.DAVISDI110OA Date April 2025 ECY 050-1-20(Rev 08/19)If you need this document in an alternate format,please call the Water Resources Program at 360-407-6872. Persons with hearing loss can call 711 for Washington Relay Service. Persons with a.speech disability can call 877-833-6341. Davis Drilling 340 NE Davis Farm Rd Belfair, WA 98528 Date: 4/1/25 Address: 161 E island Crest Rd, Grapeview Well depth: 130' Well tag: BQC 492 Pump size: 1.5 HP Static water level: 22' TIME WATER LEVEL GPM Om 22' 0 5m 112' 30 30m 120' 20 1h 120' 15 2h 120' 15 3h 120' 15 4h 120' 15 RECOVERY 1 m 116' 2m 106' 3m 102' 4m 97' 5m 93' 10m 73' 15m 58' 30m 38' 1h 22' 4 : 2627h Twcl\r Trees 1.n KW • Sie.0 .r' SPECTRA LaboTatorie:. Kitxap Poulsbo,WA ...Where,eziericecc erg:. I(36o)77 Slat COLIFORM BACTERIA ANALYSIS FORM Pi!Sample(Aiiied Time Sample County r312 7 Collected IC/.YV i 2 /.y.,Gr'. VIA gSOV1 PAY+ Dsr Yes . Pli Type of Wafer System(died;only one Doe) CI GroupA ❑Cioop B fkOtne• .? 'VOA_ d _ Group A and Group B Systems-Provide from Wale Faolees'overstay(WFh IDA ---- Name: e Z- ✓/-y �__System N 1WhU1,2S _. Conrad Person: . Da'pborie: - i Cefl Phone ...... (co-�J-y37 Erred: ~ Eve Phone i Serdresu'Ha.lFMIsew**arose aaarotwee0,ether above foreieaeelreo5ceemit,: C4a.\iSd}11IIIs 1 ek Qil Cc 'f't. r• - ---_ _...-_ SAMPLE INFORMATION Sample collected by(name) 1 Specific location where sample collected Spetiai instructions or 1rnQhcJ35--Q-- - Type of Sample(check only one box) 1.❑Routine Distr union Sample( ) 2 0 Repeat Sample(A/Pi Chlonnated Yes D No❑ (horn oisateszsn system after ire?:rov5,^' Unsatisfactory routine lab number. • Chlorine Residual Total__Free. i 3.Ground Water Rule Source Sande S I I 1 UnsatisfactoUnsatisfactoryroutine coiled date Chlorinated.Yes No_N 0 Triggered (AlP) Chlorine Residua! Total Free..._ Ej Assessment(JP) I 4.Surface or DWI Raw Source Water Sample(Enumeration) S I ' ❑ E coati 0 Fecal rvmae Us____ NO_ 1 5. pe Collected for Information Only: r-- /LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY 0 Unsatisfactory rota'Cobform Present and ( Satisfactory ❑F.ohese present_ ❑E cok absent 1 . i Bacterial Density Results:Total Cadorm__mpnt100rnl.E.cof__—mph!1Ogrnl Fecal Coulon.._�_.ctu700m1 HPC du'tml. Replacement Sample Required: 0 TNTC 0 Sample to:o'd 1 ❑ Sample Volume ❑Damaged Container ❑.,._.__._.._..._..-_- ' 1 la^Fislere x^t;lanEer— Racer,:Tem:C. `O Wthod Cede 223R OT-OOI�NTr St W1) f / TriOwlarr eicYe e►b Gil:pe er4e11Atl nVry't 1 f Oa 3 0 e5 srase.eYeeM Mfa� r yaesr�erranee.- 7 r....wMl.b.�.a.ke Iyas�saoen...�vtl tltet.11rase7,ti era.war.« xa-rr•S,a:at Oslo/ba yoi;•alt, DCN IA-sa•qa e //... -eew teal l�ae em l MMa en<e 4,e1 ens:e. I • /V/r /23O/ ,�+M t,11 Mai.,'>«Th.cya:•b...l<•4.oft:Mom: . �.--- -_•� - t nV,*Dos ro c Mot=Mid ti SW.1 X.i ITT• •Mt rev*aUN•a/arse oiler 2226407 MASON CO WA 06/06/2025 01.22 PM NOTCE DPVIS DRILLINGpp It210515 Rec Fee IIII$,,35ff6'.�50 Pages. 4 Name and Return Address: I111111IIIJII1I II IIM111N1111 ill1N11 I111I1ii11I!111l1 11 3l.40 rHe r..t t? t ,2_ JUN 0 6 2025 CU By Document Title(s) 1. 7010- 1 0\(4 1 5ha re w eii weit+ Y L VS' reiw.ei-t)- 2. t\i 07 Reference Numbers(s)of Documents Assigned or Released ADDITIONAL REFERENCE WS ON PAGE Grantor(s)1. C ^/ IG1(I t'�\`Q 2. ADDITIONAL GRANTORS ON PAGE Grantee(s) 1. 2. C 111((S PhAte5 ADDITIONAL GRANTEES ON PAGE Legal Description (abbreviated form:i.e.lot,block,plat or section,township,range,quarter/quarter) ,�1� pYf�1TL of- svry ej '/ S �,x L.64:1/ o€SS�tvr+�t�'(c+1s/12 8� S yr 1 6/ Tow/i�y� � N, or1L3t I W2 ►V G �'V ADDITIONAL LEGAL IS ON PAGE Assessor'sJJ Property Tax Parcel/Account Number(s) `Z ir ,7 C-900[I o 1 20s-ii-9Q Q(Q ADDITIONAL PARCEL W'S ON PAGE THE AUDITOR/RECORDER WILL RELY ON THE INFORMATION PROVIDED ON THIS FORM.THE STAFF WILL NOT READ THE DOCUMENT TO VERIFY THE ACCURACY OR COMPLETENESS OF THE INDEXING INFORMATION PROVIDED HEREIN. I am requesting an emergency nonstandard recording for an additional fee as provided in RCW 36.18.010. I understand that the recording processing requirements may cover up or otherwise obscure some part of the text of the original document. Signature: Date: TWO-PARTY SHARED WELL WATER USERS'AGREEMENT We,the undersigned grantors, certify that the water source located on the real estate identifed under Assessors Tax Parcel Numbers and Legal Descriptions, situated in Mason County, State of Washington, has been designated to serve as a source of water to the two parcels situated in Mason County,State of Washington, herein described: Parcel Number: 12108-75-90040 Physical Address: 161 E. Island Crest Road, Grapeview,WA 98546 Legal Description:Tract 4&TL OF SURVEY 1/115 EX LOT: 1 OF SHORT PLAT 94#295386 Acreage: 0.9400 AND Parcel Number: 12108-11-90061 Physical Address:220 E. Buckingham Lane, Grapeview,WA 98546 Legal Description: PCL OF BLA#14-01 AF#2025513PTN OF GOVT LOTS 5&9 S 40/171 Acreage: 0.6700 Ownership of Two-Party Well and Waterworks It is agreed by the undersigned parties that each of said parties shall be granted an undivided one-half interest in and to the use of the well and water system to be constructed. Each party shall be entitled to receive a supply of water for one residential dwelling.The undersigned owners are responsible for keeping the well system operational and in compliance. The name of the water system is: AtlerVPhillips Water Well Cost of Water System Construction and Operation The system is designed to provide for two service connections. Planning and design approvals must be obtained from the appropriate departments prior to expanding beyond this number of services.Additionally, a water right, obtained from the Washington State Department of Ecology, is required if the water system exceeds exemption standards. Both parties herein agree to share equally in the cost incurred in well site permitting, approval,well construction, and construction and/or installation of the waterworks equipment, the pump house, distribution pipes, and all related well water quality tests. Each party hereto covenant and agrees that they shall equally share the maintenance and operational costs of the well and water system herein described. All pipelines in the water system shall be maintained so that there will be no leakage, seepage, or other impacts which may cause contamination of the water, or injury, or damage to persons or property. Cost of repairing or maintaining common pipelines or shared well equipment shalt be born equally by both parties. Each party in this agreement shall be responsible for the maintenance, repair, and replacement of pipe supplying water from the well system to their own dwelling and property. Termination of Agreement This agreement may be revoked at any time; however, it may not be revoked without each property obtaining a sufficient acceptable potable water source and prior consent of both property owners.Termination of this agreement shall require the property owners to provide 1) proof of a notarized revocation of this agreement, and 2) proof of the potable water source for each property to the Mason County Health Department for review and approval. Property owners shall then file: 1)the notarized revocation of this agreement and 2) proof of the approved potable water source for each property at the Mason County Auditor's Office as a recorded documentation that runs with the title of the land. Heirs,Successors,and Assigns These covenants and agreements shall run with the land and shall be binding on all parties having or acquiring any right, title, or interest in the land described herein or any part hereof, and it shall pass to and be for the benefit of each owner thereof. This system (has/has not) been granted one or more waivers from specific provisions of the regulations. nd Dated on this 22`day of Apr i I , 2025. Signed by Grant ) 4/1/,' Signature Printed name State of Washington ) County of Fio--ct I,the undersigned, a Notary Public in and for the above-named County and State, do hereby certify that on this 22-11 day of Apr; ( , 206, personally appeared before me h rj s*Op era Vv11 11 l i" to me known to be the individual(s) described in and who executed the within instrument and acknowledge that he signed and sealed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. % 46.411.didhldhahl TAMITEDDER Notary Public Notary Public IA and for the State of Washington, State of Washingtoni(�i i ((�� t Commission W 84181 Residing in: f ' My Comm. Expires Jun 4, 2026 My Commission Expires: ji4 Y1P V2-0 Signed: 2) C \ csat � �� � � ic Signature Printed name State of Washington 0 County of --Q1 WI ) I,the undersigned, a Notary Public in and for the above-named County and State, do hereby certify that on this WA day of_A rk \ , 2025, personally appeared before me C I ar ri Ion 1f ff\ to me known to be the individual(s) described in and who executed the within instrument and acknowledge that he signed and sealed the same as free and voluntary act and deed,for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. TAMI TEDDER • Notary Public State of Washington Notary Public anti for the State of Washington, Commission#84181 �} My Comm. Expires Jun 4, 2026 Residing in: e ff 4i ri w - My Commission Expires: • Itieve- 4 120u[ MASON COUNTY N° 22 4 GENERAL SE"�ICES�vj,PARTMENT IA l 08 _ '1 5 9 0(HO ENVIRONMENML HEALTH SECTION 303 NORTH 4th STREET • SHELTON,WA 98584 PHONE (206)426-5561 ", ; . RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTEM ?,- 1- OWNER c an� ADDRESS D,L1 3 Oq 3 S v`l,Se LN' )G" THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. LEGAL _ A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER DESCRIPTIO `t 4 I L J� S(A/ 1 /�/� al(Ai WITH PROPER MAINTENANCE AND CAREFUL USE OF G f � )_i' 1I(I Qr s95 3st WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- tom VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL /0(7. 41g0 BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH COMMENTS 7G-(i-� AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SITE t1 FIELD LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO. SIZE f;,S X FAULTY FIXTURES. DEPTH TO MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER A\ / FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND � ��� THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. CLEAN- SIZE e , ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR SEPTIC TANK (S) I (?�1 C':,.� _ 2 R,uYn,r, ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS DRAINFIELD ) t FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH 5 cf-E) MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA= SQ. FT. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THEsar CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS TILE [' CORRUGATED RIGID I CEMENT DEPTH - 15 RECORD WHEN HE COMES. DEPTH HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE ROCK BELOW TOTAL CU. YDS. i PIPE b / L DEPTH DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS SPACE RESERVED FOR RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD: CI AO • SQ. FT. SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING ARE LATER CONTEMPLATED. + NORTH SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO 1.,I 0 THE SEPTIC TANK AS THEY WOULD INTERFERE WITH CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH THAT SURFACE WATER IS NOT POCKETED ON THE DRAINFIELD. ANY SETTLING OF THE GROUND OVER THE TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX- 5 0 CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. (S-- WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT I 1 - - EQUAL TO ONE HALF INCH OF RAIN PER DAY. I FOOTING DRAINAGE, DOWNSPOUTS AND WATER i I V I G� SOFTENER RECHARGE WATER SHOULD NOT BE CON- NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE - 1 DRAINFIELD AREA. 6 It - - , THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE 5- ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- I A JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK f HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY CHANGING THE CHARACTERISTICS OF THE SOIL. THE NORMAL USE OF BOWL CLEANERS OR CLEANING COM- POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW _ SOUTH DOWN THE OPERATION OF THE SEPTIC TANK. 6-%( Aa THIS IS AN IMPORTANT DOCUMENT } I DATE APPROVED BY f Printed I _II IN TH DEED ai OTHER)U(1 L�I U IVI'� -. c, - �, /1 p!� JJJJ V` /1i.dtit,\--. 11 Prints IONa S• TV DMS DATE CERTIFIED BY Apr 11 13 10:12a Joyoelyn Johnson r J [1bb p.1 RECORD DRAWING ASBOILT) Musson Cnu tty Public Hearth Pcnnil Numbs ,4YV4 a 0 — C?d /� ' Assessor's 'Pa1°d I ,�O a I, `oo it I' (TWety -D►gu Number) Applicant's �h r� ph J..I i `"; :°" (NamndDlvtSioaBwclyd.al) Applicant Addseas ra g7/ pkli:p S a Lo rnseller':lemurs „ ( ;// lu,)� , ax, . , r,Lfp0 4�a 9 6S: r , -.. . , rAii '- vvRe hi- •. N/A Yes Prior to Cerapletion I. SEPTIC TANK >s R t famtdatiaa?...................._. ....... ............... _ ........ p 0 / ' >50 ft from wells? ..»...................». . »............._...._.._ 13 Oil,. ❑ >SO S aeuihce weren't .....».............. ....._................. _.. _ O ❑ Building stubout to septic trek cleanont if not 1-2%?...... 0 ❑ Baffles . O ❑ Dividingwal nitact?............... ...... ........_.........»...._._ :� 0 - Screen bosh- ,•far �61 nsaneetf ralhois awe)......... ._..+.. Q 4 o ash size: 1� "-,sal.; Manufacuser 07:��, �r �6e.Yk IL D-BOX Leveled with wafer? ' / 0 0 Speed leveler used? — (� ❑ ❑ III DRAINFIELD >10 ft from foundation? 0 _0/ >S ft property lines and easement tines? CI la 0 >100 ft from wells? 0 V 0 >100 ft from surface water? .. 0 ❑ >10 ft from potable water lines?. O e/ ❑ I.AIerake level to±1 inch It end caps present if not looped? _ I1K !. 0 Graveness chambers utilized? ... ❑ 0 Gravel clean,properly sized,and proper depth' • 0 Cl PRESSURE SYsnsasts Sand quality ASTM C-33? ................_................ ... 0 0 • . Head heigbt;radix= ?124 inches? Actual head bclgbt„ L_ 0 jd' Cl Clean-outs and observation ports present? - 0 (�i ❑ Mound: Side Slope 3:1? 0 1—a/ 0 • Owner informed electrical conneetiona rust be made by owner or licensed electrician and inspected by L.&1? , 0 V 0 IV. PUMP/PUMP / Pump make Gov ; Pimp model Gu per.�1 a Tel /77 ❑ c3as:i .�bex size , gal; Manufacture .07.Zt p • ,Izr - 0 K i Height of pimp off bottom of pump chamber 41 • inches I al 1 Pump chamber draw-down ? " gdioes per rods per minute a sa Pomp capacity per minute Pump Timer,Elapsed Time Meter, (Circle all 0 ❑ f7� �i that apply). If". .Puri Vo © Q i Off .k;'I15 All . • ++-�1 t Riser installed for access? _......:_._.......»....»......._.._.._. 0 00 CE41 L.n Printed From Mason County DMS • Printed from Mason County DMS Apr 11 13 10:12a Joyorriyn Johnson ARIVIN/523M (RA '(-:•, SEIM Wall pal . . ,.... ,-.... V.v.,•-,f!,,.,?;:-,;:..14049.sitilv .. , 0. A p u Lid VINEINZaraallainaWf- _,tailallidiASIgtitt. ,, ..,.. .. . ilC111110CLIST , c,..5e_ irv,.../- Drainfteld& ntanilbld othmtation • ici &layout , Trona/bed climatal:Ws Rod • t critical distances ,.. S 0-C - i withinlayot it Septic/pimp tas.k . . placenand , • Location of 4 buildings . i 10 Obeeniatioa port& - ,,41 -- c 4 (NJ or.k. clean-out location -' 1 •,t•, \ fi 41 Locating&Wells& • il Undisturbed native . ' - '•... 41 - -.•• : V . IT - c :-) .f i soil between . .sq • ' \ 13 . .k.,..,, s, „yr, i. . -:. traecires • • ' fi. 1, 11‘) 1 • •• L 1 /--f L. ri North*wear 41 k3 • ' • . 1 ,„..., t r . . . -1-4-naaeriortatissr ire Iv she iv ant .•ty • ..4.--4.-,..1.-.1 ,,.• • .,• '"Fi'. 41d- a—tvistrirzwatZalymatizaziaidoilalibotsF1214.4palrect ibillerr-AAlair ' ' r - . ....71. ..,.......,...imiihom.10.6,6 -i.Tf"-Xlf*' ' '- ' •• • , ... . 1': ...L.'s-4A- . •.,..-• • -.: - •:. -'•• • higlitaVe-Pitra a , -..'litcrir"A"and W.sign and dale the certification A. Jirrrtilititilyittall Millis/thasyslato M*out toy 0 I certify that al/&Mations from the destipt stamped de4Sii011.01111%4601211211 stewed i'APTiovwf by "APPROVED"by WPM we shown above. B. =that-II: asniakledl . tlie designer and len the 0 I did not contact the designer prier so final corer because the Willie"In;CI ittiptiction op 6,48 Ins prior to COWL designer waived the notification requiternant. i furthareset*thatailirdereariteneentained on this fbon is warm& I understood that If the infomusies " is net 'accorate,there will byes' teases ihr immediate nopension of iny inotailer certificatios. . . • ' 47/Zit e3 • ' abate er . . . . The settlasigned'pliant'die insight:hi on bdadf of Mason County Public Health. Z.t.., • - • .. - • • . CIA4 4(f •51 •?ttr, Health Specialist Den Reviled hostery iDOS _ . . . • - 4 . ,.. . . . I