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HomeMy WebLinkAboutSWG2021-00288 - SWG Application / Design - 7/13/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00288 Parcel # 122167590032 Applicant Name DAVID MUSSLEMAN Subdivision (Name/Div/Block/Lot) Applicant Address 990 KAZAC PL SE PORT City, State, Zip PORT ORCHARD, WA, 98366 Installer Name TESSA HOLT Site Address 51 E PENDRAGON DR Designer Name LAWRENCE PURDAM INSTALLATION CHECKLIST II Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type PUMP TO GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A ® YES ❑ No >50 ft. from wells. Z >50 ft. from surface water? - - - - - - - - - - - - - - - - - ❑ ❑■ El Cleanout between building and tank? El ® ❑ D� U Tank baffles present? - - - - - - - - - - - - - - - - El ❑ - - - - - a24" access risers over each compartment?- - - _ - ❑ ® El W Effluent filter installed?- - - - - - - - ---=-- - - - - - - ❑ ❑ U) Septic tank capacity (working) 1500 gal Manufacturer INFILTRATOR D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A © YES ❑ NO oO Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ ® ❑ CC Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ El OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ®4 ❑ 5 ❑6 El Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A © YES ❑ NO >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ * El W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ © El ti >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - El ® ❑ ? > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ 0 El Q W > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ U ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - - ❑ ® El Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ N/A ❑ YES ❑ NO Pump tank capacity (flood) 1287 gal Manufacturer INFILTRATOR CM-1060 Q24" access riser(s) and accessible from surface?- - - ❑ ® El ❑ El a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - - ❑ 0 ❑ - Pump installed in ❑ Bucket or • On Block or ❑ Other Pump Make/Model LIBERTY 280 ® Floats or El Transducer Tank draw down 1 in/min Pump capacity 50 gpm Squirt Height n/a ft Pump on time 3.2 min Pump off time 4 hrs Daily flow set at 480 gpd Updated 8/21/2018 Mason County ass_Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic comp nents abandoned as part of this project? - ---------- YES O NO If yes, please describe: Were all components pump d out and properly abandoned per WAC246-272A-0300? -------- ❑ YES NO I JII RECORD DRAWING This is a permanent record and muss be accurate and descriptive enough to reaocate in the need of maintenance activities and future development Typical Record Dngs contain: Drairfietd&manifold rientabon&layout,Septidpump tank location,North arrow,reserve drainfield,edsting and proposed buildings,location of wells,waterlines. wells,observation ports,deanouts,and ther maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that/installed the system in accordance with !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 here have been cleared/approved by both the designer shown here have been cleared/approved 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 contained on this form and attached R cord Drawing is accurate. form and attached Record Drawing is accurate, V Th32Z Ig. atu e of Ins alle Date Printed Name of Signee 7Health.- faayft-rnenY PUBLIC HEALTH approves this Installation Report and on behalf of Mason County Public f p rrvronmen I rlealrn Specialist Date (stamp signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VI ON THE MASON COUNTY WEBS E updama azinm¢ WELL TANK NOTES [1]INFILTRATOR IM-I530/1537 GAL WORKING VOL !WJ 1,787 FLOOD CAPACITY TWO COMPARTMENT SEPTIC TANK :•:....R54�TtCESs:'. ':':':'.' : " 'W "'......' (2)INFILTRATOR CM 1060/1094 GAL WORKING VOL SCALE 1 = 30 I .. 1,287 FLOOD CAPACITY/SINGLE COMPARTMENT PUMP TANK };.;.:::::.... : . "fhr::: 5 30 60 1 \ "•-. :::::::::::. .\...•••....,.••....•\ \ 360.16' \ ` ':IYiri':\':':''''''''' \ \ '° RESERVE DRAINFIELD � \ \ c}/• \ \ \ /'/1/,/////////// DRIP IRRIGATION WITH A PRETREATMENT DEVICE \ - \ Ry \ \ \ ////////////// MEETING TREATMENT LEVEL"B"750LF ttii\ \ \ ♦9•. 1 \ ❑ ////////////// OF NETAFIM 08WRAM.4-f21R'DRIP LINE 2'OC I ' I \ \ •:' ::: \ O / DATE:5/21/2026 \ \_% \ \ \ 4-8 E OR O O 'tom O I j ; M ?"SCy / iii Y\ `\ RES/DEN �pV o ?For SHo. _ 1 _ _ _ O\\ \ \ \ \ C E D-SOX o i•Nl r\ \\ \ \\ ` LL\\ LL i CUT BANK O'L1CrN8Eb t9iGNER 1 \\ W 1 \ Y\ \ I \ 360.16' g` `w\ ASBUILT RECORD DRAWING $\ PUMP TO GR.AVITY DISTRIBUTION PORT CLIENT: DAVID MUSSLEMAN 360-229-3118 I rrPl SITE ADDRESS: 51 E PENDRAGON DR PARCEL: 122167590032 PRIMARY DRAINFIELD PUMP TO GRAVITY DISTRIBUTION WITH INSTALLER: TESS HOLTI DODGE EXCAVATION LLC 280LF 9"GRAVELESS CHAMBERS 7 OC 36"WIDE TRENCHES 800 SO FT ABSORBTION AREA PERMIT: SWG 2021-00288 INSPECTED BY: JUSTIN W COOPER ALLONS PER DAY:480 SEPTIC TANK: INFILTRATOR IM-1530 TWO COMPARTMENT P R®V E UMP TANK: INFILTRATOR CM-1060 SINGLE COMPARTMENT PUMP: LIBERTY 280 DRAWDOWN:1.5 INCH/MIN PUMP CAPACITY 50GPM PUMP TIME: ON:3 MIN 2 SEC OFF:4 HOURS MAY 2 8 2026 DISTRIBUTION MEDIUM: GRAVELESS CHAMBERS LOW ARC INFILTRATORS 36"WIDTH MASON COUNTY ENVIRONMENTAL HEALTH 280LF 4"SCH40/7'O/C TRENCH DEPTH: 16" COVER MATERIAL: 12" RET I/rtrt�,,`1p1 INCSURVEY THEWFORMTroNAM LOUTroNS 5HOWry ®II IESCOOP II vE/NAREOERIVEDFROM PU9UC RECORDS.OWNER STATEMENTS. `\J IVI�_ UILN IIY_ ASTFiElD09SERVARONS.NOWARRANTYI5 FXPRES5E00RIMaT AS TOACCURACV,WE RECOMMEND MAl WHENOUES IIONS E%IST 12201 OSPREY DR NW GIG HARBOR,WA 98332 TNEDWNEROBTAMTHESERVICESOFALICENSED PRDFESSIONALlAN00 SURVEYOR PNroR NLONSTRUCTroN OR RFLMNCE ON THIS IrvFORMATI . 253-376-0479 coopJustln@gmall.com S51 rd°asau�°�°o"LaT RPDSFs°F SFRTro HEALTH DEPT APPROVAL Traverse PC " < •1 tea" £-• a • Fi : • a 1____ r7ic ; ('S) - ' 4: J 6 eG