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HomeMy WebLinkAboutSWG2023-00304-ASBUILT - SWG As-Built - 7/2/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00304 Parcel# 31921-14-00000 Applicant Name Olympia Oyster Company Subdivision (Name/Div/Block/Lot) Applicant Address 1042 Bloomfield Road City, State, Zip Shelton, Wa 98584 Installer Name Spear Construction Site Address XXXX Bloomfield Rd. Designer Name Bob Paysse INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair P ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? -- - - - - - - - - - - - N/A ®YES ❑ NO >50 ft. from wel!s� - - ❑ Y �_ -�_- -�, >50 ft. from surface water? - - - - ® ❑ z �1- ---- -- - ❑ ❑ ❑Cleanout between building and tan - V Tank baffles present? - - - - - - - _ ❑ a24"access risers over each compart ❑ Effluent filter installed?- - - - _ _ - _ - $y- ❑ ® ❑ Septic tank capacity(working) 1 00 gal Manufacturer Existing D-box water level and speed levelers used? - - - - - - - - - - - - - - - 00 Manifold/D-box accessible from surface?- - - - - - - -- - - - - - - - ® ® ❑ ❑ "/A U YES ❑ NO QQCheck valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - _ M Transport Line Size 4" Schedule/Class SDR35 ❑ ❑ Bedrooms installed (check one) ❑■ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ® YES ❑ NO j3 >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ W >100ft. fromsurfacewater? - - - - - - - - - - - - - - -- - - - - - - -- ❑ I ❑ ❑ Z >10ft. frompotablewaterlines?- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ❑ ® > 5 ft.from property lines and easements?- - - - - - _ _ ❑ © ❑ ❑ > 30 ft. from dowr,gtadient curtain/foundation drains? Drainfield level and observation ports present - - - -- - - - - - - - - -- ❑ ❑ ❑ ❑ Graveless chambers or 9 Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - _ - ❑ Ii ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ® N/A ❑ YES ❑ NO Pump tank capacity(flood) gal Manufacturer Z <( 24"access riser(s)and accessible from surface?- - - - - - - - - - - - - ❑ ❑ ❑ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - -- ❑ ❑ ❑ 4. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 11 Pump Make/Model ❑ Floats or ❑ Transducer Tank draw down in/min Pump capacity acit P Y 9Pm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 31921-14-00000 ABANDONMENT RECORD Were existing septic coritponents abandoned as part of this project? - - - - - - - - - - - - - - - ❑ YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - - 0 YES ❑ NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawings contain. Drainlield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. II Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /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 Record Drawing is accurate. form and attached Record Drawing is accurate. rgn re of lnst er ate Loqan Spear Printed Name of Signee MASON COUNTY PUBLIC HEALTH VVV O RCIBERT.H�(igySSE �s The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public EXPIRES - Health: Signature of Environmental Health Specialist Date (Stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 ' ft . I H 1_ 31921-14-00000 31921-14-00010 1 SLEEVE SEWER LINE OR WATERLINE 10' BOTH DI RECTIONS AT CROSSING EXISTING 1200 GAL. -_ EXISTING FAILED EPTI TANK DRAINFIELD I1J SC D-BOX \ j EXISTING RV ll% I EXIST, 1 SHED --- ---------------- m OB. PORT (X2) APPROXIMATE WATERLINE LOCATION INSTALL TWO 50' LATERALS PQ HILL OF EXISTING I I INSTALL 30 MIL LINER 4' DEEP LATERAL. INSTALL 1)-BOX AND I (ROOT BARRIER FOR DOWNSLOr L , "."LE) CONNECT TO EXISTING SEPTIC TANK. INSTALL RISERS AND EFFLUENT FILTERON EXISTING TANK. I APPROVED 1 JUL 00. 2026 MASON COUNTY ENVIRONMENTAL HEA RETO;,,,RCBEt Tk WtiSSE N (� / �/�`�,� ^ AN ASBUILTI INSTALL SIGNOFF FEE WILL I. S ts� "� BE CHARGED AT TIME OF INSTALLATION PIONEER DIGGING, INC CUSTOMER O11vtmIA OYSTER CA. TEST Hi�LE I: 058 HOLE 2: PARCEL#-.31921-14-00000 FLO I S o O [S' ROOM a TO 45 RWTS TO 45 SEPTIC DESIGNS ADDRESS: I0XX SE BLOOMFIELD RD DMCWM M TNM M NOT A SURYSY.REFERENCES INCLUDE:APPUCANRCOUNTY PROVIDED 3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER ROBERT H.PAYSSE PLATS OR SURVEYS.FIELD MEASUREMENTS AND COUNTY OM.DESIGN INTENDED FOR SEPTIC OFFICE-360-426-1803 FAX-360.427-2353 SHEET:SITE PLAN(2)SCALE:1"=20' DEPP`PARTMENTIAG NCY REY EW BOFESEaoNER�rroT RESPw+$IDLE FOR S5ETRRAACKs�UNRELATEn o SEPTIC COMPONENTS