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HomeMy WebLinkAboutSWG2023-00002 - SWG Application / Design - 1/2/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 23-00002 Parcel# 22009-12-90012 Applicant Name Michael Johnson Subdivision (Name/Div/Block/Lot) Applicant Address 52 E. Old Winery Rd City, State, Zip Shelton, Wa Installer Name Spear Construction Site Address same Designer Name Bob Paysse INSTALLATION CHECKLIST 0 Full System Installation ®Tank(s)Only 0 Grainfield Only ❑ Repair ❑Other System Type ATU -existing community d/f Pretreatment Type Nuwater BNR 500 >5 ft.from foundation? - •- ❑ N/A ®YES ❑ Na >50 ft.from wells? - - 0 ® 0 Z >50 ft.from surface water? - - El IN < Cleanout between building and tank? - - ❑ IN ❑ ✓ Tank baffles present? - - ❑ ® 0 d24"access risers over each compartment?- - CI NE CI IW Effluent filter installed?- - NI ❑ CI o Septic tank capacity (working) BNR 500 gal Manufacturer Sound Placement D-box water level and speed levelers used? - - MIN/A ❑YES ElNO CLLManifold/D-box accessible from surface?- - • ❑ ❑ Qz Check valves installed? - - Cl ® 0 Transport Line Size 2" Schedule/Class 40 i Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - ® N/A ❑ YES ❑ NO 0 >100 ft.from wells?- - 0 ❑ ❑ W >100 ft.from surface water? - - 0 0 ❑ ti >10 ft.from potable water lines?- - ® ❑ ❑ z > 5 ft.from property lines and easements?- - ® ❑ ❑ 12 > 30 ft. from downgradient curtain/foundation drains? - - © ❑ ❑ Drainfield level and observation ports present - - ® 0 0 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ® ❑ 0 Pump tank setbacks consistent with septic tank? - - 0 N/A ® YES ❑ NO ZPump tank capacity (flood) 1500 gal Manufacturer Sound Placement Q 24" access riser(s)and accessible from surface?- - ❑ II ❑ I— D. Alarm or Control Panel Installed? - - ❑ PE El • Control Panel equipped with Timer/ETM/Counter- - 0 0 0 a Pump installed in ❑ Bucket or ® On Block or ❑ Other CI Pump Make/Model Liberty 280 ® Floats or 0 Transducer R Tank draw down 1 . 75 in/min Pump capacity gpm Squirt Height ft a Pump on time 1.5 min Pump off time 4 hrs. Daily flow set at 360 qpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# 22009-12-90012 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? • - YES NO RECORD DRAWING Thia 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: DraInfield&manifold orientation&tayout,Septic/pump tare(location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation pods,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 0 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 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. 1/2/24 Signet of Install r Date Logan Spear • Printed Name of Signee MASON COUNTY PUBLIC HEALTH ,.��+ The undersigned approves this installation Report and ' .�f�� Record Drawing on behalf of Mason County Public is ALEX Lb PAYS&E Health: (( i • . • • e, alcZ1—`(\Q}Mr«4a. YOVI Signature of Envirenmentel 1vvlih Specialist Date (stamp, signature and date) Updated arztrzota THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE AN ASBUILT/INSTALL SIGNOFF FEE WILL _ t I . / i G BE CHARGED AT TIME OF INSTALLATION e EXISTING STUB OUT/ ,\ II CONNECTION POINT ----\ rr \�, i _ 1 //, .� APPRRoX.EXIISTTSEWERUnE�_.. ..o..1-i...' � � -- _ , --""`-- �� OLD WINERY RD ,______i__ _____.._...______.._ I• _.._.._--- ----- - —— APPROX.EXIST.WATEkLINE /I �1 EXISTING STUBOUTAND CONNECTION TO EXISTING FORCEMAIN. INSTALL r SERVICEABLE 2" BALL & CHECK VALVE II AT POINT OF CONNECTION, \ —'" JAN 0 2 2023 IF NONE ALREADY EXISTS. , �\ MASON COUNTY ENVIRONMENTAL HEALTH RET II CONNECTION EXAMPLE: I / \*. CHECK VALVE —��— FORCEAIAIN --- I 1 r y F I • I. �' CM 111=11UU ' s ! 1 a PROPOSED 1 I BALL VALVE I 11 RESIDENCE/SHOP � - vLv� iox to GRADE i II 1 •,,I IN'11'ENVIRO MEH1AL III:; I. t;\ C/O t � , t R` Rca ' W1Y.SC — _ . ,, 'vim:e c .•�� . !1,1 . • i t E;Pifi_S r e I — PROPOSED 2" SCH. 4.0 SEPTIC LINE u PROPOSED NUWATER BNR500 • irip 4---,---- 8z 1500 GAL. PUMP TANK C.LL�TOMGI2: MICHtiFL i01-P:�501 \��TEST I I��:.'>\l'LUFI�'•!'A\I:ONLY iI . PIONEER DIGGP`1G, I . PARCEL z�oo�Ia 9ooiz 1 $ PTIC DESIGNS V ADDRESS: 50 E OLD WINERY RD 1 . -�•„�g.� �.' i 3083 E.MASON 3E7�la) RD. G:cn!�EVIEw,wn 9tt5 DESIGNER: ROBERT I L PAYSSE 1.a.,d'E.0:.641.:1.�s Z=o�'TYoS ESo ��FACf .60•426I2 O3 FA .•"G(�427 2353 PE RT m._Y rcarcee -a.f,or:.zn- mow. OF suACKS TO TEDTO I ` -• SHEET: DF DETAIL SC.P.I F. I"=20' , �,�T����YN6V3V. 7:8.T\Ei MIT REeDal:p 61E f01154TMCK6 UNRELATED TO I! ,..•..�..����� .8:. „ . �.--Q. .-... . , ,,,iA �.>< :_ - _,- ._._ .,�-9 .•n,;