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HomeMy WebLinkAboutSWG2021-00648 - SWG As-Built - 12/15/2023 DocuSign Envelope ID:721904BA-AABA-49EA-9A13-A2AF7D114703 n 4/ Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00648 Parcel # 32127-50-00005 :DecT.'...12.. Applicant Name JENNIFER L WALTON Subdivision (Name/Div/Block/Lot) 1 2102J Applicant Address 5040 WOODBINE DR SW LAKE LIMERICK 1 LOT: 5 S 47/15 �4-7fre© City, State, Zip OLYMPIA WA 98502 Installer Name Chris Smith Site Address 841 E BALLANTRAE DR Designer Name Micah Halverson INSTALLATION CHECKLIST 0 Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type 2bd ATU to pressure trench Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - r ❑ N/A X❑ YES ❑ NO >50 ft. from wells? -4t.+,wu"'1�'� `')` - -_ T5- ® ❑ ❑ Z >50 ft. from surface water? - .. ❑ 0 ❑ FQ- Cleanout between building and tank? - r�F-C 1 I -4.�2-3- ;- ❑ 00 ✓ Tank baffles present? - ❑ 0 ❑ ITT: 24"access risers over each compartment?- - A - ❑ 0 ❑ W Effluent filter installed?- - x❑ ❑ ❑ N Septic tank size 500+ NuWater gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ 0 El co-2 Check valves installed? - - ❑ 0 ❑ ❑Q 2 Transport Line Size 2" Schedule/Class Sch40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other 44 >10 ft. from foundation? Z 2a Lt DC)t Z." - © N/A ❑ YES ❑ NO cm >100 ft. from wells? CdJ"' �''C �� �<'r - 0 ❑ ❑ W >100 ft. from surface water? -W �Zot 1 -001 W L - 0 ❑ ❑ LL. >10 ft. from potable water lines?- - ❑ El ❑ Z > 5 ft. from property lines and easements? ��r LCZ( ON LJ 2- - 0 ❑ ❑ Ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ • Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A Q YES ❑ NO • Pump tank size 1223 gal Manufacturer Sound placement < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ H a Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ n a_ Pump installed in ® Bucket or ❑ On Block or ❑ Other d• Pump Make/Model zoeller n-152 0 Floats or ❑ Transducer a • Tank draw down 1" in/min Pump capacity 24 gpm Squirt Height 30" ft Pump on time 2min15sec Pump off time 6 hours Daily flow set at 1$0 gpd Updated 8/21/2018 DocuSign Envelope ID:721904BA-AABA-49EA-9A13-A2AF7D114703 Mason County OSS Installation Report pg. 2 Parcel# 32127-50-00005 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - © YES ❑ NO If yes, please describe:tank pumped crushed in and filled Were all components pumped out and properly abandoned per WAC246-272A-0300? - - © 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. Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,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. xQ 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 4,At49ched Record Drawing is accurate. form and attached Record Drawing is accurate. (,t is Sit,t{L 12/11/23 h h`J4Etl ltt`JF5441 Signature of Installer Date it/ Chris smith Printed Name of Signee • • ,1�. MASON COUNTY PUBLIC HEALTH tr y I, The undersigned approves this Installation Report and i / ssfoo4oeI Record Drawing on behalf of Mason County Public �' mcoio n rourensoN$1 Health: ' uc DESIGNER 1� \, -3-)\5),A,\-v-KYY) 7/( moss:Mid 40 Signature of Environmen l Health Specialist Date g P (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 DocuSign Envelope ID:721904BA-AABA-49EA-9A13-A2AF7D114703 Asbuilt: 51"152021 -0064S JENNIFER L YNALTON Site Address: 841 E BALLANTRAE DR SHELTON I NA g8584 Parcel#32121-50-00005 Lake Limerick N 4 Edge Of OHWM F its- 1— cv 4 IV +I I I I I 5' Utility & Drainage Easement— — - 5' Utility & Drainage Easement I I _ — I---diNuYVater BNR-500 1 50' From OHM Sound Placement Trash/ I _ Pump Combo I 15' From OHINM Shed I OPc.. Disconnect — CO — -Qsee Tr-_ ench 11 a -► m _ Resew rn v, - -e TrencFi_ I-� O _ 1 _ - ---- _ Res. m N o� h%e Treri __ w i ,.rr Ch I A M + �nma Trench "l 7 1 lirI Lot 4 Septic Tang Location I See Easement Recorded . : • I AF# 1125663 BLD2022-01430 I , 2 Bedroom 5FR I + I 11 , ;1 I ,;t5 I i.: tl os- r4ih•i , . +� ,,,�/ I / „y,�� p i. Y yet f' 51nt S. , I I i , M CAH rtt' EL tIALVE?J N 1 I M LICENSED DESIGNER I EXPIRES:08/1d/ 23 Lot6 I ,� .> II Lot 4 / A / Water from tormunih�u eter System 55' +/- — — -E $ALLA N TRAM Di Q This is not a sutveu; LU This Asbuilt Drauang is intended for the purpose of �- locating and maintaining the septic system on this parcel. 1-1- Measurements and distances are approximate. J It is advised by septic designer Micah Halverson ' ` to use a licensed surveyor to determine lot lines, elevations,topography and to provide a legal site plan. Owner is responsible for establishing all property lines, < 30' 20' 0' 10 20' 30' easements and/or right-of-ways. ) I scale: 1"=20'