HomeMy WebLinkAboutSWG2020-00097 - SWG As-Built - 9/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG SWG2022-00097 Parcel # 31906-51-00033
Applicant Name HARKINS, RICHARD ELI Subdivision (Name/Div/Block/Lot)
Applicant Address 881 W DELIGHT PARK RD
City, State, Zip SHELTON,WA 98584 Installer Name JERRY UPSON
Site Address 885 W DELIGHT PARK RD Designer Name MICAH HALVERSON
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑ Repair ❑Other
System Type PRESSURE TRENCH'S WITH WAIV retreatment Type ATTENUATION ZONE
>5ft. from foundation? -------- ------- -- ❑ NIA ®YFS NO
>50 ft. from wells? - -- ------------- - ❑ ® ❑
14 >50 ft. from surface water7 --------- - - -Or�� ___- W ❑
F Cleanout between building and tank? --- --�0� __-- ❑
U Tank baffles present? - - -- - - - - - - - ❑ 0
R24"access risers over each compartmen . \- --- ❑ ❑
rW Effluent filter installed?- -- -- - -- --- -- \ --- - - ---- - El � ❑
Septic tank capacity (working) 1200 oaD, anufacturer SOUND PLACEMENT
0 D-box water level and speed levelers used? -------- ❑ N/A E] YES NO
gO Manifold/D-box accessible from surface?- --- ------------- ❑ o ❑
G< Check valves installed? - - - - - --- - ---- ----- - --- - - -- ❑ E] 0
f Transport Line Size 2 Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 R from foundation?-- - ---- - -- - - --- - ❑ NIA DYES NO
>100ft.fromwells?- --- -------- -- -- - ❑ 0 ❑
W >100 ft. from surface water? - - ---- -- -- - ❑ 0 ❑
E >10 ft.from potable water lines? -- ---- -- -- - ❑ 0 ❑
QZ > 5ft. from property lines and easements?-- - - - ---- ---- - ❑ ❑
K > 30 ft. from downgradient curtain/foundation drains?- - - --- - - - - ❑ Pg ❑
Drainfield level and observation ports present - - - - - -- ---- - - - ❑ 0 ❑
❑ Graveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfeld? ---- - --- ❑ ® ❑
Pump tank setbacks consistent with septic tank? ----- ❑ N/A 0 YES ❑ NO
Z Pump tank capacity(flood) 1200 oal Manufacturer SOUND PLACEMENT
Q 24"access riser(s)and accessible from surface?- - - - -- - - -- - -- ❑ ® ❑
aAlarm or Control Panel Installed? -- --- - - --- - - - - - - -- - - - ❑ 0 ❑
7 Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ 0 ❑
a Pump installed in ❑ Bucket or ❑ On Block or E Other ORENCO EZ-PAK
IL Pump Make/Model ORENCO PVA500511 ® Floats or� ❑ Transducer
a Tank draw down 3 in/min Pump capacity 60 gpm Squirt Height 8 ft
Pump on time WIN Pump off time 6HRS Daily flow set at 240 dpd
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Mason County OSS Installation Report pg. 2 Parcel# 31906-51-00033
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - -- - - -- - - -- YES Q NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-272A-0300? ---- - - - - YES NO
RECORD DRAWING
Tnla Ie a permanent record and..at be accurrte aM deecdpuva enough W m IouN In Me need or malnunance¢avluee and future dwelopment. rypkal Recora
DraMnge ccMain: DminfieW 8 menftM Wkxndbn&1dMd Saplk Mp lank bcatim,NMh dno r rewm dr infmkl exlaling and,ddoaed buildings,Iwntim otm, walerllnes,
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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 cleare&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 accuraa form and attached Record Drawing is accurate.
yY CAVaIlcg[/ Pq r
Signature of Installer Doto
Jev, �� I �TnSan
Printed Name of nee `(
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and �}�a
Record Drawing on behalf of Mason County Public tvLymwm
Health�:
IS J1_�kLr_\I' aYri �2p1� E%PMES:W'tY
Signature ofEnvimnm ntal Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upew erz+rzole
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Abbreviated Description: SOMERS LAKE TRACTS (UNRECORDED) TR 33 EX 33-A PCL 3 OF BLA #02-26 AF#1757440
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a verson Design LLC 31906-51-00033
RICHARD E. HARKINS W DELIGHT PARK RDPOBox 1519 Shelton Wa 98584 Mailing: 881 W DELIGHT PARK RDHalversondesi nllc outlook.com SHELTONWA98584 ELTON 98584 ox