HomeMy WebLinkAboutSWG2020-00642 - SWG Application / Design - 3/27/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00642 Parcel# 22304-76-90080
Applicant Name Stephen and Laura Els Subdivision (Name/Div/Block/Lot)
Applicant Address 330 NE Lakeridge Dr.
City, State,Zip Belfair, We 98528 Installer Name Trinity Excavating
Site Address Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Orainfield Only ❑Repair ❑Other
System Type Gravity Pretreatment Type
>5ft.from foundation? - -------------------------.. ❑ N/A OYU NO
>50ft.from wells? ---------------------------- _ ❑ ® ❑
Z >50 ft.from surface water? ------------------------ ❑ . ❑
FCleanoutbetweenbuildingandtank? ------------------ - ❑ ® ❑
V Tankbafflespresent? - - - - - - -- ------------------- ❑ ® ❑
a 24"access risers over each compartment?---------------- ❑ ® ❑
rW Effluent filter installed?- - - - - - - - ------------------ - ❑ ® ❑
Septic tank capacity(working) 1500 aal Manufacturer Haqqerman
0 D-box water level and speed levelers used? -------------- - ❑ NIA Eyes NO
CLLManifold/D-box accessible from surface?- - - ------------- - ❑ ® ❑
GQCheck valves installed? - - - - - - - - - - - - - ------------ - ❑ ❑
f Transport Line Size 4" 3ohedulefClass SDR 35
Bedrooms installed(check one) ❑ 2 E3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.fromfoundation?------------------------- - ❑ WA ® YES NO
O >100 ft.from wells?- - - - - ------------------------ ❑ IN ❑
W >100 ft.from surface water? - - ---------------------- ❑ ® ❑
LL. >10ft.from potable water lines?---------------------- ❑ ® ❑
QZ > 5ft.from property lines and easements?-------------- - - ❑ e ❑
R' > 30ft.from downgradient curtain/foundation drains?- --------- 0 ❑ ❑
Dreinfeld level and observation ports present -- --- ❑ ® ❑
❑ Graveless chambers or M Clean gravel used? (check one)
Proper cover installed over drainfiekl?----- ------------- - ❑ ® ❑
Pump tank setbacks consistent with septic tank?------------- E WA ❑ YES El No
ZPump tank capacity(flood) at Manufacturer
24"access risers)and accessible from surface?------------ - ❑ ❑ ❑
aAlarm or Control Panel Installed? ------- - - - - --------- - ❑ ❑ ❑
:E Control Panel equipped with Timer/ETM/Counter- - --------- ❑ ❑ ❑
IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
IL Pump Make/Model ❑ Floats or ❑ Transducer
f
y Tank draw down in/min Pump capacity npm Squirt Height ft
Pump on time Pump off time Daily flow set at dpd
Up .aavm+e
Mason County OSS Installation Report pg.Y Parcel is 22304-76-90080
ASANDONMENTRECORD
Were eWtbg saw canponenM abrldorW as pen Of mM vejea9 -------------- - 0M S No
If yea,PMece dncdbe'. _
Wee all components Pumped dut aid ptopM abandoned y Br WAcuw72A.0B009._---__ . 0 m 0ND
RECORD DRAWINO
Tel.rer.•�.a ...a.a.rr�.r.ra o�MM�wu�rnbgrrna weawrrirw wwr rp sere Mrynwa tt+a+M1ma
oiwawmr.�orwe a nwreaw+rm abW asN.V+ro r+msn san.m..iwnbYda,meymo P9�MW.baenawr,YYYW,
.W awwrwaasvh mmrnrawsa.w.+.M W+ame prMe.mryer♦r aAba C+nnwaYi011aT.pppa.raaeYe Fl+rY
S Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
I Worty that I installed the system In accordance with 1 Certify that the system has been installed In wcor-
the septic design stamped'APPROVED'by Meson dance with the septic design stamped*APPROVED-by
County Public Health and that any dewadons shown Mason County Public Health and that any dews*m
here have been clearedmapproved by both the designer shown here have been clseradmopmved by both
and Mason County Public Health and meet all Stale myself and Meson County Public Health and meet all
and Meson County Codes. State end Meson County Codes
!further certify that all information contained on this I further certify that all Information contained on this
1prm and attached Record Drawing Is accurate, form and attached Record Drawing is accurate.
f - _ 7-3-zy
Signahsaoflnreller Dote
Keith Chembenin
Printed Name of Signea
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health.
� 3�z7 evwasa
Signalum OfEnVionanentil Haneh Spowellr Data (slump,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUMY WEB SrTE
110'_2" -�
APPROX. PROPOSED
DRIVEWAY TAKER/OGEOR 1
I
-- -4 _._..___---J
POSSIBLE WATERLINE I j I I
LOCATION. MAINTAIN I 1
10FT+ TO SEPTIC COMP. I
PROPOSED
HOME 4
LOCATION P
10FTBUILDING I I
SETBACK 1 POSSIBLE SEPTIC TANK
LOCATION. MAINTAIN
5FTFROM FOUNDATION
& PROPERTY LINES
1 3
� I
N
I
PROPOSED DRAINFIELD
I L �_J I
50'ATTEN VATION ZONE
I I APPROVED
1 VED
MAR 2 7 2025
Irq I MASON COUNTY ENVIRONMENTAL HEALTH
RET
"RAN
I
PLAT STAKING LINE
APROX. OH WM
I I
I I
INSTALLATION I) SIGNMSIGNOFF/ASOULTITE
WILL M CHARGED ATTIME OF INSTALLATION. _
OTHMPASRkTMENS�TMREVIIEEW5,DESSCNEERRNOT I ER/CKSON/AKE �r�`\`
R6PONSIBLE FOR5ETMMS UNRELATED TOSEPTC I
COMPONENTS.
CUSTOMER: LAURA ELS SCALE 1:60
PIONEER DIGGING, INC PARCELR 2230+76.90M TEST HOLEL TEST WOLE2 TFST HOLE 3:
SEPTIC DESIGNS ADDRESS: 330 NE LAKE&ME DR air,CSL 029 GEL 0-56 WITH
36r TILL 29t TILL IMDENCEOF
3083EMA. 1113,9OIJRD. GRMEVIEWWA98%S DESIGNER: ROBEELT PAYSSE R03TS-36 (LOOTS-29 OLD HLL
OMCE-3N? 1803 FAX-3604VM53 DESIGN PAGE -OF -NOT USED