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HomeMy WebLinkAboutSWG2024-00410 - SWG As-Built - 5/27/2025 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00410 Parcel # 62017-75-00010 Applicant Name Michael Beyer Subdivision (Name/Div/Block/Lot) Applicant Address 2610 W Deckerville Rd City. State, Zip Elma, WA 98541 Installer Name Workman Contracting Site Address 130 W Doggone Ln, Elma Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Dr.i:r`ield Only ❑ Repair ® Other 660 gallon pre-trash tank System Type Shallow Pressur=© Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - -eC-44,- - - ❑ N/A . YES ❑ NO >50 ft. from wells? - 0 ❑ >50 ft. from surface water? - Af4-Y P A ❑■ ❑ Z B r6 . H Cleanout between building and tank? - - - k- - - - - -42,5-- - - //, 0 ❑ i U Tank baffles present? - - % 11 ❑ a24" access risers over each compartment?- - - - -- - - ❑ ❑■ ❑ rW Effluent filter installed?- SPA_ - - ID ❑ 0 Septic tank capacity (working) NuWater 500 gal Manufactur-r Sound Placement OJ D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO x0O Manifold/D-box accessible from surface?- - ❑ 00 oQCheck valves installed? - - - - - T --- *- - El ■❑ ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A M YES ❑ NO CI >100 ft. from wells?- - ❑ ❑] ❑ W >100 ft. from surface water? - - ❑ ❑■ ❑ u. >10 ft. from potable water lines?- - ❑ ■❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ ED Drainfield level and observation ports present - - ❑ I ❑ ❑ Graveless chambers or pi Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ❑■ YES ❑ NO Y Pump tank capacity (flood) 1,200 gal Manufacturer Sound Placement < 24- access riser(s) and accessible from surface?- - ❑ 0 ❑ F- n. Alarm or Control Panel Installed? - - ❑ © ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ © ❑ n d Pump installed in 0 Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a Tank draw down 2.25" in/min Pump capacity 50 gpm Squirt Height 5 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd ( 201� - 'iS- Goo� o Mason County OSS Installation Report pg. 2 Parcel ABANDONMENT RECORD YES IN No Were existing septic components abandoned as part of this project? If yes, please describe: _ _ _ __ _ _ - YES 0 No Were all components pumped out and properly abandoned per WAC246-272A-0300. RECORD DRAWING �;Record ve enough to re-locate in the need of maintenance activities and future development Typ This Is a permanent record and must be accurate and descriptive reserve � proposed buildings,location of wells,waterlines. wells.o s contain: Dr ports, d d&manifold orientation&layout Sept Upump�ncolocation, �e e Reco wings may create additional elays ofinal installation approval and related permits. Dra wells,observatbn Ports.�eanouts,and other maintenance access points. 11 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with l 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 aso Countyouty Public ub i Health and meet all and Mason County Codes. s I further certi that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attachedt Record Drawing is accurate. , \, ''.-lr"�.�1 ill-----, 3-Z_C.- ZS '��' . r ',,,� Signature of Installer Date diith. Printed Name of Signee t MASON COUNTY PUBLIC HEALTH ;�' • r^� rid' Ssr:. :9 . approves this Installation Report and +- PAULA JJf JQIiNSUIJ ;r The undersigned L4C>�l�E(jpE�iCt�lft" Record Drawing on behalf of Mason County Public FAMES y,� � Health: • 5_(S- Vil -C?;")/ C--- Ly- (stamp, signature and date) Signature of Environmental Health Specialist Date updated 8a1/2018 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 400•70<tti...... . . • •• 1 E . \ • . I i i { APPROVE', fib` x 3` & 4`�- MAY 2 7 2025 •I .. . . p, • \ vas -z� MASON COUNiY EtiV1RONMENTALiEA6�A 1 RET ; G, 1 - o 1 c. a UP • r3 . . \ .4 0 4014'- ' - .1.'l• i $ , b , • its' I 'li \--ei \ cc.: 1 i s•-s '`R I AZ \ I N 1 f ` 1 v Tx_ 0�, s Soo, ,.s • iev `C fir= Cleainout �,, 0 A'�do-Visua= . � E =✓0 �� i v� ..T- Lam'— !L0 00 :0 3 500 Gaon P=e-t ras tank .0 ♦ .,1I l j ks••1 I0, Water B -500 A':'IJ Tank �: P 5 �19 .l�E'i ''v 4Uh JOHNSON• i -,r Crier • ..I:iCFf_ I°Na' (s 1,000 Galion. -� .. A O Valve Cont'ol Box S`' S- aaeC 1'`�� I-?D"'Lj''`°®v 0 5 o\ ids p,,kyy Gas\r