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HomeMy WebLinkAboutSWG2024-00422 - SWG As-Built - 6/9/2025 Docusign Envelope ID: B7D57B1A-42F9-4D2E-A350-BE86DE6DOBE7 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2024-00422 Parcel # 32214-51-01020 Applicant Name VEVERKA. LUCAS J Subdivision (Name/Div/Block/Lot) Applicant Address 8207 ROOSEVELT WAY NE MAGGIE LAKE ADD #2 BLK: 1 LOTS 20 & 21 City, State, Zip Seattle Wa 98115 Installer Name Jamie Workman Site Address 330 NE LAKESHORE DR N, TAHUYADesigner Name Micah Halverson INSTALLATION CHECKLIST 0 Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type ATU to Pressure Bed Pr treatment Type NuWater BNR-500 >5 ft. from foundation? - - El N/A El YES El NO >50 ft. from wells? - - ❑ © ❑ Z >50 ft. from surface water? -\ )- - - - - ❑ ❑ ❑ H \%Cleanout between building and tank? - - - -0 34-� - ❑ x❑ ❑ U Tank baffles present? - - - - - - ❑ 0 ❑ a24" access risers over each compartment?'\1� - - - ❑ ® ❑ W Effluent filter installed?- \-'4`i- - ❑ ❑ ❑ N Septic tank capacity (working)_50fl+Ni'Water gal Manufacturer Sound Placement 9 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO oO Manifold/D-box accessible from surface?- - ❑ x❑ LI OOZ Check valves installed? - - ❑ ❑ x❑ thQ 2 Transport Line Size 2'' Schedule/Class Sch40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ❑ YES x❑ NO 0 >100 ft. from wells? - - ❑ 0 ❑ J >100 ft. from surface water? - - ❑ x❑ ❑ W LL >10 ft. from potable water lines?- - ❑ 0 ❑ or-Z > 5 ft. from property lines and easements?- ❑ x❑ ❑ > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ • Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A x❑ YES ❑ NO • Pump tank capacity (flood) 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 ❑ D a Pump installed in ❑ Bucket or ❑ On Block or 0 Other Orenco EZ-Pak d• Pump Make/Model Orenco PVA 5005 0 Floats or ❑ Transducer a • Tank draw down 2.5 in/min Pump capacity 50 gpm Squirt Height 7 ft Pump on time 1 min Pump off time 4 hrs Daily flow set at 300 gpd Updated 8/21/2018 a Docusign Envelope ID: B7D57B1A-42F9-4D2E-A350-BE86DE6DOBE7 Mason County OSS Installation Report pg. 2 Parcel# 32214-51-01020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - © YES p NO If yes, please describe:Ripped old tanks out and replaced with new 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. Initial L V 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER /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 forrgoggazgoched Record Drawing is accurate. form and attached Record Drawing is accurate,, 6/3/2025 ttcrvr.ir csbwtt Signature of Installer Date tier' 1�t • .lamie Wnrkman Printed Name of Signee a, 21 MASON COUNTY PUBLIC HEALTH ij,111 The undersigned approves this Installation Report and .171 t`100409 � Record Drawing on behalf of Mason County Public ' sn ,�,Lvr�eoN �� ,;e MEWED DEMONER Health: 2i12i 6(q L` EXPIRES 011116l Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 - 0 0 0 CO N -, c (I' < C N iU al N 7 3 N 3 __ N. co , 6 N ( R cc.6 p. O O (. (C N . -, p o. v� C a N O to co S z n E. v 3 O (NO 3 (p 3. �� n D CO S Co MED N O (p N o 3 (0 0 R. s O ry LE Ny co h 2 (TD • N ovo (moo33 � I m (D N N 0 (D m ti u, ! (o b O m 3'E O ni 0 � � I m i J c % 1 0 7, Vi • I I s l ;, O ..m,r. I tVa N cce X. \ N n �I r 1 I I\ 'E, X „ ai 3 W m 1 O • n a I I O Q Pll 0V eyed Sto�a9e • 3 A / • o to C" - • v , \ \�\ P. \ \ \ , d Hi x m w 3 \`\ \ m `\ rn `` \ Ow C .�` `\\ 1► c + a b ���=0 Oe` \ _- _n U) cr W N o z < a �� o.z ` 3g W CD N — mom �7Oni P► °� vii �! v Caonc (n R n \ © o ED Z CD DO 3 CD as :VT o N 3 � 310 = v c 1► cr �. � -9 . Z _W\ \ CD T WO 1 uS 0 N O (N/1 C o co )11101\ I a JJ En N o CD O i O, a N / N O a c) is co O ii / Z. N(J) o / \ N 1 / . v W i / ,-------. \ eC t S / eS \� \ 6 / 1 r ���kllT7at fir lsru ,- -------7 1 li C74 aq C 100' +/- Abbreviated Description: MAGGIE LAKE ADD #2 BLK: 1 LOTS 20 & 21 M.Halverson Design LLC VEVERKA, LUCAS J Site Info- Parcel#32214-51-01020 SHEET NUMBER PO Box 1519 Shelton Wa 98584 8207 ROOSEVELT WAY NE, Halversondesignllc(a�outlook.com SEATTLE 98115 330 NF LAKFSHORF DR N,TAHUYA 98588 1 SC'.LSICN k