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HomeMy WebLinkAboutSWG2021-00554 - SWG As-Built - 7/11/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00554 Parcel # 32104-57-00042 Applicant Name Avery& Sandra Johnson Subdivision (Name/Div/Block/Lot) Applicant Address 7143 Interlaaken Dr SW Alderbrook G&Y/Div 8/Tr 42 City, State, Zip Lakewood, WA 98499 Installer Name Villines Excavation Site Address 21 E Eastwood Ln, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Ot-er System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - - - - ❑ N/A Q YES ❑ NO >50 ft. from wells? - - - El0 CI>50 ft. from surface water? - - - - - 2CEI - - ❑ 0 ❑ Z 1-- Cleanout between building and tank? -JUL -0-9-2Q-2S- - - - El • ❑ U Tank baffles present? - - - - - ❑ . ❑ a24" access risers over each compart nt?- - - - ❑ • ❑ w Effluent filter installed?- By ---- - - ❑ ❑ ■❑ U) Septic tank capacity (working) NuWater 500 gal Manufacturer Sound Placement D-box water level and speed levelers used? - - El N/A YES 0 NO DO Manifold/D-box accessible from surface?- - El ] El u. co- Check valves installed? - - ❑ ❑ 0 0< 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) El 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑CommercialfOther >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO >100 ft. from wells?- - ❑ ❑■ ❑ —r >100 ft. from surface water? - - ❑ ❑■ ❑ w u.. >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ d ix > 30 ft. from downgradient curtain/foundation drains? - - ❑ © ❑ 0 Drainfield level and observation ports present - - ❑ © ❑ Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A El YES ❑ NO Pump tank capacity (flood) 500/1000 gal Manufacturer Sound Placement-Trash/Pump Combo Q24' access riser(s) and accessible from surface?- - El U ❑ F- a Alarm or Control Panel Installed? - - ❑ • CI 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ I El D ci- Pump installed in ❑ Bucket or ■❑ On Block or El Other ci' Pump Make/Model Orenco PF200511 - 20gpm ❑■ Floats or ❑ Transducer a. a Tank draw down 2"in 10 min in/min Pump capacity 3.7 gpm Squirt Height -- ft Pump on time 8 min Pump off time 1.84 hr Daily flow set at 360 gpd MAY 1 5 2025 ©0 ,Tw Mason County OSS Installation Report pg. 2 Parcel# 'jZl0`F —57— 000+2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -I - 0 YES NO if yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-O300? - - YES 0 NO RECORD DRAWING This is a permanent record and must ba accurate and dewsutPtiw enough to reaa ota in thew need of maintenance activities and tutus dsva opreent. Typical Record Drawings contain: Drra6a:J 8 manifold orientation&layout,Septic/pump lards location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterines, waits,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permit. ® 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 an 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 accurate. form and attached Record Drawing is accurate. z •= l l �I -Z4 Air Signature of Installer Date 01. Printed Name of Signal „�- �� .. �,� MASON COUNTY PUBLIC HEALTH ,1 ./i ��s, The undersigned approves this Installation Report and - Lls.PAULA JOY JOHNSONRecord Drawing on behalf of Mason County Public fG SeISUE iGi�tcft'tR S siiiir .., ,' Health: exvlrs ,ill Ii I Z� S—cs—Zs Signature of Envi nmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8r21/2o18 fiver fSan6ra ,1chr,sor Y y LI - 10(-1_57-000g2 • 1 2 t Fact-wood Lk) �x �• .5 • C : I " _ ZG " � Dry C1 gL, Scat � � I 2y. ► o r o 2,0 390 ► v viC 1'Y y h_ S:Oe.c / 9 ?' 05 er/. 41' ,'."°1 A etZ• \Cit\. \ 1 . 0 CI ..3‘k 16A 7 " 6 Co°- 6 f =f`" �� /° f% ' . .tL \ 'F'T(-kl )A \ \ �. f'' �~ VS AP P R0 �= / ej- ' -� f JUL 1 1 2025 ��` � IS 4\l°1 T (�1 rn MASON COUNTY ENVIRONMENTAL HEAL . (G!d 1,0 Lc REt •=`+ - vim, { Kev: kit() ,�.v�,Sri OAudio Visual Alarm 0 Cleanout ' 0NuWater BNR-500 Pretreatment Tank • . �>> 04 1,000 Gallon Pump Chamber -11‘,,0 o-vim A.•o ' ``.� • System Headworks •�, 7 /' O5 Subsurface Drip y •F,; re 51C 348 .. 1'. y��• PAULA JOY JOHNSON '•� L'iC tai1el,-)KaiONOV:". �i • mcps ' 7 c` ,� 5 l S Zs-