Loading...
HomeMy WebLinkAboutSWG2025-00095 - SWG As-Built - 7/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2025-00095 Parcel # 22330-50-00082 Applicant Name CODY & STEPHANIE POWELL Subdivision (Name/Div/Block/Lot) Applicant Address 16014 BAY RIDGE DR City, State, Zip POULSBO, WA 98370 Installer Name JACK JOHNSON Site Address 41 NE RHODODENDRON BLVD Designer Name ALEX PAYSSE INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type NUWATER> SHALLOW 7 i ,9,tr nt Type NUWATER BNR 500 >5 ft. from foundation? - - L`Y . � . 1! N/A 111 YES E NO >50 ft. from wells? - IV 2 6-2O 5 - 0 ❑ Z• >50 ft. from surface water? - - ❑■ ❑ HCleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - T.- ❑■ ❑ a24" access risers over each compartment?- - ❑ ❑■ ❑ W Effluent filter installed?- - ❑ ❑■ ❑ N Septic tank capacity (working) BNR 500 gal Manufacturer HAGERMAN O D-box water level and speed levelers used? - - EN/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ X ❑ mZ Check valves installed? - - ❑ ❑ ❑ CIQ E Transport Line Size 2" Schedule/Class SCH. 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑U 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO O >100 ft. from wells?- - ❑ ❑ tit'\Q a❑■ W >100 ft. from surface water? - - ❑ CI ,Li csL ❑ LT.. >10 ft. from potable water lines?- - ❑ � ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q L > 30 ft. from downgradient curtain/foundation drains? - - ❑ © ❑ o Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑■ YES ❑ NO • Pump tank capacity (flood) 1500 gal Manufacturer HAGERMAN < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ ~ a. Alarm or Control Panel Installed? - - ❑ III 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ IN ❑ D d Pump installed in ❑ Bucket or ■❑ On Block or ❑ Other a• Pump Make/Model LIBERTY FL100 ❑■ Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 75 gpm Squirt Height 40" ft Pump on time 1.75 MIN Pump off time 4 HRS Daily flow set at 450 gpd Upcatec 8(21/23 8 Mason County OSS Installation Report pg. 2 Parcel# 22330-50-00082 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES NO If yes, please describe: 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 re4ocate In the need of maintenance activities and future development. Typical Record Drawings contain' Drainfield&manifcdd orientation&layout.Septic.!pump tank location.North arrow,reserve drainfietd,existing and proposed buildings,location of wells,waterlines, welts,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 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 for nd a ed Record Drawing is accurate. form and attached Record Drawing iS accurate. 6-20-25 St re off taller Date i f Jack Johnson ; . I Printed Name of Signee r f et f a,'. I or": ` '' MASON COUNTY PUBLIC HEALTH lr. t''�',c�s • is �' ti �.�. The undersigned approves this Installation Report and Sr. Lt.;Ae Record Drawing on behalf of Mason County Public d' Health: 4 1 (3I' Signature of Environm ntal Health Specialist Date (stamp, signature and date) 4 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upda tee 8r21t2t118 NUWATER BNR500 RECORD DRAWING � & 1500 GAL. PUMP TANK HAVEN LAKE \\ (50'+TO LAKE&WELLS) vv . °' fA8,1 / \ .— \ N \ \ * \ EXIST. \ \\ O® \I _---- WELL \ \ „N _ /// EXIST. \` \\\ V ® — — / CABIN \ ;� \ \ \ \ \ \ EXIST. WELL \ h /0 � \ EXIST. (WAIVER REQ.) \\ / • • CABIN \ • \ ,/\ \ // �,, _ \ \ R7 5, _—\ ,A� 00- \ II \ I —— \ FUTURE EXIST. I / HOME \. GARAGE I 30' DRAIN SETBACK LOCATION (NO FOUNDATION/FOOTING DRAINS WITHIN \ \ 30'DOWNSLOPE OF DRAINFIELD AREAS) �\ \_ \ 4/ h / \ \ ` PARKING Q" -- / pR/1�RF // I 10' BLD SETBACK �/7 Ii N,-\ \1111. way \- �� / Or �\ — —_ (I 001111. -- / II Ioll'I''' oil" �°N Vllllllll''''' IIIIU111111' IIII• \ \ Iilll'''Iill''I' \ ' \' Illlll \ Allllllll' IIII' IIIIIII''ill'l11 \ / O 4 BEDROOM dllll''1111111. ' III'''''''' �� d PRIMARY & RESERVE \ �IIIII'Illlllllllll'I O0� / INSTALLED AS \ dll' II'I'lllll• .Z.�� / JUL 10 2025 - -\\ = ••� \\ _ : ,�� MASON COUNTY ENVIRONMENTAL HEA.T.H := RET ' �N •04" �'' / ,•;>+• / INSTALLER: J. )OHNSON ii N�`' .4• ' 3x, til SQUIRT- 40" �^• men..'`% DRAWDOWN - 1.5" EXIST. WELL ! . PAYMSE ••. ON - 1.75 MIN I (WAIVER REQ.) 4. r 4.3 OFF - 4 HRS I AN ASBUILT/INSTALL SIGNOFF FEE WILL I ° BE CHARGED AT TIME OF INSTALLATION I i l US I OM R: JOHNSON/POWFI[ TEST HOLE I: TEST HOLE 2: TEST HOLI:I0-12 : PIONEER. DIGGING, INC. PARCEL# 22330 50 00082 12-3 DIST. 018 DIST. SL 45+0-45 O 12-36 GSL 018 I GSL 45+Iv10TT/R 45 SEPTIC DESIGNS ADDRESS: 41 RHODODENDRON B 36+MOTT/R-36 52+MOTT/R-52 3083 E MASON BENSON RD. GRAPEVIEW,WA 9854( DESIGNER: ALEX L PAYSSE SOR TH S NOT FIELD SURVEY.REFERENCESINCLUDEY DESIGN APPLICANT/COUNTY ED PROVIDEDEPTIC PUTS DISCLAIMER: SURVEYS.FIELD MEWS-RELENTS REF AND EN COUNTY N OS DESIGN NTI INTENDED FOR D OFFICE 360-4261803 FAX 360 427 2353 ry PURPOSESME ONLY IEWPROPOSED DEVNOT REST MAY IBL OR EBAC ST OTHER SHEET: ASBUILT SCALE I"=4V SE°PC COMPONENTS REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATEDTOTO