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HomeMy WebLinkAboutSWG2022-00017 - SWG As-Built - 8/1/2025 Mason County OSS Installation 4port pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG a2e2,— 62©of7 Parcel# I Z4O5"52_6O1 1Z— Applicant Name J aE_ 'ct.-b Subdivision (Name/Div/Block/Lot) Applicant Address q31 i4E_ V ,." 1>2.-5" City, State, Zip SEAT r�u- W '`\ 1f t ii, Installer Name �� f4� 430 t -(LAsuiit-C rsw,+D 0�`Designer Name 1 1J6'� �a Y�G.-rE Site Address /}wtr V 4.4 ok INSTALLATIO CHECKLIST ❑ Full System Installation ank(s)Only Drainfield Only CI Repair ❑Other System Type I.-I Pretreatment Type >5 ft.from foundation? - - ❑ NIA ❑YES ❑ NO >50 ft.from wells? - - ❑ ❑ ❑ • >50 ft. from surface water? • - ❑ ❑ 0 Z ❑ H Cleanout between building and tank? - ❑ ❑ ❑ U Tank baffles present? - - ❑ a24"access risers over each compartment?- - GI CI W Effluent filter installed?- -. -- ❑ ❑ ❑ rn Septic tank size gal Manufacturer 9D-box water level and speed levelers used? - - ElN/A ❑ YES ❑ NO ❑ gO Manifold/D-box accessible from surface?- - 0 0 - - •• - mZ Check valves installed? - - ❑ ❑ 0 Transport Line Size hedule/Class Bedrooms installed (check one) 0 2 3 ❑4 0 5 ❑6 ❑Commercial/Ot >10 ft. from foundation?- - - - - - - ❑ N/A ❑ NO >100 ft. from wells?- • -- - -ia P R .7 0 ct W >100 ft.from surface water? • - - - -- - - - - '�_'••••. � ❑ Z >10 ft.from potable water lines?- - -AJt - ■`i �.,� ❑ > 5 ft.from property lines and easements?MA rSpjv cauN 2u'J r;,_.0' l"J / ❑ > 30 ft.from downgradient curtain/foundation drains?- -YENV NMt/yAC I!�A' , ❑ Dr Drainfield level and observation ports present - - - - �- -`���-- -- LJ �� ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 0 ❑ Pump tank setbacks consistant with septic tank? - - El NIA i YES ❑ NO ZPump tank size gal Manufacturer 1�`t�,h/ e) < 24" access riser(s) and accessible from surface?-E- %� `�, ❑ CI a. Alarm or Control Panel Installed? I'/ - ❑ ❑ 0 E Control Panel equipped with Timer/ ETM/Counter- - - - ❑ ❑ ❑ D IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other SPump Make/Model ❑ Floats or ❑ Transducer 0. C. Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - D'YES 0 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 end proposed buildings,location of wells,waterlines, wells.observation ports.deanouls.and other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval and tainted permits. APPROVE N. AUG 0 4 2025 1 , MASON COUNTY ENVIRONMENTAL HEALTH JBW 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 m d aft he ecord awing is accurate. form and attached Record Drawing is accurate. C • / 20-Z3 Signatu of Installer Date i)etr cs I Nem / Printed Alkme of Signee /�s� aJ °F.vayytiO• MASON COUNTY PUBLIC HEALTH 45 The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public O• RO .:RT H�1 se 1 Health: EXPIRES `-. e_ C .fik j j kkil-n--) C6—t.-.15 ,2e.e, —vue-a, eti-AL44P-I if" Si atn nvironmental Health Specialist Date (stamp, signature and i ( P 9 date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/201 e RECORD DRAWING (continued So 1107 ' sa � o� ��� P _ ► 't 7 46 41-1 4L • CO Lt0 1a' APPROVER AUG 0 4 2025 MASON COUNTY ENVIRONMENTAL HEALTH JBW O LOT 194 NUWATER & PUMP TANK NEW HOME 0 0 400 SOFT(RESERVE LOT 194) 0 350 SQFT (LOT'194) 0 � 7'X 50' DRIPAREA / 300 LNFT (6 0 50') 584 SOFT (LOT 112) �— 1‘ '12.5 'X 40750' DRIPAREA 467 LN FT (10 0 40'-509 \:..-•"11 ...—, `k‘o �,..��""� APPROXIMATE LOT 112 7-- TRANSPORT & RETURN LINES (DIRECTIONAL BORE UNDER ROADWAY) _ - 154 SOFT (RESERVE LOT 194) V\I" .- "..1° .... .\c,li\ C)s -- , v° — It 5 :///////////// Q1I \‘\ RESERVE AREA FOR LOT112 \(675+ SOFT), NEEDS BOTH SIDES OF DRIVEWAY I., \ \\ * LOT 112 NUWATER \ vv$ s�: ' PUMP TANK,aiwAs4. v PPROVED \ NEW HOME ° lJ� O S'CON \ � k ra: s[ _ AUG 0 4 2025 `r ` ` MASON COUNTY ENVIRONMENTAL HEALTH RECORD, DRAG J B W \ A PIONEER DIGGING, INC. CUS IOMER: JOE&CHRISTIE BERG CALL 1:30 PARCEL#:12105-52-00194/112 REFERENCES:SURVEY MN 2060612.COUNTY CIS, SEPTIC DESIGNS ADDRESS: 930 E TREASURE IS DR COUNTY 055 RECORDS,&FIELD MEASUREMENTS 3083 E.MA.ti)N BENSON RD. CRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE OFFICE-360-426-1803 FAX 360 427-2353 DESIGN PAGE ASBUILT • • 4 b ba E ya-ce-Aty, 1• :,,,.,,( t Ari1/44A) )z 1 0�- c z- o o, ,Z .- i\-0.).),rvY1 0 Q- -T cc+�� Q z IOL v ,,,‘_,A, 1 .. Va‘tx- ( 1°4'2-'1 )0 0 2- 'Clif- e) < 6--yN-Qsa %C—Cit C\Qt k.li‘ P .1,0Aert) •C be-ti\to 5 cc Co00 t 9 Or °' 6:f0,1 60000.iii: w - c'e2)1 cie\I-0,:‘, oic 2. 1410 \7?ftv‘ si a �i 5 \.L-t re �, ,,,5 • .. c' x 1274369/dey A c"-e4°1 17.4 ,, ( 2- ' . r . 36( i" ' rii,c., 4• 0‘1 t,3 r • t,. i 11 i