HomeMy WebLinkAboutSWG2022-00181 - SWG As-Built - 8/15/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2022-00181 Parcel # 32029-12-00050
Applicant Name Dianna Kasch Subdivision (Name/Div/Block/Lot)
Applicant Address 571 SE Arcadia Rd TR 5 OF W1/2 NE S 411111
City, State, Zip Shelton,WA 98584 Installer Name Joe Fassio Excavating
Site Address same Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s) Only ❑
Drainfield Only ❑ Repair ®Other sgo gallon pre-trash tank
System Type Pressure Trench Pretreatment Type NuWater BNR-500
>5 ft. from foundation? - ❑ NIA Q YES 0 No
>50 ft. from wells? - - ❑ ❑■ 0
>50 ft. from surface water? - - 0 ■❑ ❑
0 0
F 0 Cleanout between building and tank? - IN ❑
V Tank baffles present? - ❑
f— 24" access risers over each compartment?- 0 CI ❑
cL ❑ ❑
h Effluent filter installed?- Sep ❑
Septic tank capacity (working) NuWater BNR gal Manufacturer Hagerman
G D-box water level and speed levelers used? - • N/A ❑YES ❑ NO
QJ
0 Manifold/D-box accessible from surface?- ❑ NI 0
m$ Check valves installed? - ❑ ■❑ ❑
qQ 2" Schedule/Class 40
m Transport Line Size
Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? ._ �"—'--�_-..-- _ - - ❑ NIA Q YES ❑ NO
i _ - ❑>100 ft. from wells?-
0 0
OJ >100 ft. from surface water? ` - - ❑ ❑■ ❑
LL >10 ft. from potable water lines?- • ❑- ■ ❑
> 5 ft, from property lines and easemer1 ?- - - - -\ - ❑ MI
C > 30 ft. from downgradient curtain/foundation drains? - ❑ o 0
Drainfield level and observation ports present - ❑ gl ❑
Q Graveless chambers or 0 Clean gravel used? (check one) IS ❑
Proper cover installed over drainfield?- ❑
Pump tank setbacks consistent with septic tank? ❑ N/A ® YES ❑ NO
ZPump tank capacity (flood) 1,000 gal Manufacturer Hagerman
Q 24" access riser(s) and accessible from surface? ❑ ® ``� ❑
wi
~ Alarm or Control Panel Installed? - - - -S — SP: k-B o ❑
a UA��,�(J- ❑
�d Control Panel equipped with Timer I ETM/Counter- - ❑ ❑
a Pump installed in ® Bucket or ❑ On Block or El Other
a.
2 Pump Make/Model Zoeller 161 • Floats or ❑ Transducer
Tank draw down 2.25 in/min Pump capacity
43 qpm Squirt Height 5 ft
a
Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd
Updated.erz 1rza,a
Mason County ass Installation Report pg. 2
Parcel# 3201'1 \2-000so
ABANDONMENT RECORD
0 YES NO
Were existing septic Domponents abandoned as pan of this project'? - W
If yes, please describe. YES NO
Were all components pumped out and properly abandoned per WAC24fi-272A-0300? -
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough m masts sts in the need of maintenance activities and future development Typical Revd
vM lOeacm.North arid.rextte dmiMtld,ersins and popped buildings.Hatton of vela.wamline-s.
DrevAng
taosmmto Dc .chat manifold ether main BSnlayout access
pointyand Mailed peal
ps may inNWevsmueupImP a�
was.otiewman ppb.aeana+u.and aver maintenance a�u wma. i��rolue r+ea�d o�a.,n create atlers
•
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with /certify that the system has been installed in senor-
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 Hearth and meet all
and Mason County Codes. State and Mason County Codes
1 further certify that all information contained on this I further certify that all infonnation contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
�j-,� ' D2/0117.3
SiggafGre of Installer r bate L,}k
tj
Printed Name ofSignee fp
va nk MASON COUNTY PUBLIC HEALTH .a A
The undersigned approves this Installation Report and : •
: sf
Record Drawing on behalf of Mason County Public
PAUL Ov ONSON �`
Health: Cali SICL SEbISIGVER"
e` aes fiSS.
2-3- L3
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 upe'e°m12p1
403 .3q Soiw !
l +° �--c.ea� 2 I �1ahna Ka sch
,SSN' 100 + ova` Fan ?W.3zoZ? l72000G0
A i __A
SeaS�� �a94
LSi Pt7a 'di
''JII .. GI- GAis1
V ---__ __ ---- ----__ —: k . L c #11V /LI " L.S + f i P4-
F@ �r'c,S 0 4-120@ 33'/37id,5-t
Fyrti4*2 -- 27" L51omat% na wgttc
1 . c — #3^'' 26' Loam
y i rn
oftdamP@
' u ba+forn
38II lR1: pc,Vtwa7
� e�p I can @, 1; ��}� 3' XSG �ima�
F k
�' 1 ,'1 i DP treV1 ch<.S
\OC 1 115-eVLJ? brl°1"1
So
Ke :
,a y O Audio-Visual Alarm
i00 ,,,, 40 2-Par r
to ne;9ti bear WGp
O.. Cleanout
yV ell
500 Gallon Pre-Trash tank
O4 NuWater BNR-500 ATU Tank
is 1l7-3- �Y,`"�` O 1,000 Gallon Pump Chamber
etiM 1 ,I n U t-LH � ‘"LL{'' - 3 Valve Control Box
i I °ark ," "
bks+ o;swd j 3
i JL v �J
P.
v ,f w a a /I 34 T,
}
6 a P [ J say
SCco-( . 1 ,,; 30. ren IXFRES 0311671\1
i0 45 F
— \ _ 2 - 3-25
—
— 5e FYrco,d;o\ tz d