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HomeMy WebLinkAboutSWG2021-00380 - SWG As-Built - 8/28/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00380 Parcel # 32127-53-00155 Applicant Name Doug &Jeannine Zibell Subdivision (Name/Div/Block/Lot) Applicant Address 20 E Angus Ct Lake Limerick 4 Lot 155 City, State, Zip Shelton, WA 98584 Installer Name Mikkelsen Septic LLC Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑ Tank(s)Only ❑ Drainfield Only II Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - \-- - - - ❑ N/A YES ❑ NO >50 ft. from wells? - �� V - ❑ El ❑ Z >50ft. fromsurfacewater? - - - - - -V- -y- - ❑ 0 ❑ Q Cleanout between building and tank. - s- - ❑ CI ❑ F- � V Tank baffles present? - - \ ❑ El ❑ d 24"access risers over each compart - - - - - - - ❑ ❑■ CI LW Effluent filter installed?- By ❑ ❑� ❑ Septic tank size 1,200 gal Manufacturer Existing 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO oO Manifold/D-box accessible from surface?- - ❑ 00 oQ Check valves installed? - - 0 0 CI 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - El N/A 0 YES El NO >100 ft. from wells?- - ❑ ■❑ ❑ W >100 ft. from surface water? - - ❑ U ❑ u.. >10 ft. from potable water lines?- - ❑ ■❑ ❑ Z Q > 5 ft. from property lines and easements? - ❑ 0 El> 30 ft. from downgradient curtain/foundation drains?- - ❑ ® ❑ 0 Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑■ YES ❑ NO Pump tank size 1,250 gal Manufacturer Traffic Rated- Hagerman Q24'access riser(s) and accessible from surface?- - El MI 0 a Alarm or Control Panel Installed? - - El © ❑ * Control Panel equipped with Timer/ETM /Counter- - ❑ II El D a_ Pump installed in PABucket or ❑ On Block or ❑ Other ii' Pump Make/Model Liberty 280 II Floats or� El Transducer d Tank draw down 2" in/min Pump capacity 45 gpm Squirt Height 3 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd tlated 9:21^J+8 Mason County OSS Installation Report pg. Z Parcel# 3 2 l 2 7- r-D3- G O i J J W Were existing septic components abandoned as part of this project? - 1 YES I NO If yes, please describe: r� V.F. a bA n ciu re d ed e x f S t 1►�q -T a I1 K ('.e--}fo=F i't'�E 8 Were all components pumped out and properly abandoned per WAC246-272A 0300? - - [Ei YES 0 NO .t// -w` 17.-. fOall WOW P ..}A'..p ` v,> ,L:n'1 Tilts 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 Draw.ngs contain: Dramfleio a manifold onemation a layout,Sept,rdpump to.location,North arrow,reserve drairrfield,existrg and proposed bullrings,location of wells,watertines, wells.observation ports,deanous,and other maintenance aaess po:ns I:icc.rnplets Record Drawings may aeate additional delays in foal in521.1ation approval ar:d related parrots. /4---4(Ac \iAl1.- -ei s Record Drawing Attached ,C ; 7:-K%..m m.:^•. ;c,• .'zit, �'�g s rt-.01 • .y�w¢of,�y-1 g� • INSTALLER DESIGNER/ENGINEER 1 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 l further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. �/ @ / S ature of rest /er / Date :Zit Panted Name of Signee •i,.. Aj, i MASON COUNTY PUBLIC HEALTH elfs *� il�i2- The undersigned approves this Installation Report and • 0 V? • '.v,�•} Record Drawing on behalf of Mason County Public H}-;,`,. sic crag Q-. PAULA JOY JOHNSON;• . Health: !IC S>✓ Ui;StGiug ; 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 Up d 8212ota+ • AS .bui. 1 + . Dau k JfQmai.i}ill . ?ar [ 32121l53-00155 . 2d - A-Y� U S CT SCw ) . . -30 S 14`� c,-r ' n i r � o k ? � 15 30 ys coo `1J griVt w y I t\c� t� h A1) IIb li O i x © I N f--�°4 Exist-;n,� SR , i — !, -i4 A G Se I 1F., 1 • • 1 A ta 3 Audio-Visual Alarm' Cleanout 01200 l5:S ptic Tank 2-Corapart'nent Ssi3-6".-A6U.ed Effluent meter 4 R.z-s.-1 i-,'as 44 1251) Gallon Pump Chamber -J_e w -trams;c ra4-td fare OValve Control Box -ilk,,..., .d, w '..: %) if3 t1f *-0."� AP , , ._ r P^ t•r00349 '/�\ O, / .,'' PAUTA JOY JOHNSON 7" v p C.LI V$ ION AUG 2 8 ?025 R i MASON -i4--zs G ..bw,.;:� coCOUNry Ekinm NMENTAL HEALTH