HomeMy WebLinkAboutSWG2022-00018 - SWG As-Built - 9/4/2025 447
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Mason County OSS Installation Report pg. 1 02Jr
MASON COUNTYR�CF/� •
APPLICANT/PERMIT INFORMATION PUBLIC H
Permit Number SWG ZO z 2 /�6 �g
Parcel# ZI OW WWI
Applicant Name !o— E4-6
Subdivision (Name/Div/Block/Lot)
Applicant Address 483i nt o p_
City, State. Zip '.SE,,tT.,w WA
Installer Name
'!so 7+t �s�� �,�
Site Address Ayk�r dji
Designer Name
c`
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only
0 Drainfleld Only 0 Repair 0 Other
System Type Dr...--1^7
Pretreatment Type
•
>5 ft.from foundation? -
-
>50 ft.from wells? - ❑NIA 0 NO
-
IC >50 ft.from surface water? - ❑ ❑
Z -
0
Cleanout between building and tank? - 0
-V Tank baffles present? • 0 El
d24"access risers over each compartment?- ❑ 0
W Effluent filter installed?- ❑ [] /
- 0 0
Septic tank size____f l5b gal Manufacturer �A C+�
�9 D-box water level and speed levelers used? -
- DrQ$2 Manifold/D-box accessible from surface?- _ NIA YES ❑ NO
QQ Check valves installed? - _ ❑ L7 El
Line Size 0 L El
Schedule/Class J
Bedrooms installed(check one) 2 0 3 0 4 ❑5 ❑6
>10 ft.from foundation?- -
0 Commercial/Other
0 >100 ft.from wells?- ❑ NIA --[�YEs 0 NO
d >100 ft.from surface water?- ❑ v 0
z >10 ft.from potable water lines?- _ 0 [❑ u�' CI
❑
g
>5 ft.from property lines and easements?- - ❑ /
>30 ft,from downgradient curtain/foundation drains?- 0
lrJ El
level and observation ports present [3lEr �
0 Graveless chambers or 0 Clean gravel used? (check one) 1'4 f- L'7 0
Proper cover installed over drainfield?-
Pump tank setbacks consistant with septic tank?-
"��
❑ NIA YES ❑ NO
z Pump tank size / gal Manufacturer �qG �.�q� /
/
aQ 24"access risers)and accessible from surface?- - .
Alarm or Control Panel Installed? • - LiEl ((� 0
X Control Panel equipped with Timer/ETM/Counter- 0
❑ 0
a- Pump installed in ❑ Bucket or
0 ❑ On Block or Other U N L�lr)
s Pump Make/Model ��r o P/`201 o r Z. -�/
dTank draw down F oats�� or ❑ Transducer
in/min Pump capacity StG-o" g!pm Squirt Height
Pump ontimeeq 4rfi� a 9 __s-�" ft
Pump off time_ 4 bt_...__ Daily flow set at 071i o
gpd
Updated 812i/2O18
Mason County OSS Installation Report pg. 2 Parcel# / / , 1( j/�i
— ABANDONMENT RECORD
Were existing septic components abandoned as part of this project?
If yes, please describe: 0 YES NO
Were all components pumped out and properly abandoned per WAC246-272A-0300?
• 0 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 wntali: Drainteld 8 manifold orientation&layout.Septic/pump lank location.North arrow,reserve drainfield,existing and proposed buildings,iorggpn of wags,waterlines.
wefts,observation ports,cleenouta.and other taintenance uccoss 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
nd atta had ecord cawing is accurate. form and attached Record Drawing is accurate.
Signatur of Installer Date at
1-•- ick r I [ 14-CYr11 9—) 4146E% 0 ',I:et.
Printed No47e of Signee
MASON COUNTY PUBLIC HEALTH ,:.�- '�t • .t
The undersigned approves ® i r �''" V
g this/nstalgtltion Rea,. -nd ROe
Record Drawin on behalf of Meson Cos Pub �� l l�Ofiys,. '
EXPIRES
Healt . ��F ` �`
9�YZo71' o�% �s
Signature of Environmental Health Specialist Date ��
<A,;,. (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBCOVIEW ON THE MASON COUNTY WEB SITE vpdaloa 021201E
CLEANOUT
400 SOFT
TERr i
PUMP
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a 154 SOFT ✓4 FNTgI
` � yr
C DESERVE LOT 194) �'9lT
ii , ' ` ti
350 SOFT(LOT 194) , "
7'X 50' DRI PARER ,�'�; •. ;;1
300 LN FT(6 0 50') I 'v=".�. -
584 SOFT(LOT 112) i, ' R 0Q"' '�`
areas
12.5 'X 40'/50' DRIPAREA POWETER POST��
467 LN FT(10 0 40'-50')
PIONEER DIGGING, INC. CUSTOMER: JOE 6z CHRIS IE BERG SCALE I:30
PARCEL#:12105-52-00194 REFERENCES;SURVEY AFN 2060612,COUNTY GI5,
SEPTIC DESIGNS ADDRESS: 930 E TREASURE IS DR. COUNTY OSS RECORDS,&FIELD MEASUREMENTS
3083 E MASON BENS ON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT 13 PAYSSE
-)FFICE-360-426-I803 FAX-3G0-427-2353 DESIGN PAGE OF
asish
930 E Treasure Island DR (Berg)
Flush open gauges 48 48 0 with 13 GPM
Flush closed gauges 52 52 50 3.5 GM
Flush return set at 20psi gauges 50 50 20 8 GPM
On time 2:51min
Off time 1hr
Gallons per dose 10
24 doses a day for 240 gallons per day
3.5 GPM dosing
Cycle counter 8
Pump timer.51
441t0A
74.)
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coGNry 0�? �®
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RECORD DRAWING continue
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