Loading...
HomeMy WebLinkAboutSWG2021-00673 - SWG As-Built - 9/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00673 Parcel # 22133-50-00019 Applicant Name Joseph Julson Subdivision (Name/Div/Block/Lot) Applicant Address 7.i Di OS r� e tai �'- City, State, Zip v ` 1 Installer Name Affordable Septic 1 Site Address 250 E. Osprey Lane, Shelton, Wa Designer Name Bob Paysse INSTALLATION CHECKLIST IL Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Standard Pressure Pretreatment Type >5 ft.from foundation? --- -•- 0 N/A II YES ❑ NO >50 ft.from wells? - r r ?:i - - ❑ II 0 • >50 ft.from surface water? - - - -- Z -- • Cleanout between building and tank?`i rt —,—— ,1—� Z�� + El in V Tank baffles present? - 0c1\1 - ❑ ® ❑ d 24"access risers over each compartrrtaent?---- vp - ❑ II El W Effluent filter installed?- --- -- -- - ❑ ® ❑ N Septic tank capacity(working) 1 00 gal Manufacturer Haggerman o D-box water level and speed levelers used? - - ® N/A El YES 0 NO oO Manifold/D-box accessible from surface?- • - CI III iv C Q Check valves installed? - - 0 II CI 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) El 2 0 3 ®4 0 5 0 6 ❑Commercial/Other >10 ft.from foundation?- •- ❑ N/A ® YES ❑ NO >100 ft.from wells?- -•- El I ❑ o W >100 ft.from surface water? - - ❑ II 0 LL >10 ft.from potable water lines?- - ❑ II ❑ cr-Z > 5 ft.from property lines and easements?- - El II d > 30 ft.from downgradient curtain/foundation drains? - - © 0 0 Drainfield level and observation ports present - - ❑ El ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO NC Pump tank capacity(flood) 1500 gal Manufacturer Haggerman < 24"access riser(s)and accessible from surface?- - ❑ ® ❑ ~ a Alarm or Control Panel Installed? - - 0 0 0 • Control Panel equipped with Timer/ETM/Counter- - ❑ II ❑ t - Pump installed in ® Bucket or El On Block or ❑ Other g Pump Make/Model Liberty FL 100 ® Floats or ❑ Transducer a Tank draw downs'' `>a) in/min Pump capacity C.i 0 gpm Squirt Height Ljg 0'+ ft Pump on time 1111D f ,olS1‘"+F-.Pump off time 4L.4 - Daily flow set at 9' O qpd Updated 8J21/2018 r Mason County OSS Installation Report pg. 2 Parcel# 22133-50-00019 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 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 drainfiield,existing and proposed buildings,location of wells,waterlines, wells,observaton ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 11 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 inform 'en contained on this I further certify that all information contained on this form and attached Re Drawing is accurate. form and attached Record Drawing is accurate. ( 7( z-ij Signature of Installer Date ``� � Scott Johnson !'$'" %• Printed Name of Signee /, � : • As MASON COUNTY PUBLIC HEALTH `4�� •sr� The undersigned approves this Installation Report and ,Io?� ROBF.RT 03,7 $e 7•74, Record Drawing on behalf of Mason County Public ►". '.;. Health: EXPIRES i\N--k (A/ycovl 11 () Signature of Environmen aI Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018 .- y-- R100'TO EXISTING WELL /APPROVE D Awl- SEP 16 2025 DRAINFIELD \� MASON COUNTY ENVIRONMENTAL HEALTH RET 1 [1 • 1 1.7 1 71 1 %/ APPROXIMATE �/ �'� /� TRANSPORT LINE �,-'� <\ I r' Ii . - - \ ---". . I / \ ,--- v_..,--- / 1 1 It,„. COMMUNITY i j SHOPWELL -_ ,�' SEPTIC it-, [ TANKS - �� I \ N _ ,� _ - ICI / I I i `� \\ i� 1� [II' ----\----\ a I `- ` 1 \ I\ APPROX. \ -� NEW HOME \\ WELL I \\ I I \\ I N �. LN - - ,o.�3_ - - - - - - - - -- __ 'p N',1,c�r.n '' A•swv lc EASEMENTS SHOWN ARE APPROXIMATE. NOTA SURVEY Y ,o:: RCEV'T N 11: SE �l r ('"�njJ Lclr RECORD DRAWING PIONEER DIGGNG, LNG CUSTOMER: JOSEPH JULSON �l.E t:50 ' PARCEL#:22.133-50-00019 SEPTIC DESIGNS ADDRESS: 250 E OSPRAY LANE 3083 E MASON BENS ON RD. GRAPEVIEW,WA 98546 DESIGNER: R.OBERT PAYSSE DISCLAIMER:THIS IS NOT A SURVEY REFERENCES INCLUDE DESIGN INTENDED APPLICANT/COUNTY PROVIDED PLATS OR SURVEYS.FIELD MEASUREEE!EV AND COUNTY GIS DESIGN INTENDED FOR SEPTIC PURPOSES ONLY PROPOSED DEVELOPMENT MAY BE SUEVECT TO OTHER OFFICE-360-426-1803 FAX-360-427.2353 DESIGN PAGE ASBUILT DEPARTMENT/AGENCY REV EW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS