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HomeMy WebLinkAboutSWG2022-00277 - SWG As-Built - 10/1/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00277 Parcel # 22018-50-00225 Applicant Name Joel Roswall Subdivision (Name/Div/Block/Lot) Applicant Address 2038 Beverly Beach Dr NW Timberlake#1 LOT: 225 City, State, Zip Olympia, WA, 98502 Installer Name Bayshore Construction Site Address 160 E Agate Dr, Shelton Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST r ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ® Other 500 Pre-Trash System Type Shallow Pressure Trench treatment Type NuWater BNR 500 >5 ft. from foundation? - - Pri-Vt _ - ❑ NIA ry YES ❑ No >50 ft. from wells? -3 ❑ a ❑ z >50 ft. from surface water? - - - - - 8'MS_ _>i _ ❑ ❑■ ❑ H Cleanout between building and tank? .I SEQ ❑ ❑■ ❑ V Tank baffles present? - U _ _ _ _ ❑ a ❑ f- 24' access risers over each compartm — _ LU W Effluent filter installed?- 1NR- Septic tank capacity (working) NuWater 500 gal Manufacturer Infiltrator a D-box water level and speed levelers used? - ❑ N/A ❑ YES 0 NO oO Manifold/D-box accessible from surface?- - ❑ a ❑ OQ Check valves installed? - L C's^'"e '�A^"°K - ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑Q 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ft YES ❑ NO 0 >100 ft. from wells?- - ❑ U ❑ W >100 ft. from surface water? - ❑ ❑ ti >10 ft. from potable water lines?- _ ❑ U ❑ � > 5 ft. from property lines and easements? re > 30 ft. from downgradient curtain/foundation drains? - ❑ Al ❑ 0 Drainfield level and observation ports present - - ❑ IC ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ❑■ YES ❑ NO Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator Z < 24" access riser(s) and accessible from surface?- _ 0 © ❑ a Alarm or Control Panel Installed? - _ ❑ U ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ® ❑ a- Pump installed in ❑ Bucket or ❑/ On Block or ❑ Other n' PumpMake/Model Liberty280 � 0 Floats or ❑ Transducer Tank draw down 1.5 in/min Pumpcapacity 38 SquirtHeight p y gpm Hei ht 4 ft Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8,21 i20 la Mason County OSS Installation Report pg. 2 Parcel# 22-0 1 — S�— �2 ABANDONMENT RECORD Were existing septic components abandoned as pat of this project? - - ❑ YES ® NC If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ',ifs ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to reaocate in the need of maintenance activities and future development Typica Recarc Draw ngs cc ntam: �rautield&manifold orie.:ation&layout,Septci.urtp tank lcaton.North arrow,reseNe c2wfie_id,us-ling and proposed w:iidings,Iccedcr,of wets.water'.:nes, wells,ooservation ports 5ea.out.aro other mantenance arras points. :ncOrmlete Recor_•Ors.'nr;s may mea=_additional delays ir,final installation appro. and related permits I V v- t f I 1 3 1 A E l IIRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 certify that i installed the system in accordance with !certify that the system has been installed in ammo- the septic design stamped"APPROVED"by Mason dance with the septic design stamped'APPROVED"by I 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 Heal",and meet all State myself and Mason County Public Health and meet all and Mason County Code . State and Mason County Codes 1 further certify that information contained on this 1 further certify that all information contained on this form ad'7 ac e Record Drawing is accurate form and attached Record Drawing is accurate. �� 11, r` `j -Zg- 'rlf I Signatur,yo'ffI speller ;;are/ Asr -�l c • (i'(L% i 1 /�v O r t 'f '%V L�/'41 AtQ` � ! Printed Name of Signee "o* ••ay a� ), MASON COUNTY PUBLIC HEALTH + - � ; Ai; The undersigned approves this Instaiiat r•-..• rt and ,� s t_ 3'' Ns %L Record D •ling on behalf of Mason County +{ � PAULA JOY JOrINSON '?�� Health: '\- r • IC 1` IDEgIGNI: q as I "°, ExPlRR8 Ti —— Signs ure of Environmental.Health Spe oIi t Date 2Q,� (stamp, signature and date) I THIS FORM MAY BE SCANNED Al -LFOR PUBLIC VIEW ON THE MASON COUNTY WEB SIT_ Ur ate"/a2_ota A-S— 6 Q = Trs+ iol r Joel Kos (,vci (I tiN2c) ` SL. + roofs to HZ° Key: PoIrcel$#220/8-50-onz5 4$2,�, 32" SL. + rooks - Id 0 Audio-visual Alarm 170 7O ii)' aft Dr 3 w 27" SL +rooks +P H70 O Cleanout Sca l -Z O 500 Gallon Pre-Trash tank 1 < L o rc 3a ya , (L-1) 3 x 5 r vY,a Y O NuWater BNR-500 ATU Tank CL rol l Vl -j.Q ltl ) 1.tAA,S C J O 1,000 Gallon Pump Chamber 5` o.c . �" l/U t T►1 fe Sv'C V e 0 Valve Control Box b{ fOW. - 5C0(CO Blocks l09.07' — C T0-1-1-Ch Pt— I1/Pt1 E Is / / 51� t C 3tT a/i ll (----spy It. 27' .o d ,..'a9 1. 41 N / • � oQ j3R o / 4g' / House. a o e+ Iill / / / • ao 1.°,! M/ 1 3 °l '' S i _ 44p ‘ \c"i\c......, l`'`8.3 8' A 4i1ciY/r .P �• 1950 °Cl V •,, N 1 • \ , _, 0 Ai `'IR r ` v� nn ,--la:2�PAULA JOY J N50f4 li; y`-907z, i . .. �iC JSE N GN ' } `t—c49-Lr