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HomeMy WebLinkAboutSWG2024-00123 - SWG As-Built - 10/1/2025 • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00123 Parcel # 32021-56-01030 Applicant Name Joel Roswell Subdivision (Name/Div/Block/Lot) Applicant Address 2038 Beverly Beach Dr NW Shorecrest Terrace 3rd Add, Blk: 1, Lot: 30 City. State, Zip Olympia WA, 98502 Installer Name Bayshore Construction Site Address 390 E Panorama Dr Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only LI Drainfield Only ❑ Repair ®Other 500 PreTras' System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - ❑ N/A El YES ❑ NO >50 ft. from wells? - -r tS-� 2 ❑ 0 ❑ • >50 ft. from surface water? - �=� 1 ❑ ❑■ ❑ Z < Cleanout between building and tank? - - 1tt� - sE._AA4 II - - ❑ ❑ ❑ U Tank baffles present? - - ❑■ ❑ a24" access risers over each compartment?'1� - - 0 ❑ coW Effluent filter installed?- $� - - ❑ ❑ ...._ Septic tank capacity (working) Nuwater 500 gal Manufacturer Infiltrator o D-box water level and speed levelers used? - - ❑ N/A ❑ YES El NO J oO Manifold/D-box accessible from surface?- - El a?2 Check valves installed? - - - - it"''"*"t-1c°4f4C - ❑ El ❑ o a 40 E Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 El 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CD >100 ft. from wells?- - ❑ * ❑ W >100 ft. from surface water? - - ❑ • El u. >10 ft. from potable water lines?- - ❑ I ❑ Z > 5 ft. from property lines and easements?- - El ❑ a ❑ II ❑ � > 30 ft. from downgradient curtain/foundation drains?- - 0 Drainfield level and observation ports present ❑ PE Ci] ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank?- - ❑ NIA ❑■ YES ❑ NO • Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator < 24" access riser(s) and accessible from surface?- - ❑ .I ❑ H Alarm or Control Panel Installed? - - ❑ El a E Control Panel equipped with Timer/ETM/Counter- - ❑ El ❑ n a Pump installed in ❑ Bucket or [I On Block or ❑ Other a• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer D. a Tank draw down 3 in/min Pump capacity 75 gpm Squirt Height 4 ft Pump on time 1.2 min Pump off time 6 hr Daily flow set at 360 gpd —pasted 5:71,2C'3 1 Mason County OSS Installation Report pg. 2 Parce 3Z O 2 t S(o - O 1 ©'jam 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? - - El YES D NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re•locata in the need of maintenance activities and future development. Typical Record Drawings contain: Dramfieid&manifold otlentation&layout,Septripurrtp tank location.North avow,reserve drartfield,existing and proposed buildings,location of wets,waterlines. wells,fv,ervation ports deanouts.and other maintenance access points. incomplete Record Drawings may aeate additions delays in final irstaitat+on approval and related permits j IIIRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that I installed the system in accordance with 1 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 i-,Iffland meet all State myself and Mason County Public Health and meet all and Mason County Code . State and Mason County Codes I further certify that information contained on. this 1 further certify that all information contained on this form a7d? e Record Drawing is accurate form and attached Record Drawing is accurate. f` : r 4-3-Zs Signatw of 1 steer Date f JN Printed Name of Signee 1 -"' '.�• !f 1 e?;:: id MASON COUNTY PUBLIC HEALTH 9SO O `i ii--- `�s • 4' `�), The undersigned approves this Installation Rep6 d S s'"�2.' •519I t43 r Record D g on behalf of Mason Coty.Public ?/ ° F^ULA JOY JOHNSON �}1, Health `ryF,y/R �, ,�� �E iCNI=Fi'y .'� (O I( l 7/�, J"q�N,l�p..'o s >�7• ? mob I l ( C/ C F q- r (o-Z. Signature of Environmental Health Specialist Date t ` yF.� (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIE�WON THE MASON COUNTY WEB SITE UP"atetl 9r21=°t8 ,A A- - --.. 1: 9 t aJ a U 1 !+ ALE . R �0 ..f ,? = r As -buy 1 i I, !�`b4 - 3 - DAL . L arc;e1 3/02t-5to-0 1.030 r . i 1 wi Lev- s k---r esad- GkAst•-to Cliadi E O se ft i --------- Ilioi 0 ' % / ! 444 v i J ai y�3 5,0.34. -.,,_t: of �� , PAULAJOYJOHNSON i 1 "I'VILW4:"N..1‘ •IMP_ 1 ...•••••• 1'b I.5\�� f � y � ��i��Y' ( l4 � A50 v) -�of yay'cu e, rer,thes . 0 q jr se • � \ . • O Audio--JiszaA-a- I1P - Ai+ 3 Cieanout ®fr _ ASoO01 0i 0,2025 ONu Waiter ester BNR-500 AT I:Ta _. 4/00 q 3 1,000 C-a to n Puma C ,e_ 4/4 44�N wlorrti-51 el ov1 rgl yF 'y. 0 Valve Control Box