HomeMy WebLinkAboutSWG2022-00573 - SWG As-Built - 10/21/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00573 Parcel # 22005-51-00903
Applicant Name Mike Matz Subdivision (Name/Div/Block/Lot)
Applicant Address 1212 E Phillips Lake Loop Rd PHILLIPS LAKE DIV. 2 TR 64 W 1/2
City, State, Zip Shelton, WA 98584 Installer Name Mason County Excavating
Site Address 1215 E Phillips Lake Loop Rd Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type
Shallow Pessure Bed tment Type NuWater BNR-500
>5 ft. from foundation? - r ,� - - ❑ N.A ❑■ YES ❑ NO
>50 ft.from wells? - ❑ D ❑
>50 ft.from surface water? - -f. KT 2 a�8 - 0 0 ❑
Z ■ ❑
H-- - ❑
� Cleanout between building and tank? - 1 - 0
Tank baffles present? - — 0 0 0
1- 24" access risers over each compartmer t2 - - - - ❑ ❑
a El 0
w -Effluent filter installed?- $N R- ❑
cn
Septic tank capacity(working) NuWater 500 gal ManufacturerHagerman
L3 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO
DO ManifoldlD-box accessible from surface?- -
❑ I 0
OOZ Check valves installed? - - ❑ El 0
Da E Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO
0
>100 ft. from wells?- - ❑ 0 El❑ 0 ❑
W >100 ft. from surface water? -
-a- >10 ft. from potable water lines?- - ❑ 0 ❑
d
> 5 ft. from property lines and easements?- - ❑ 0 ❑
ce > 30 ft. from downgradient curtain/foundation drains?- ❑
ct
Drainfield level and observation ports present ❑ li El
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO
Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
Z ❑ l� El
24" access riser(*) and accessible from surface? - ElH Alarm or Control Panel Installed? - - ❑
IN a 2 Control Panel equipped with Timer/ETM /Counter- - El I ❑
n
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
nPump Make/Model Zoeller N152 0 Floats or 0 Transducer
=
a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 10 ft
Pump on time 1.85 minutes Pump off time 6 hours Daily flow set at 360 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2
Parcel# 2Z o -5[- 00 ! ,D3
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES X 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 3 layout.Septidpump tank location,North arrow.reserve crainieid.existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanous,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installaton approval and related permits.
'1 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
form and atta hed Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signature of Installer Date r i
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Printed Name of Signee I+�E '. o' w F
MASON COUNTY PUBLIC HEALTH 4 . a: �' ,,� � `
The undersigned approves this Installation Report and t 5ta0348• 4:./., ,
y�`
Record Drawing on behalf of Mason County Public ' -' PAULA JOY JOHNSON
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Health: 1 O / f• -%--
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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 updates a2t2otb
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'i o 4.` . ,s„ 1 (hi) _.c1 .25" Sched 40 Laterals
{5 ? 3/16" orifices 60 O.C.
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_ 30" ,� 1� is'17 f roar end of bed.
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SCREW ON CAP
45 DEGREE ELBOW
NOTE, / LATERAL
.1O=OBSERVATION PORTS--TO BE 4" • F oQlF!CE
PVC PIPE FROM BOTTOM OF TRENCH END Or1 It
TO FINISHED GRADE. REMOVABLE DZTCH_1 "
i�.�o DETAIL
- CAP SMALL BE INSTALLED ON CLEAN OUT
OBSERVATION PORT PIPE. ANCHOR ON
BOTTOM WITH GLUED ON TEE. NOTE, CLEANOUT TO BE FROM 0 TO
MINIMUM OF 4 IN SYSTEM. INCHES BELOW FINISHED GRADE.
MARK ENDS WITH REBAR. CLEANOU7
REQUIRED AT END OF EACH LATERAL
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OCT 2 7 2025 r�
MASON COUN1 /Etii.,�RCN:MENt +
a�2! RET AL HEALTH,T.
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