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HomeMy WebLinkAboutSWG2021-00640/ASBUILT - SWG As-Built - 10/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 20S-00640 Parcel# 22025-78-00060 Applicant Name JOHANNES PRINS Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 3254 City, State, Zip SHELTON,WA. 98584 Installer Name 0 arks Int4( C d-P Site Address 241 E RITZ DR Designer Name CINDY WAITE J INSTALLATION CHECKLIST a ® Full System Installation ❑Tank(s)Only El Drainfield Only ❑Repair ❑Other System Type iIreki.(`I Pretreatment Type >5 ft. from foundation? - J >50 ft from wells? ❑ N/A II YES ❑ NO Z >50 ft.from surface water? - r�,;�'_ � jy1 -' ❑ El El FQ- Cleanout between building and tank? -- 11 t--- • 0 0 ❑ V Tank baffles present? - _ l"24 2Qz5__ I ❑ d 24"access risers over each compartment?1 ._,,_ ----\ 0 ® ❑ N Effluent filter installed?- & ❑ © 0 , il Septic tank capacity (working) i - T Manufacturer ). _crr CID-box water level and speed levelers used? - 0 N/A MIYES ❑ NO oO Manifold/D-box accessible from surface?- _ u. mZ Check valves installed? - _ 0 III 0 OQ It fr ❑nn ❑ Cl Transport Line Size Schedule/Class Sate 3 CgO3liJ Bedrooms installed (check one) ❑ 2 11113 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES 0 NO o >100 ft. from wells?- - ❑ II ❑ W >100 ft. from surface water? - - 0 0 ❑ Z >10 ft from potable water lines?- - CI © El > 5 ft. from property lines and easements?- _ 0 0 Ill > 30 ft. from downgradient curtain/foundation drains?- - ❑ 0 Drainfield level and observation ports present - 0 0 Graveless chambers or ® Clean gravel used? (check one) El NI El Proper cover installed over drainfield?- _ 0 0 0 Pump tank setbacks consisteitt with septic tank?- - 0 N/A ❑ YES MI NO Pump tank capacity (flood) igal Manufacturer < 24"access riser(s)and accessible from surface?- . ❑ 0 0 a.H Alarm or Control Panel Installed? - El El El Control Panel equipped with Timer ETM/Counter- ❑ ❑ 0 a Pump installed in 0 Bucket or 0 On Block or 0 Other \`LI a. Pump Make/Model ` 2 0 Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8l21/2018 Mason County OSS Instal*ion Report pg. 2 Parcel# 22025-78-00060 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? If yes, please describe: j i ❑ YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 NO 11 RECORD DRAWING This is a permanent record and must he accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientationp reserveow, existing proposedbuildings, wells,obse.'vation ports,Cieanouts,and other maintenance access po'nts.tIncomp ete Record Don,North rawings may create adds onal delays in Mal installatiion a location of and relwellated waterlines, approval related permits, it)8 lee- .5,,,,,p P 0 A./ „s-r ite ® Record 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 APP OVED"by Mason dance with the septic design stamped"APPROVED"by County Public Health and that an deviations shown Mason County Public Health and that any deviations here have been cleared/approve by both the designer shown here have been cleared/approved by both and Mason County Public Health nd 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 informationlcontained on this I further certify that all information contained on this form an ed or rate. form and attached Record Drawing is accurate. E////22 ignature of Installer Date „so.t. Y�'le tcA* 9�',,.. Printed Name of Signee ``� ,! : s + ,, o " J MASON COUNTY PUBLIC HEALTH ? pp�' �`ri�_r:` ':,T ?; The undersigned approves this!n$tallation Report and41'1 41 �a Record Drawing on behalf of Masclp County Public • ,, • Health: Rito.0,4(--,111 �r f( 1�0(7is �. J� .)iti 1.1 Signature of Environmentaldealt!)Specialist Date � (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated Eu2112°18 I � e. �' .R,/z ice' I 1 of s1� ' ' ► A& . 5, . ie . ...,„ \ ,,,..., ,,,,,, Iii, , . .,,s .q., -. - -4, e ..ve ,_y 18 1 b , f o e CINDY E.WAITE. ..,,, 4 I .i • LICENSED DESIGNER 1, 1 • 1 gloom �eNr�� ���w�, E.WIRI:S 05/10i V !1 P 6 Ai 1 p APPROVED , ( OCT 3 0 2025 MASON COUNT'E Vi oNYEN TAL HEALTH RET • i I i i brit g StJ'ytedo' PRE 19. e;',').or Plittapi tr id • VII j • C") 'zoo cva ce etc Se" - t CO I) Fox , ', 0 <—& I c,oloasee? IN G (1 e . 2 '. i;)- 0 ' , • <---c 1 1 /Gfi, , 200' 1 3Oo' 1 _ - Elp I ": lvo, i `cI 4°-'12 L- ' 224' y) -4 2 AV: Or., U — t " LC o La t•',AI teld Z 0A2foc,k,.s _ ...,_...,..._. .... ... ..... _.._..._. Paoped-Ar 1 _--....• - ,sa-b ',,e6,.,-.-4--------------. f 4 I .... La tl" r.......-i /7 1 /_-..-- /Of . - 1 I ....... it 1 sr-_ L----- .--------- .. . t 0 z 0 -4) " A d P°Iffr . i -r I 011 APPROVED 0 / th e ett,4 et... 0_7?i..._ .-C-feelik OCT 3 2025 VV r - _... ON couhry ENVRON.Y.Eh TAL HEALTH !!-!0._/11.2.-.,, RE I pi . T • „ . 1 i ' fart r 1i-A e- 4,_.. r_:-..4.r.,..:. I _ ....._. 44'Ajtra' 6.41'0* 0 - 10 18 3 1 i cl NOY WAITE I LICENSE DESIGNER' Ve4-4°COP EXPIRES 05.1Qi I