HomeMy WebLinkAboutSWG2024-00475 - SWG As-Built - 11/18/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number swG 2024-00475 Parcel # 12107-14-00110
Applicant Name Greg Mcfarland Subdivision (Name/Div/Block/Lot)
Applicant Address 250 E. Lombard Rd. N.
City, State, Zip Grapeview, Wa 98546 Installer Name Pioneer Digging Inc
Site Address
Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
ll Other
Full System Installation El Tank(s)Only ❑ Drainfield Only 0 RepairNuWater BNR-500
System Type ATU - Pressure Pretreatment Type
>5 ft.from foundation? - - •- 0 NIA Dt YES ❑ NO
>50 ft.from wells? - 21g1qM
❑ I. t� kai'l ❑
-
• >50 ft.from surface water.
- - - - - -- ❑ NI 0
Z 0
< Cleanout between building and tank? -NOV-'�4 Ul - - - - ❑ ® 0
V Tank baffles present? - - ❑ ❑
a24" access risers over each compartm ntt y - - - 0
II W Effluent filter installed?- _- -r"-- 0 0 N gal tank capacity(working) NuWater Manufacturer Haggerman
C D-box water level and speed levelers used? - - 5 NIA
YES INO
oOJ Manifold/D-box accessible from surface?- - 0 0
a?Z Check valves installed? 0
II GQ 2" Schedule/Class 40
• Transport Line Size try""'
Bedrooms installed (check one) 0 2 El3 ❑4 0 5 ❑6 ❑Commercial/Other
NIA YES NO
>10 ft.from foundation?- - Illg( ' ❑
>100 ft.from wells? 0
W >100 ft.from surface water? - - 0 ❑
Li >10 ft.from potable water lines?- ❑
zQ > 5 ft.from property lines and easements?- - CI III t_ � ❑
2 > 30 ft.from downgradient curtain/foundation drains? - - ❑
CI
Drainfield level and observation ports present - - ❑ II eilp 0
❑ Graveless chambers or 5 Clean gravel used? (check one) 0
Proper cover installed over drainfield?- - 0
Pump tank setbacks consistent with septic tank? - - 0 N/A
MI YES 0 NO
1500 gal Manufacturer Haggerman
• Pump tank capacity(flood)Z 0 ® 0
< 24" access riser(s)and accessible from surface? 0 0
I—
d Alarm or Control Panel Installed? -
2 Control Panel equipped with Timer/ ETM/Counter-
- 0 MI 0
M
n- Pump installed in • Bucket or 0 On Block or 0 Other
2 Pump Make/Model Liberty 290 II Floats or 0 Transducer
0=.. Tank draw down 2 in/min Pump capacity 60 gpm Squirt Height 24"+ ft
Pump on time 1 min Pump off time 4 hrs Daily flow set at 360 gpd
Updated 821i2018
Mason County OSS Installation Report pg. 2
Parcel# 12107-14-00110
ABANDONMENT RECORD
of this project? ( ' �`- YES
Were existing septic components abandoned as part il��O
If yes, please describe:t'.i�, ,� bo c� \Y') 't?- v V u?�� (),4 �^Pfs"u _ P
��rQe `^ i
0 NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? 0 YES
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 drainfield,existing and proposed buildings,location
of and wells,
wa terli nis,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval
o 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 myselfte and Mascn o Countyouty Public
ub i Health and meet all
and Mason County Codes.
s
1 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Vist3eicii:;),GT 11/6/25 '�5`
Signature of Installer Date '' ` •`
Robert H. Paysse ��,' ' y`
Printed Name of Signee .1' •`� wqs ��
MASON COUNTY PUBLIC HEALTH `�,7q.•• ROBE 5100317 SE �
The undersigned approves this Installation Report and .1., . :".:11j.
Record Drawing on behalf of Mason County Public
EXPIRES
Health: 1 I�'i ��
Signature of Environmental ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8l2112018
PUMP OUT& ABANDONea 1 ."-ic
• ' s CrA8 NON-CONFORMING SYSTEM
1 300'
i
EXISTING SHOP
i
fl
APPROVED
/klyotAk-41NOV 18 2025
I --
I MASON COUNTY ENVIRONMENTAL HEALTH i.
I - `\ RET
I I r
I' 1 I
��'�� ', IL
PROPOSED DRAINFIELD
a PRIMARY & RESERVE
1+ I I � rn
.I M
I < \ i a i o'
NUWATER BNR500
cI a N__
PUMP TANK
PROPOSED HOME
i \
// \
/ \
// EXISTING \\\
/ cow:\/7- WELL
I RIOO' I
�
11;
1
/ 11 ...�
j \ / I JE:=
•
\ / EXPIRES
\ /
\ AN ASBUILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
SCALE1:50 I
CUSTOMER: DREG MCFARLAND ES TEST
TT HOLE I: HOLE 2
4 4PIONEER. DIGGING, INC. PARCEL#:12107-1400110 0ES 0-2
I SEPTIC DESIGNS ADDRESS: 250 E LOMBARD RD 31+TILL TILL
N : 3083 E.MASON BEN.SON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT PAYSSE
;�� I OFFICE-36(}426-1803 FAX•36l1-427-2353 DESIGN PAGE SITE PLAN -............