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HomeMy WebLinkAboutSWG2025-00147 - SWG As-Built - 12/5/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00147 Parcel # 32028-50-01901 Applicant Name Vanessa DiBenedetto Subdivision (Name/Div/Block/Lot) Applicant Address 7639 191st Ave Sw WALKER PARK TRACTS BLK: 1 LOT: 7-A City, State, Zip Rochester, WA, 98579 Installer Name Goldy Septic Service, LLC Site Address 131 SE Alder Rd, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 111 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑■ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - f'�____s - - ❑ N/A Q YES ❑ NO >50 ft. from wells? - n - - ❑ U ❑ >50 ft. from surface water? - - - - - t - - ❑ El ❑ �z Pk _DEC-03-10 - - - - Ela ❑ Cleanout between building and tank? U Tank baffles present? - - ❑ ❑■ ❑ F- 24" access risers over each compartm nt?- - - - - - ❑ ■❑ ❑ a W Effluent filter installed?- r�- f - ❑ N u) HB Tanks Septic tank capacity(working) 1,200 gal Manufacturer O D-box water level and speed levelers used? - - ❑ N/A ❑ YES El NO DJ ❑ El 0 O Manifold/D-box accessible from surface?- - LL mZ Check valves installed? - - ❑ 0 ❑ Q 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 1 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ NIA 0 YES ❑ NO 0 >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water?- - ❑ NI u, >10 ft. from potable water lines?- - ❑ N ❑ > 5 ft. from property lines and easements?- - El ❑ Q El II Elet > 30 ft. from downgradient curtain/foundation drains?- - 0 Drainfield level and observation ports present - - ❑ © ❑ ❑ 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) 1,100 gal Manufacturer HB Tanks < 24" access riser(s) and accessible from surface?- - ❑ © ❑ I` a Alarm or Control Panel Installed? - - ❑ NI ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ IN ❑ D a- Pump installed in 0 Bucket or ❑ On Block or ❑ Other o-• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a- a Tank draw down 2.5 in/min Pump capacity 50 gpm Squirt Height 5 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd Jpcated S,211231£ Mason County OSS Installation Report pg. 2 Parcel# 32028-50-01901 ABANDONMENT RECORD YES ❑ NO Were existing septic components abandoned as part of this project? If yes, please describe: Old Tank Removed, Old Drainfield Abandoned Were all components pumped out and properly abandoned per WAC246-272A-0300? Q YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptivem enough ankoCatiCn,re-locate North arrow,the��of rve Grainfield nexrisCng andce activities proposed build ngs,re vocation of wells.elopment. rw�ate•tinel s Drawings contain: Drainfield&manifold orientation&layout,Septicp p wells.observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 5 e e- 'Cc�cX& 0 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. A I -z Z 4reonstaiter Date • ....). 5 •:)4tb Jake Goldy . .. Printed Name of Signee °914 i MASON COUNTY PUBLIC HEALTH !3 .r The undersigned approves this Installation Report and ,C' s t oc.. :cq� �^� PAULA JOY JOHNSON '•�T. Record Drawing on behalf of Mason County Public SOWS?.S? NM'. Health: �~ +•~ E)cPtRES PI Si '� 1Zt5/zC 1( - a -7'r 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 update°821/2018 v✓ 4AR 'L PRRG5.[. 3-2.c z8-se' -v1R01 202 -SO-0k00-1 i a . _ t k.0 / ""\--ce4N"‘ / 1 e® r1 ; - o A ® IT. Saf sr:o p , l U \ , Pi L.:,...... Lu i -E- ,,Y'' 4 ' 3 e or V) 25D` @ & 44".A7S-\N-42.1-t. 6,„,x / I_t ! t — • .— 4z 1 . t8 ` Rev: 55C-Pcl_ Cr -5C I a�: o-V=_s1"=l AlarZ e 25 50 -,5 °d As-but•' tt cm C;oaou v?A's-ESSA D 3-"-tiS-D5-1T C 3. 1200 C•-�on Sep c Ta PhA C-€ 3Zo2a-0 - c 'a0 2_�o - w lr.Filter l'l SE fo-D E-g, R D C 11Oo C`o-r,-, Chamller k-t-, ---v ► s t '165i3 Valve Control Sox - Z PA ® G la -t-csM k v-e.ywDve.sk t XZS, PR1 -i 4C2 D.F. T2Et 3 yy•�� (4)3` ysc -- (4)S 1-� Ti 6 q ` G - e_ _ w : -fr-1 Z eS g r-vE. !ti 8 ET``,E APPROVED 513-"9 N0 PAULA JOY JOHNSON q g t rcak;irso`$ic:r=a•. DEC 0 5 2025 fir; s` -. I - 2 8 ; MASON COUNTY ENVIRONMENTAL HEALTH RET