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HomeMy WebLinkAboutSWG2025-00437 - SWG As-Built - 1/14/2026 w Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00437 Parcel# 42201-50-01009 Applicant Name Joe Upton Subdivision (Name/Div/Block/Lot) Applicant Address 5220 Johnson Point Rd NE HOLIDAY BEACH BLK: 1 LOT: 9 City, State, Zip Olympia, WA, 98516 Installer Name Maples Excavating Site Address 151 N Susan Ave, Hoodsport Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only Q Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - - -3r- - ❑ N/A ❑ YES 0 NO >50 ft, from wells? - l-IV M - - El El >50 ft. from surface water? - - - - - ❑Cleanout between building and tank. � ' -- ❑ 0 O Tank baffles present? - - -Aa 1-3.210_ _ - - O • ❑ a24"access risers over each compart ' . - - - - - ;i - ❑ 0 ❑ W Effluent filter installed?- BY- - ; Ai-:•4.- - - - ❑ ■❑ ❑ Septic tank capacity (working) 1,::I gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES El NO DO Manifold/D-box accessible from surface?- - ❑ El ❑ o a Check valves installed? - - ❑ CI 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - -R-*-t.%-: ,-C - l'N-0- ❑ N/A El YES O NO O >100 ft. from wells?- - ❑ ID ❑ >100 ft. from surface water?- - 0 0 ❑ LLI LL >10 ft.from potable water lines?- - ❑ ❑■ ❑ Z Q > 5 ft. from property lines and easements?- ❑ 0 ❑ a > 30 ft. from downgradient curtain/foundation drains?- - El 0 CI Drainfield level and observation ports present - - 0 NE ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ID El Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator HAlarm24"access riser(s) and accessible from surface?- - ❑ © CIEL or Control Panel Installed? - - ❑ © ❑ Control Panel equipped with Timer/ETM/Counter- - El © ❑ - Pump installed in ❑ Bucket or ■❑ On Block or ❑ Other fl Pump Make/Model Zoeller N152 ❑■ Floats or 0 Transducer a Tank draw down 1.75 in/min Pump capacity 44 qpm Squirt Height 8 ft Pump on time 1.3 min Pump off time 6hr. Daily flow set at 240 gpd Updated 8/21/2018 1 ` Mason County OSS Installation Report pg. 2 Parcel# X220 I " - O k 009 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ® YES NO If yes, please describe: O(a- Teil \3 & ) -r-St-' f)çk--0.'i tv 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 developmen Typical Record Drawings contain: Drainfield&manifold orientation&layout.Septicfpump tank location,North arrow,reserve drainfield,existing and proposed buildings,location wells,waterlines, wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approv and related permits. -Thfor_ cAx.sAb-e.- red, s-k--A13-0 r *ems 4-e_ 6.X v -s + €, &Scw -ich Q.-a. c.• �a €_k_- 4\s9fCk-- -dtNjUk- Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with /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 1 further certify that all information contained on this /further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. IZ.- Z3-ZS g ature of Installer Date t� Printed Name of Signee ,.r a. :4e 'r.rt MASON COUNTY PUBLIC HEALTH t ' ; The undersigned approves this Installation Report and ; Record Drawing on behalf of Mason County Public LI. '. ULA JOYHealth: rb't)8 ivl~Fi 11. 41%...1.461f COM 1Lf (7'4 EYPtRES 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 Updated 812t/2018 I\ CAT-Q-Q-‘c Leio' H--- n1 c 14v f t i L- t I Ail iv E- C to Z 30 4.0 _ I ,A;Ay - -I S -bid J CD. V F-7o ��,4oRT I � �C : 42Zot-5C—Olco�i i '� ,--- Excs-citQc �� i N vti � r` 6 O _ 2 a� k .C)D5ce�-� w g6si8 0 ` Y 1 O I o f i -Su't`- 5 Q ' Bev: C4) 3' x 3� . � lR�o�c`r-L) 1). P. Audio-Visual.4a: - (2-- c-f- S 5 ' 0 . C .. t. 1 Cleanott 134' L of RESE�GF 'EN`l-fES u 3 :cl00 C- flon Septc Tazik 2-Com az ent with Effluent Filter 3 1000 Cl?o-_Pump Clia-r,be_r 3 Valve Control Box AnpED © 01d �-- Y'2mo►•cd, 1 .RO IAN 14 2026 OS Ce_f a • .-i: - 1 o c cL.L',o�. • SON COUNn ENYIROV .NZ AL HEAlT 45? � �`Jwr.e. e'MA RFCa. : ?, t :z;,.). ( ( Flu►►�b n9 drexinS into :'� s � Sep-I-ic Tav►k: •• .`10;349 -:•;' ,,�• PAULA JOY HNsCN 'yln Q .. 1n ! 5�D UkSiGNLb of s$5P r' '