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HomeMy WebLinkAboutSWG2025-00105 - SWG As-Built - 2/4/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00105 Parcel# 319154100000 Applicant Name EVANS ET AL ERIN Subdivision (Name/Div/Block/Lot) Applicant Address 3320 SE BLOOMFIELD ROAD City, State, Zip SHELTON, WA 98584 Installer Name Bayshore Septic Sewer Water Site Address 3320 SE BLOOMFIELD ROAD Designer Name BOB PAYSSE INSTALLATION CHECKLIST I. Full System Installation ❑Tank(s)Only O Drainfield Only O Repair O Other System Type Pressure Pretreatment Type N/A >5 ft.from foundation? - - O N/A gm YES ❑ NO >50 ft.from wells? - - -- - - _prn • ❑ © ❑ Z >50 ft.from surface water? - j `' Lai_ . ❑ ® ❑ il N Cleanout between building and tank? -jf f FEB ❑ FLia B 8 707 D O v Tank baffles present? - r - O IN O E: 24"access risers over each compartment?---- ' - ---- - O ® O tu Effluent filter installed?- -- _ _ _ ❑ IN ❑ In Septic tank capacity(working) 1200 gal Manufacturer Infiltrator e D-box water level and speed levelers used? - - ® N/A ❑YES ❑ NO ,1O Manifold/D-box accessible from surface?- - O III O ®Q Check valves installed? - _ O ® O 2 Transport Line Size 2" Schedule/Class SCH40 Bedrooms installed (check one) 0 2 O 3 O 4 O 5 O 6 O Commercial/Other >10 ft.from foundation?- - O N/A IN YES O NO i0 >100 ft.from wells?- _ O ® O ill >100 ft. from surface water? - - O IN El LL >10 ft.from potable water lines?- - O ® O Z > 5 ft.from property lines and easements? O ® O a ix > 30 ft.from downgradient curtain/foundation drains? - - O ® O Drainfield level and observation ports present - - O El ❑ ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- - O ® O Pump tank setbacks consistent with septic tank?- - O N/A Ill YES O NO Z Pump tank capacity(flood) 1200 gal Manufacturer Infiltrator Q 24"access riser(s)and accessible from surface?- - O ® O 0.. Alarm or Control Panel Installed? - - ❑ NE O 2 Control Panel equipped with Timer/ETM/Counter- - ❑ PE O a- Pump installed in ® Bucket or ❑ On Block or O Other a' Pump Make/Model 250 Liberty FL30-Series � ® Floats or ❑ Transducer = Tank draw downt� 4. INCH in/min Pump capacity 20 _gpm Squirt Height 3 6 ft Pump on time I MIN '40 ' EC Pump off time 4 H R5 Daily flow set at 240 qpd Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? If yes, please describe: O YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? O YES O 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 Drainfieid&manifold orientation&layout,SePtc/PaMp tank location North arrow reserve drainfield,existing and proposed buildings,location of wells waterlines wells observation ports deanouts and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits. LI Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /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 con ' on this I further certify that all information contained on this form and attach d d Dra g is accurate, form and attached Record Drawing is accurate. 12/5/2025 Signature of Installer Date Brandon Thompson ih��' Printed Name of Signee / ;! ?≥ p • MASON COUNTY PUBLIC HEALTH � 51'00317- aa� 41)^ Yom' slog The undersigned approves this Installation Report an +$0 ROBERT h DAVSSE lid Record D ing on behalf of Mason County Public ® Health' tzs EXPIRES /C �gSoNCo FF4, Z l ( (7076 G4,ly � 2 Signature of Environmental Health Specialist Date FN�� 0�6 O N,%� (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLK;44pVV ON THE MASON COUNTY WEB SITE updated 8/21/2018 q0;h, EXISTING HOME ."---_ & SEPTIC SYS.r_______ . .........„. ..... _ 4 _ft_ ..•I II-- 1/ W/L --\ 2- \ \ I I I I 0 I _ I I k • • SEE SITE PLAN // \ i I " 2 FOR MORE I r" PETAIL 1 ;tea PROP. / \\ APU & �>I SEPTIC \vr i SYS I I ��OOM :' APP ps ® M ~ 5r. DY wags* �a . , FEB 0 4 ?026 v FOC&.'StT y3TW1>'SS@ MASON COUNTY ENV►RONMENTAL HEALTH '.- '-').444 rYy`'' , ! DMA x�l:;;=s 1 AN ASBUILT/INSTALL SIGNOFF FEE WILL BE CHARGED AT TIME OF INSTALLATION PIONEER. DIGGING, INC. CUSTOMER: ERIN EVANS TEST HOLE I: TEST HOLE 2: PARCEL#:31915-41-00000 0-21 21('1S. } 'I 27� 21-36 WETAIOIT 27-36\\1.lAiOfi SEPTIC DESIGNS ADDRESS: 3320 BLOOMFIELD RD I I20@ 28/R@21 I I20@ 32/R@27 3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT FL PAYSSE DISCLAIMER:THIS IS NOT A SURVEY.REFERENCES INCLUDE APPLICANT/COUNTY PROVIDED PLATS OR SURVEYS.FIELD MEASUREMENTS AND COUNTY GIS.DESIGN INTENDED FOR SEPTIC (� PURPOSES ONLY. PROPOSED CEVE_OPME?.T MAY B_ SJEJECT TC OTHER 1 OFFICE-36(}426-1803 FAX-360-427-2353 SHEET: SITE PLAN SCALE 1°=100 DEPARTMENT/AGENCY REVIEW.DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO I SEPTIC COMPONENTS. J