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Home My WebLink AboutSWG2023-00218 - SWG As-Built - 3/4/2026 R Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH SAFPLICANTIPE MIT 1Ni/ORIUTATi N . a Permit Number SWG 2023-00218 Parcel# 22007-50-00070 Applicant Name Bob Backstein Subdivision (Name/Div/Block/Lot) Applicant Address 1512 37th Street NW TIMBERLAKE#7 TR 70 City, State, Zip Gig Harbor,WA 98335 Installer Name Workman Construction Site Address 30 E Aspen PI, Shelton,WA 98584 Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST. fiiiiiiil II Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type Shallow Pressure tment Type rg E---T--- -J 'lZ[ V� �z I ❑ N/A Q YES ❑ NO >5 ft.from foundation? i71 rtr 4Ci fig- -;�3 >50 ft.from wells? - I; : t q ■ i��. h >50 ft.from surface water? - t -�� 2 20 - ,- . 0 U 0 Cleanout between building and tank? \-I 0 ❑ 0 illtill Tank baffles present? - \ u ❑ ❑■ 0 t-- 24"access risers over each compartment'„ '= 0 El 0 titilzg �- - mu45 Effluent filter installed?- - ❑ 0 ❑ Septic tank capacity(working) 1,500 gal Manufacturer Sound Placement AERM ibiecliki D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO Manifold/D-box accessible from surface?- - 0 ■❑ 0 Ye Check valves installed? - - 0 ■❑ 0 SAC ; kitaA Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 0 3 ❑4 0 5 ❑6 0 Commercial/Other • >10 ft.from foundation?- 0 N/A ❑■ YES 0 NO t >100 ft.from wells?- - 0 0 0 >100 ft.from surface water? - O ❑■ 0 t >10 ft.from potable water lines?- 0 0 0 i.' zIn >5 ft. from property lines and easements?- - 0 0 0 arXig > 30 ft.from downgradient curtain/foundation drains?- - 0 • 0 Drainfield level and observation ports present - 0 ® 0 Oligigl O Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ■❑ 0 litiMI Pump tank setbacks consistent with septic tank?- - 0 N/A Q YES 0 NO 5t,Pbdt.a4 Pump tank capacity(flood) 1,500 gal Manufacturer Sound Placement klZtiM . 24"access riser(s)and accessible from surface?- - O ® O F Alarm or Control Panel Installed? - - 0 ® 0 ogio Control Panel equipped with Timer/ETM/Counter- - 0 ® 0 Pump installed in 0 Bucket or ❑ On Block or 0 Other irt:iifg Pump Make/Model Zoeller N152 0 Floats or 0 Transducer g,laplH Tank draw down 2" in/min Pump capacity 56 m Squirt Height 8 ft : � P Y 9p q 9 Pump on time 1.5" Pump off time 6 hours Daily flow set at 336 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 22 d " J�O-D®�� ABA IfDQNMENT REC,ORO Were existing septic components abandoned as part of this project? - - O YES 1Z1 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES ❑ NO RECORD UR Ii1 NC This Is a permanent record and must be accurate and descriptive enough to relocate 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 wells,waterlines, welts,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. tg Record Drawing Attached CER3 ICATION Q.F.`JNSTAILATION. 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. v\-\.:i ;Ai t /rq4 Signature of Installer ate )Gonnte V)orVouto ,- •'4 . Printed Name of Signee ,j ' wag MASON COUNTY PUBLIC HEALTH,41 The undersigned approves this InstMii_ a,••and Record Drawing on behalf of Mason Coun 'P A' r "' t7�r 5100349 '-cyi PAULA JOY JOHNSON t Health: l'IC)/L// JOHNRt Mq -��EXPIRES�sv )1.2 3- Z—z.ro Signature of Environmental Health Specialist YFiyJn (stamp, signature and date) This FORM MAY BE SCANNED AND RPAILLABL 1E PU LIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018 771 y f , (() 3c )(2,5: �� c `� " % ,qua �� L'� O e LE.s, o,c, _ Betio Rctcksi�-sir C Par e14:r22007- 50-00070 1.------Go S` 1 v, 3o s n PL `fo `'4441C gyp,t..,...o.s SCalc i =20 f:0%/c.'t ! t. t3�,/ • o to Zo 30 R Fle �, 4 sis / ' 0 O , C P ' D / ,a, o Ses , bThi-e`^ a z sc tp, 4, `f 8 1' %O1, . z evi • � I sk.so ,p c � O Audio-Visual Alarm /ar j • 3 Cleanout ,� 3 15'00 Gallon Septic Tank p �4 O 2-Compartment with 'rP,r�44- �' (II / Effluent Filter /CZ / O ]500 Gallon Pump Chamb( OValve Control Box ri • ..4) MAR 0 47:02V6 �� . MASON COUNTY ENVIRONM •ENTAL HEALTH • 0 4 �r, �• 5100349 '•.(��'j • DA• `tom' PAULA JOY JONIVSON � .U:8 l to l^5Sl°i�dv��i y . 3—Z--2.