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HomeMy WebLinkAboutSWG2025-00122 - SWG As-Built - 3/18/2026 Docusign Envelope ID:AA15DE44-D6D5-47A7-80F7-8B67B023FC91 r _ R Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2025-00122 Parcel# 32032-41-00000 Applicant Name PETERSEN, THOMAS E Subdivision (Name/Div/Block/Lot) Applicant Address 1001 SE COLE RD City, State, Zip SHELTON WA 98584 Installer Name JAMIE WORKMAN Site Address SAME AS MAILING Designer Name MICAH HALVERSON INSTALLATION CHECKLIST ■❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only O Repair O Other System Type PRESSURE TRENfk Pretreatment Type SEPTIC TANK >5 ft.from foundation? - 1 11 ter i g W-E- ` ❑ N/A 0 YES ❑ NO >50 ft.from wells? - ❑ 0 O Z., . >50 ft. from surface water? - MAR t.:,, Zan- J ❑ 0 ❑ I-- Cleanout between building and tank? - A tip';;_?;; -sz . 7_ 0- ❑ ❑ E t Tank baffles present? - - O 0 0 I— 24" access risers over each compartment?- - O 0' O a. W '. Effluent filter installed?- - O 0 O Septic tank capacity (working) 1200 gal Manufacturer SOUND PLACEMENT CI D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO gO: Manifold/D-box accessible from surface? ❑ ® O - - o0Z. Check valves installed? - - O ❑■ O DQ E Transport Line Size 2 Schedule/Class 40 Bedrooms installed (check one) O 2 O 3 ❑■ 4 0 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - ❑ N/A 0 YES ❑ NO >100 ft.from wells?- - O ❑■ ❑ W..' >100 ft.from surface water? - - O 0 O ii >10 ft.from potable water lines?- - O ❑■ O Z`° > 5 ft.from property lines and easements?- - O 0 ❑ d > 30 ft.from downgradient curtain/foundation drains?- - O 0 O Drainfield level and observation ports present - - ❑ 0 ❑ O Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - O ■❑ ❑ / •` Pump tank setbacks consistent with septic tank? - - O N/A 0 YES O NO Z ::Pump tank capacity(flood) 1500 gal Manufacturer SOUND PLACEMENT 24"access riser(s)and accessible from surface?- - O © ❑ a Alarm or Control Panel Installed? - - O ® O 2: Control Panel equipped with Timer/ETM/Counter- - O 0 ❑ M a Pump installed in ❑ Bucket or ❑ On Block or ® Other ORENCO EZ PAK Pump Make/Model PVA3005 ❑■ Floats or ElTransducer a Tank draw down 1.75 in/min Pump capacity 45 gpm Squirt Height 7 ft Pump on time 1MIN Pump off time 3HRS Daily flow set at 360 gpd Updated 8/21/2018 Docusign Envelope ID:AA15DE44-D6D5-47A7-80F7-8B67B023FC91 f Mason County OSS Installation Report pg. 2 Parcel# 32032-41-00000 ' ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ID YES O NO If yes, please describe: Pumped and abandoned old septic Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. IN Record Drawing Attached . CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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. uocoslenw by 3/16/2026 Signature of Installer Date V).:1, i Jamie workman \i't ::' le Printed Name of Signee ' '!il �` 1 MASON COUNTY PUBLIC HEALTH ,�,g4 t4 t of The undersigned approves this Installation "et-' gke; = 5 oogo9 . �` �1I Record Drawing on behalf of Mason County Public ' )0 sr.` MICAHTIMMHALVERSON • LICENSED DESIGNER 'F1 3 Health: �qR, V . ����.�,`.��,,.►..�►���...:, //wilcz.64404,, EXPIRES:091161���vTj,�N 8 ��26 Signature of Environmental Health Specialist Date n/k/Roi,� N (stamp, signature and date) .- i,cz� Updated 8/21/2018 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUblut4//E,W ON THE MASON COUNTY WEB SITE Docusign Envelope ID:AA15DE44-D6D5-47A7-80F7-8B67B023FC91 X 4 BEDROOM ON-SITE WASTEWATER ASBUILT (swg2025-QQ122) - m grip, 11 W co 1505'+/— Q O O Z O O O I--- J %-- W a$ r- �° _ M L Garde_` `, N CI --I 4t W TD J Approximate Land Size:12.5 Ac / 5hop V CO U LU / \ / v, O This is not a survey: R=100' Nell , `� I This Asbuilt Drawing is intended for the purpose of I ! locating and maintaining the septic system on this parcel. SF C \/W u)\ / ° Measurements and distances are approximate. /e R \ Dye / Q It is advised by septic designer Micah Halverson °ad \ O to use a licensed surveyor to determine lot lines, , _ a'dpet elevations,topography and to provide a legal site plan. 1nitia1 n9rij = Owner is responsible for establishing all property lines, ~ easements and/or right-of-ways. z W Inspection Date: 4/11/2025 C]) LLI 1 / / w , a e , - f L___ , Garden - / PROPERTY l INE TABLISHED BY OTHER , _ ; __ 594'+/ __ , '`/ _ `- 1N0' 100' 200' + IIIIIb , - shopA CJ \` 1 2 - 50' "15' O \R� e\ 4 '► Scale: 1"=100' -- i CO SeM> •f. y / 1 �, • 3 \ c O 45. esen,„n / '7Le \ F O \ , F / "-i 4USo MAR 1 � 2026 4,a,. ®CO u T.,-; '01 I 1)4"ASTM3034 WITH CLEANOUT COONTYENVIRO % �t ( CO NMENT CD Well I 2) 1200 GAL SEPTIC TANK A( JI ' e �� 0 , -c, �� R=100' 3) 1500 GAL PUMP CHAMBER D,AHEA(TH 4.I. > xo I 4)2"SCH40 EFFLUENT TRANSPORT PIPE : 5100409 f ° O I 5)MANIFOLD ACCESS , I. cs > / 6)SWEEP ACCESS THIS END OF EA.TRENCH AlIGA6i11�ANIEL.HALVERSON i I 0' 25' 50' 100' 150' \ 1 7)OBSERVATION PORTS THIS END OF EA.TRENCH .0 LICENSED DESIGNER t a 2 6imiiiimi \\ / EXPIRES:00110/2.A. \ / / Scale:l"=50' \ /