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HomeMy WebLinkAboutSWG2025-00339 - SWG As-Built - 3/16/2026 Docusign Envelope ID:1 EF5AFE3-54D4-4118-A712-44A448EE9DCD is Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2025-00339 Parcel# 22018-51-00123 Applicant Name KRAUS, ANTHONY J Subdivision (Name/Div/Block/Lot) Applicant Address 15815 SE 48TH DR TIMBERLAKE #3 LOT: 123 City, State, Zip BELLEVUE WA 98006 Installer Name Jamie workman Site Address 31 E NISQUALLY PL, SHELTON Designer Name Micah Halverson INSTALLATION CHECKLIST O Full System Installation ❑Tank(s)Only . El Drainfield Only El Repair ❑Other System Type ATU to Pressure Trenchs A _ R(etreatmentType NuWater BNR-500 >5 ft. from foundation? - -cr-�-.. IL_ { -- - ❑ N/A x❑YES ❑ NO >50 ft. from wells? - 16,-is ',..'` _ - - O x❑ ❑ >50 ft. from surface water'? - -- - - , ,- '; z -MAC- gQ��--`��F°.�- ❑ 0 El HCleanout between building and tank? -'.' ' - ❑ x❑ ❑ ✓ Tank baffles present? - ' - ---7--- � - O El a24"access risers over each compartme� t?-.--- - - O ® ❑ W Effluent filter installed?- - El x❑ O N Septic tank capacity (working) 500+ NuWate gal Manufacturer Sound Placement 5 D-box water level and speed levelers used? - - ❑ N/A El YES x❑ NO oO Manifold/D-box accessible from surface?- - O El mZ Check valves installed? - - El x❑ O CQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) El 2 ❑3 ❑4 El 5 ❑6 El Commercial/Other >10 ft. from foundation?- - ❑ N/A © YES ❑ NO CI >100 ft. from wells?- ,c _ - O 0 ❑ W >100ft. from surface water'? P80 -- - - ❑ ❑ ❑ .� x i.. >10 ft. from potable water lines?-- -- = - El x❑ O ?▪ > 5 ft. from property lines and easemdi - -1114-/-6 e M - x❑ ❑ > 30 ft. from down gradient curtain/foundation ] ® O "7 tjiP Drainfield level and observation ports present - - �-/RO4/4� - g O Graveless chambers or ® Clean gravel use 1-check giiipoi Proper cover installed over drainfield?- - El x❑ O Pump tank setbacks consistent with septic tank?- - ❑ N/A x❑ YES El NO • Pump tank capacity (flood) 1223 gal Manufacturer Sound Placement Q24"access riser(s)and accessible from surface?- - El ® El HO. Alarm or Control Panel Installed? - 2 Control Panel equipped with Timer/ETM/Counter- - O ® ❑ IZ Pump installed in In Bucket or ❑ On Block or ❑ Other d• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a Tank draw down 1.5" in/min Pump capacity 35 qpm Squirt Height 5 ft Pump on time 1:15 Pump off time 6h rs Daily flow set at 180 gpd Updated 8/21/2018 Docusign Envelope ID:IEF5AFE3-54D4-4118-A712-44A448EE9DCD Mason County OSS Installation Report pg. 2 Parcel# 22018-51-00123 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - D YES El NO If yes, please describe:O1 d System had failed compl etel y Were all components pumped out and properly abandoned per WAC246-272A-0300? - - D 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 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. initial Owners Initial : ‘ J ‘1) in V -•-• = T°i lily MAR 16 2026 :4:. MASON COUNTY ENVIRONMENTAL HEALTH J El 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 cf,A(1pched Record Drawing is accurate. form and attached Record Drawing is accurate. 2/10/2026 `—�tvrvraar�vnv�c... ' Signature of Installer Date `titer dd Jamie Workman U Q#1 Printed Name of Signee ib MASON COUNTY PUBLIC HEALTH i� The undersigned approves this Installation Report and • , ' Record Drawing on behalf of Mason County Public 5100409 ilICAHMANIS.HALVERSON. Healy• MEWED DESIGNER (^)U 3-/ Es:091181, Sig turn o E.vironmental Health Spe alist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 Docusign Envelope ID: 1 EF5AFE3-54D4-4118-A712-44A448EE9DCD ,� —SITE iNAST /ATFR AS�I�ILT (SVVG20��-00339 i lei.Z y.I T RL f J co W � KE \ ., o N e 7.- . . ; 46* % a Lot#124 Lot#125 if, ►o �� old Ill r Q co a y`�`/ �# CALLOUTS 590x409 J o } +.ci:CAIELw�v y0��• 1) RV Dump 4"ASTM 3034 DESIGNER` '. WW �/ 2) Sound Placement Trash/Pump Tank 3) NuWater BNR-500 Tank Exam 09/109/16/s. � - a) a 0� 4) Nuwater Control Panel & Disconnect I—. ) D 5)2" Sch40 Effluent Transport Line 2- / 6) Preferred Manifold Access c d Z O • 7) Observation Ports Q- W / 8) Sweep Access 0 o M • 9)Waterline , , t o PBAR ;VI 6 ;� „�i C1 a) MA;i:SON COUNTY ENRONMENTAL HEALTH -' I, / ROPFRTY LINFS ESTABI(SHED BY OTHER `: 8.4 } 171' +/- / ¢ o 0 cture Power pole/ _ a c, \ i / Exlstmg 5tcu % @ Z H Subject Lot#123 Lij /1//:S• ¢ W Approximate Land Size .33 A� aye// moo. " (/ ' W l pp e,dstin9 Drivew q k �s 1 g r J I 9, °o W / Y � m \ I Fir Tree / 30" . '-1 Water 00/1 yy I '� Meter A Owner/ I / / '2" / Applicant: • + \ OS °CI / eqj \ -e-1\ \ I , (,,e,,k,6(:,„00)° . O; :..Q J in 0 \ (3>70'1. ':' :� , x2) o 0 ,Lot#122 Lot#121 a �@ • \\., 4 �o 60' I I /\ a I ® � • I I b � o h o 130' +/- co 7, .0 This is not a surveil: ,`b ,.c Nc) `�ci) CD o This Asbuilt Drawing Is Intended for the purpose of > x 2 locating and maintaining the septic system on this parcel. w m CD Measurements and distances are approximate. It Is advised by septic designer Micah Halverson In itial initial to use a licensed surveyor to determine lot lines, � O Ielevations,topography and to provide a legal site plan. v1 30' 20' 0' 10' 20' 3I' 2. a I Owner Is responsible for establishing at property lines, / I I ' easements and/or right-of-ways. Scale: 1"=20' t \ & InsperI-inn Date-9/90!7075