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HomeMy WebLinkAboutSWG2025-00069 - SWG As-Built - 3/17/2026 Mason County 0SS Installation Report pg. 1 APPLICANT/PERMIT INFORMATION MASON COUNTY PUBLIC HEALTH Permit Number swG 2025-00069 Parcel# 22233-5Q-00015 Applicant Name David Revander Subdivision(Name/Div/Block/Lot) Applicant Address 9021 Willow Grove Rd. City,State,Zip Longview,Wa 98632 Installer Name T.l's Site Address 4280 Mason Lake Dr.West Excavating Designer Name Bob Pelisse INSTALLATION CHECKLIST O Full System Installation ❑Tank(s)Only O Drainfield On ly []Repair ®'Other System Type Pretreatment to pressure treatment Type NuWater BNR 500 >5 ft from foundation? - : >50 ft.from wells? Wa YES Ea NO >50 ft,from surface water? ---_ ti.,S _\ Qif O Q Cleanout between building and tan ® �-� ✓ Tank baffles present?- -- - � - --- - O fa a. 24'access risers over each compartme Q iu N Effluent filter installed?- �► ' Et - O B Q Septic tank capacity(working) 100 i�" ,al Manufacturer Haggerman �0 D-box water level and speed levelers used? lit WA ❑YES Q'NO - mBI Manifofd/D-box accessible from surface?- - Qa Check valves installed?- _ O 0 • Transport Line Size 2° O O O Schedule/Class 40 , Bedrooms installed(check one) ❑2 0 3 O 4 ❑5 ❑6 ❑Commerciaf/Other >10 ft.from foundation? el >100 ft from wells?- - ®WA ❑YES Q No O W >100 ft.from surface water?- _ ® O I! >10 ft.from potable water lines?- O O !Z >5 ft.from property lines and easements?- _ O IN O >30 ft.from downgradient curtain/foundation drains?- O 0 Drainfield level and observation ports present- 0 O O Graveless chambers or 0 Clean gravel used? (check one) ® O Proper cover installed over drainfield?- _ 0 MI Q Pump tank setbacks consistent with septic tank?- NI Z Pump tank capacity(flood) WA ❑ s O NO �l Manufacturer Q24"access riser(s)and accessible from surface?- _ 0 0 0 Fs. Alarm or Control Panel Installed? - - O 2 O Control Panel equipped with Timer/ETM/Counter- - ❑ O a O a Pump installed in © Bucket or O On Block or a. Q Other a Pump Make/Model El Floats or ❑Transducer = IL Tank draw down in/min Pump capacity_ apm Squirt Height ft Pump on time Pump off.time Daily flow set at qpd updatedamena Mason County OSS Installation Report pg.2 Parcel# X33-50-00015 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - If yes,please describe- - OYES Q NO Were all components pumped out and properly abandoned per WAC246-272A-0300?- - OYES No RECORD DRAWING Thb is a pem�are�record and must 6e accurate and dosed Drawings penny Drai d 8 marrifeldt be accutation 8 Pave enough ton r ate In the need of maintenance activities and future dawrop:ant r WPM.Soptidpump tank(oration.North wag reserve&affRtete&existing and proposed lYA eat Record wens,obseNatfen pods,demists,and other maintenance access points.Incomplete Record D P P eundmg�'location aemits.nd reretedpernfirs. edp tires. ,p �r+9smoytreat�edddfonatdelayslnruvatfrtsiiiltatienaPP�tac�,�re[ated'permtts OreCl � sz eok—`V'• y ac ht-A . �Y'� frk-er SZr P1-. -rb 1,-re e *- - e - t o v . v �o �-�� �� d ow y L z,i ® 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 Codea 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. 3 -1- Signature fins ller Date TJ Goos t4 Printed Name of Signet MASON COUNTY PUBLIC HEALTH • n l . The undersigned approves this Installation Report and a X10/ RosrRr va _ Record Drawing on behalf of Mason County Public ►�„��:.�3»����r��� He t xp,REs Si f wronmental Health Specialist Date (stamp,signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SETE trpaa1tl2tr2aas 4 ♦ • 1 I I --p ! ABANDON/REMOVE TOP(2) j ii 9 DRAINFIELD LATERALS TO INCREASE ' FUTURE BUILDABLE AREA i , : 6 6 fl, r}y I • ��a) Q �9 �IIj�i44 I + , t� r�,�'��Ei3ACK I ; /! ' I L �';' r d � ii �! CLEANOVT 1 B E fi v i �, INSTALL NEW 4" ; �'�_, .. . . _ _ I 1 3034 SEWER PIPE I _ 29 Pf�I/ti4Al1F 4 ! DOWN TO EXIST. 1 I "'� i� 9 i E f TANKS FOR FUTURE 1/27./WIKA2W/7°<:///7/4: t, I ! PLUMBING I 1/7. Z3._-- .1/0.,. ../0-fikiW,- _.;q. . _./t.. __/... \ DESIGNER SUGGESTS '-- • -39LPRIMA-RY -'-----------' _`----- -.� �` I USE OF 45`STEP ----- ..._,................ .„_-_____L------- - ` DOWNS ON 4"SEWER27.0 / __ -- h PIPING TO ENSURE /S�`�',� / �, ,r� �[ PROPER FLOW. °'O`°RRl I I MANY ° ° a ° i l'?ffl;/:;!'-./.6--/:.*''AYV-7----7-X•j ///7.1/// !T ''' I , I • I I RE-LOCATE VALVE ' !•-af. ---; Aie ci.-4-- --' ; CLEAI�fOVT I� BOX& RE-FEED • 1 I ALL LATERALS o INSTALL (2) NEW DRAINFIELD H LATERALS BELOW EXISTING 0 1 ;" , RECONFIGURED 100% i I `'b RESERVE AREA y I i1�.�TgyC1 RE-UTILIZE EXISTING �"' �' 5 3 , =• TRANSPORT LINE :• S•��„Z r-.7°.......,ace.� r»:!,. Iv AN ASBUILT/INSTALL SIGNOFF FEE WILL - _ �,` .; ` BE CHARGED AT TIPAE OF INSTALLATION t.-u;:a^ �' CUSTOMER: DAVExEV DEa SAP=0' PPIONEER. I�+I ,c - PARCEL 2223330430015 NO NEW TEST HOLE. SEPTIC DESIGNS ADDRESS: 4280 MASON LK DR Wk SEE PREVIOUS DFSIQ SNQp16{I0323: 3083 E MASON BEV,iON 1W. CRAPEVIE ,WA 98546 ►DESIGNER: ROBERT}L PAYSSE 2W36 TYPE 3 ABOVE TILL �T OFFICE-3G0 42G-1803 FAX-360427-23M It DESIGN PAGE DRAIIV�.D DETAIL