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HomeMy WebLinkAboutSWG2025-00384 - SWG As-Built - 4/1/2026 e � Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH r `"` ' APP,LI,CANTf,PERMII'j INFORtIATIN Permit Number SWG 2025-00384 Parcel# 22025-75-00030 Applicant Name Robert Perlow Subdivision (Name/Div/Block/Lot) Applicant Address 470 E Meyers Ln TR 3 OF SURVEY 1/201 City, State, Zip Shelton,WA 98584 Installer Name Mason County Excavating Site Address same Designer Name Arrow Septic Designs m INSTALLATION,C,:HECKLt5T 4 . Full System Installation ❑Tank(s)Only ❑ Drainfie ❑ Repair ❑Other System Type Shallow Pressure retreatment Type >5 ft.from foundation? ---- ------ --- -- ❑ N/A fJYES NO >50ft. fromwells? -- ------- - -- ❑ UI ❑ YF `>50 ft. from surface water? ---- �\ ���- °��_--- - - - - ❑ ❑ .� Cleanout between building and tank. -.�� - -- -- ❑ © ❑ Tankbafflespresent? -- - -- - -- - -- - -- --- - ❑ 0 fJ► 24" access risers over each compartmen?--{ - ------ --- - ❑ II ❑ rW ": Effluentfilterinstalled?---------------- - - ------ ❑ 0 ❑ aYY�` Septic tank capacity(working) 1,200 gal Manufacturer Hagerman D-box water level and speed levelers used? --------------- ❑ N/A ❑ YES UI NO Manifold/D-box accessible from surface?-----------------, ❑ UI ❑ � zCheckvalvesinstalled? -- - - ----- ----- - -------- - - - ❑ 0 ❑ fad Transport Line Size 2 inch Schedule/Class 40 fi"M, Bedrooms installed (check one) ❑ 2 UI 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation? -- - ---- ------------ ------ ❑ NIA ❑■ YES ❑ NO >100ft. fromwells?------- ---------- ------------ ❑ ❑■ ❑ xJ >100 ft.from surface water?-- - - ------------------ -- ❑ ® ❑ po table otablewaterlines?--- ---------------- --- ❑ 0 ❑ zz 5 ft. from property lines and easements?----- - - -------- - ❑ ® ❑ >30 ft.from downgradient curtain/foundation drains?- -- - -- -- -- ❑ © ❑ Drainfield level and observation ports present - - --- -- - - - - --- ❑ ® ❑ Graveless chambers or ❑ Clean gravel used? (check one) Propercoverinstalledoverdrainfield?----------- -------- ❑ © ❑ spy Pump tank setbacks consistent with septic tank ------ ------- ❑ NIA U YES ❑ No Pump tank capacity(flood) 1.000 gal Manufacturer Hagerman F< 24°access riser(s)and accessible from surface?--------- ---- O © ❑ - Alarm or Control Panel Installed? ---- - - - - - --- - ---- -- - ❑ Control Panel equipped with Timer/ETM/Counter - - - --- -- - - ❑ ® ❑ Wes"` Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Model Zoeller N152 UI Floats or ❑ Transducer Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 8 ft .., ... Pump on time 1.8 min Pump off time 6 hours Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# Z2 d 25 - 15-6003 0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑ 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,epsting 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. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /certify that I installed the system in accordance with /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 /further certify that all information contained on this I further certify that all information contained on this form and atta,fied Record Drawing is accurate. form and attached Record Drawing is accurate. 3 l2 '2�(p Signatu a of Installer Date P-'N n Printed Name of Signee V �/ jug ca•�v y��'° MASON COUNTY PUBLIC HEALTH The undersigned approves this In tallation Re9g and Record Drawing on behalf of Mas t1 my Pu &0 ! �l '' PAULA JOY JOHNS0N Healt . 00 'iClf� tit�lEi6NE'�i" U,yryFNL ?C, EXPIRES i sr Signat re ofEnviranmen al Health Specialist Date LyFq�l (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON.COUNTY WEB SITE updated 8121/2018 OI ' • �2pYj>rj� is ' el�a�,J 2Si shed , 2'' • � o b N( CQ r • • 1 u^�.o' A adi�vs 0 3fl b� R D :Zo • P5�U L l - A Cle�aut 3 'r— r -tz iat3J 1200 C-anon Sep cTa `./ 2-Co=.?a, e.=With ZcE.L- 22 32S-'I5— e E ISe tF-Mer 4-LD E e s i.t is i000 ono Pump cumber • `�L`ry` !� } al S$ W� 1 o�vvh-Si PL'oir^ 5 valve Cr_₹ro1 **Note to installer• * APR 0 2026 e • • Sleeve waterline when within 10' ASOA/coo w26 <WA%4\J of septic transport line.Maintain D J ENVIRONMENTAL o 8 (� • 10' minimum between water A HEAL 1'H• line and sec tanks/diainfield. 5100349 •._A • PAULA JOY JOHNSON •. ,4d • •• • • • -. 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