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HomeMy WebLinkAboutSWG2026-00012 - SWG As-Built - 4/1/2026 Docusign Envelope ID:E4D5DA7C-2A4B-4ABE-885C-56ED4285CE7B Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2026-00012 Parcel # 2 2006-30-01010 Applicant Name CARL E JANZ Subdivision (Name/Div/Block/Lot) Applicant Address 1001 E MALANEY CREEK 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 ❑ Repair ❑Other System Type ATU to Pressure Trench 1treatmentTypeNuWater BNR-500 >5ft. fromfoundation? - -- --- -- - - - - -- - - - - - ❑ N/A ❑YES NO • >50ft. fromwells? - - - - - - - - - - - - - - -- - - - - - >50 ft. from surface water? - - - - - - - - - - 'r L - - . - - x❑ ❑ Z ^`•�_ Cleanout between building and tank? -- - �%�- - x❑ ❑ Tank baffles present? - - - - - - - - - - - � - •d 24"access risers over each compartment?- . - -- - - ❑ ® ❑ W Effluent filter installed?- -- -- -- - - -- -- - -- - - - - - - - ❑ ❑ x❑ 07 Septic tank capacity (working) 660+ NuWate anufacturer Sound P1 acement D-box water level and speed levelers used? -- - - -- - - - - - - - - - ❑ NIA DYES x❑ NO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - -- - ❑ x❑ ❑ mQ,;Q Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ x❑ ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ©3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation?- - - - -- - - - - - - - - - - - - - - - - -- - - ❑ N/A ❑ YES NO >100ft. fromwells?- -- ---- --- - - - -- - - -- - - ---- -- - - ❑ x❑ ❑ >100ft. fromsurfacewater? - - - - -- - --- - --- - - --- - - - - - ❑ x❑ ❑ W u. >10ft. frompotablewaterlines?-- - - - - --- - -- - - - - - - - - - - ❑ El ❑ Z > 5ft. frompropertylinesandeasements?-- - - - - - - - - - -- - - - ❑ x❑ ❑ > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - -- - - - - - - -- - - - ❑ El ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?---- - - - --- - - - - - ---- ❑ x❑ ❑ Pump tank setbacks consistent with septic tank?-- - - -- -- - ---- ❑ N/A x❑ YES ❑ NO `1. Pump tank capacity (flood) 1275 gal Manufacturer Sound Placement < 24"access riser(s) and accessible from surface?- - - -- -- ---- -- ❑ El ❑ • : Alarm or Control Panel Installed? - - - -- - - -- - - - - - - - - - -- - ❑ El ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ ® ❑ a Pump installed in ® Bucket or ❑ On Block or ❑ Other • Pump Make/Model zol l er 152 El Floats or ❑ Transducer O=. Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 7 ft Pump on time 1 min Pump off time 4h rs Daily flow set at 300 gpd Updated 8/21/2018 Docusign Envelope ID:E4D5DA7C-2A4B-4ABE-885C-56ED4285CE7B Mason County OSS Installation Report pg. 2 Parcel# 22006-30-01010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --- - -- --- ---- -- ® YES NO If yes, please describe:Pumped and abandoned old septic tank 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,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 Initials: 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 Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all information contained on this f �g 49ched Record Drawing is accurate. form and attached Record Drawing is accurate. 03 16 202 Signature of Installer Date Jamie workman 2 Printed Name of Signee /�t� r� Wu MASON COUNTY PUBLIC HEALTH - . The undersigned approves this Installatipp•/� e,�ort an�� Record Drawing on behalf ofjf7on C uhty P'ul lio 26 Healt : N000,1 u DDESIGNER l7' G(( ?o 6 bjA �MEN TA4 HE 4 ns+lgt CTy Sign turn of Environmental Health Specialist 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:E4D5DA7C-2A4B-4ABE-885C-56ED4285CE7B X 3 Bedroom ATU to Pressure Trench ? NZ0 ; Asbuilt (SWG2026-00012) 7 ' AP o w AsoNc R 01 ?OZ6 Nry �.Q 4:- £MThAN!ELHaVERSCNNONh1ENTA� UEslt Initial N W A HEA�Ty ( EXPIRE6:mute► Parking - - - - - - - ca 2 w ------------------------------- / f \ o0 / r" \ i=n N 9 :! L / allo ,ts I / O /,'t 7.7 1) 4" ASTM 3034 with Cleanout w 20 / Yy 2) 660 Gal. Pre Trash , M '7 3) 4" ASTM 3034 / Al 4) NuWater BNR-500 W o / 5) 1200 gal Pump Chamber / 1 u 6) NuWater Control Panel/Power Disconnect / "555 ..J _ 7) 2" Sch40 Effluent transport line \` Oo toL / h , 8) Preferred Manifold Access {, 9) Rock walls '-,; , �. Owner/10) Assumed Waterlines Applicant: /SI 11) Existing Interceptor Drain \ - . / /:/ I:.! U J 00 O s; J Lo O •1N Rese�y0, elle I �� •N � � O Rese�e 1 z N O S • V This is not a suryeij: N i • ,e= This,4sbuilt Drawing is intended for the purpose of O locating and maintaining the septic system on this parcel. L- -0 `^ Measurements and distances are approximate. N ❑o 11 It is advised by septic designer Micah Halverson J X N to use a licensed surveyor to determine lot lines, - O- . a elevations,topography and to provide a legal site plan. = m >O Y Owner is responsible for establishing all property lines, a 2 30' 20' o' 1o' ao' 30' (�, easements and/or right-of-ways. Scale: 11=201 Inspection Date: 3/01/2026