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HomeMy WebLinkAboutSWG2025-00355 - SWG As-Built Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00355 Parcel# 32127-52-00017 Applicant Name Jess Mosley Subdivision (Name/Div/Block/Lot) Applicant Address 163 Hawthorne LN City, State, Zip Shelton,Wa 98584 Installer Name Spear Construction Site Address 290 E. Shamrock Dr Designer Name Bob Paysse INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type ATU-Drip Pretreatment Type Nuwater BNR 500 >5ft.fromfoundation? - - - - -- �� ] --•- ❑■ NIA ❑YES ❑ NO >50ft.fromwells? - - - - - - - -- - - - - - - - - -�/- - - -- - ❑ ❑ Z ; >50 ft.from surface water? - - - - -APR- 2- -zoo - - -- ❑ ® ❑ Q ' Cleanout between building and tan . --------- - - - -- - ❑ i ❑ ` Tank baffles present? - - - - - - - B - - - - - - - - -- ❑ UI ❑ p 24"access risers over each comp -- - - -- ❑ ® ❑ WEffluent filter installed?- - - - - --- - - - - - - - - - - ----- - - - - ❑■ ❑ ❑ Septic tank capacity(working) 1050 Nuwater gal Manufacturer Sound Placement D-box water level and speed levelers used? - - - - - ----- - - - - - ® N/A ❑YES ❑ NO J• Manifold/D-box accessible from surface?- - - - - - - -- -- - - - - - - ❑ ® ❑ cOZ- ; Checkvalvesinstalled? - - --- - - --- - - - - - - - - - - - -- - - -- ❑ ❑ CQ , 2 Transport Line Size 1e Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - - -- - - - - - ------ - - - - - --- - -- 0 NIA DYES ❑ NO >100ft.fromwells?- - - - - - - - - - - - - - - - - - - -- - - - - - --- ❑ © ❑ >100ft.fromsurfacewater? ❑ 0 ❑- - - - - - --- - - - - - - - - - - -- - -- u.l CL >10 ft.from potable water lines? - 4 - ❑ ® ❑ Z >5 ft from property lines and easemnts - j; - - ❑ 0 ❑ >30 ft from downgradient curtain%foundation drains?.r - - „`. ❑ ® ❑ • 'D �� �'-.� Aaae� �- - -Ir� Drainfield level and observatioqports present-- - - - - - - -- ❑ ® ❑ G'4k' i ❑ Graveless chambers or CleaPg�av�IpQ, e8i -6%eekHone�H Proper cover installed over dramfield?-- -- - , 9 -------- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ---------- - ❑ N/A ® YES ❑ NO Y ;Pump tank capacity(flood) 1500 gal Manufacturer Sound Placement Q ;24"access riser(s)and accessible from surface?- -- - - - -- ---- - ❑ 0 ❑ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ D Control Panel equipped with Timer/ETM/Counter - - - - - - - - -- ❑ ® ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Flow Inducer Pump Make/Model 1/2 hp turbine PF 2005 ® Floats or ❑ Transducer d. Tank draw down in/min Pump capacity 8 gpm Squirt Height n/a ft Pump on time 6 min. Pump off time 2 hr. Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg.2 Parcei# 32127-52-00017 ABANDONMENT RECORD Were existing septic compertents 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 a).rawingscontain:l)ralnfield A:manrfdid-cnenlation&layout,Septiepump tank location.North arrow,reserve drainfeld,existing and proposed buildings,location otwells,waterlines, 'wails,Observation ports,oieanou`ts,and other maintenance access points.Incomplete Record Drawings may create additional delays in final installation approval and related permits. ill , xk�"� APR 302026 MASON COUNTY ENVIRONMENTAL HEALTH Jv Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERi ENGINEER I 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 attar ed Record Drawing is accurate. form and attached Record Drawing is accurate. � Z y gn ras df In taller Date Logan Spear Printer!A'farne of SI nee 9 •�wv 'r •� ri MASON COUNTY!PUaLIC HEALTH 7129:undersigned approves₹his Installation Report and RT N , rt'G6ES1 0 VAl'� E ;9 :Reco swing on:behalf of Mason County Public EXPIRES Health: Sig n n En, `ronrrlental l-i alth Specialist Date (stamp,signature and date) THIS FORM-MAYBE SCANNED AND AVAILABLE FOR PUBLiC'VIEW ON THE MASON COUN7YWEB SiTE Updated 812112018 '" SHAMROCK DRIVE PROPOSED WATERLINE .k7 MAINTAIN 10'+ OR DBL SLEEVE AS REQ. _ __/ - DRIVEWAY I rri 675 SQFT PARKING / 11111 1 I (PRIMARYAREA) 1 11111111111 I I I 1 1 IIIIIIIIIIII IIII1111111 I flllllllllll IIIIIIIIIIII 52' iiiiiiiiiiii I 111111111111 111111111111 111111111111 111111111111 - ----------L_1_,1 13' iiiiiiiiiiiiI (10'MIN.) IIIIIIIIIIII 11III1111iiiiN PROPOSE I N 3-BEDROOM Il 900 SQFT [ HOME I (RESERVE AREA) I I I I C/O 0 I N 1 18' I NUWATER BNR500 & 1500 PUMP TANK ' p © W \ fyR' �,x'�J P !� 20 1NASON COUNTY ENVIRONMENT L HEALTH 75' j j:? �eer:czr H vdY.5E � t;::Flid�S AN ASBUILT/INSTALL SIGNOFF FEE WILL BE CHARGED AT TIME OF INSTALLATION PIONEER. DIGGING INC, CUSTOMER: JESS MOSLEY TEST HOLE I: TEST HOLE 2: TEST HOLE 3: PARCEL#.32127-5200017 0-32 GSL 0-32 GSL 0-28 GSL 32+TILL 32+TILL 28+TILL SEPTIC DESIGNS ADDRESS: 290 SHAMROCK DR ROOTS @ 32 ROOTS @ 32 ROOTS @ 28 3083 E.MASON BENSON RD. GRAPEVIEW,WA 98 446 DESIGNER: ROBERT K PAYSSE DISCLAIMER:THIS IS ROTA SURVEY.REFERENCES INCLUDE:APPLICANTICOUNTY PROVIDED PLATS OR SURVEYS.FIELD MEASUREMENTS AND COUNTY 015.DESIGN INTENDED FOR SEPTIC OFFICE 3604261803 FAX 360427-2353 p PURPOSES ONLY. PROPOSED DEVELOPMENT MAV BE SUBJECT TO OTHER SHEET: SITE PLAN SCALE 1 =20' DEPARTMENT/AGENCY REVIEW.DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.