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HomeMy WebLinkAboutSWG2023-00228 - SWG As-Built - 6/5/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLLPANTI PERMIT Permit Number SWG 2023-00228 Parcel# 12207-50-00019 Applicant Name Devereaux Lake LLC Subdivision (Name/Div/Block/Lot) Applicant Address 220 E Cronguist Rd LAKEWOOD PLAT M TR 16 EX E 100 S 53/140 City, State, Zip Allyn,WA 98524 Installer Name Maples Excavating Site Address 181 E Lucky Ln,Allyn Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only U] Repair ❑Other System Type Shallow Pressure Pretreatment Type >5ft.fromfoundation? -- ---- -- - -- - --- - -- ---- ❑ NiA U] YES LINO >50 ft.from wells? - - - - - - - - - - - ❑ U] ❑ >50ft.fromsurfacewater? -- - -- - - - -- - - - - - - - - - - ❑ Q ❑ Cleanout between building and tank? 1111- JUN-U-2?025- - - ❑ ® ❑ Tankbaffiespresent? - - --- -- -- -- -- - - - - ---- -- - ❑ It ❑ 24"access risers over each compartm fit?--- -j- - - ❑ ❑ l, ;zEffluentfilterinstalled?-- ---- - -- --- - - - --- - - ❑ It ❑ Septic tank capacity(working) 1.000 gal Manufacturer Roth r � D-box water level and speed levelers used? ---- ---- -- - ---- ❑ N/A ❑ YES ■❑ No iJ Manifold/D-box accessible from surface?--- --- -- - -- - - ---- ❑ ® ❑ Checkvalvesinstalled? -- -- - - - --- - -- - -- -- --- -- --- ❑ U] ❑ Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) III 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?-- -- - - ------ -- - - -- -- - ----- ❑ N/A DYES ❑ N0 >100ft.₹romwells?------ - ------ ---- - -- ----- ---- ❑ ❑ >100 ft.from surface water?- - - - - - - --- ---- --- - - ❑ ❑ Scee >10 ft.from potable water lines? -- - - --- -- - - - - ❑ ❑ > 5ft. from property lines and easements?- - - - - - - - --- -- - - - ❑ 0 ❑ > 30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - -- - - - - - --- -- ❑ ® ❑ ❑ Graveless chambers or U] Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - ---- - - -- - - -- - ❑ ® ❑ £Pump tank setbacks consistent with septic tank?-- ---- - --- - -- ❑ N/A ❑■ YES ❑ NO Pump tank capacity(flood) 1,000 gal Manufacturer Roth 24" access riser(s) and accessible from surface?--- --- -- - - --- ❑ Ii ❑ Alarm or Control Panel Installed? ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter-- - - - - - - - -- ❑ ® ❑ - Pump installed in ❑ Bucket or On Block or ❑ Other Pump Make/Model Zoeller N152 [ Floats or ❑ Transducer Tank draw down 1.25 in/min Pump capacity 31 gpm Squirt Height 7 ft Pump on time 1.9 minutes Pump off time 6 hours Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS installation Report pg. 2 Parcel# 22_O 1- O 0-OQ6 Q ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- ■ YES ❑ NO If yes, please describe: U L& 0 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.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 I certify that I installed the system in accordance with 1 certify that the system has been installed in accor- the septic design stamped"APPROVED"by Mason dance with the septic design stamped APPROVED A 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 l further certify that all information contained on this /further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date Al Printed Name of Signee o ti MASON COUNTY PUBLIC HEALTH o' 1� The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public f PAULA JOY JOHNSON Health- 11YY J J v� (P-•-2-?� Signature of Environments Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212018 j e,Je- x. {�j (/-►,spy rL fs 1 P 2GEL t1toi-So-ooc tQ (gLD DPPc) FIELD E 1._uc y 1-,n IE 1 L� OLT/ S. . ' T - APPROVED © S JUN 05 2026 MASON COUNTY ENVIRONMENTAL HEALTH 2� X • • RET TT •• I •O aLo ( l � k�1 1 Audio-Visual Aiarn, L _____ __ Cleanout ZQ"t = 4L-F 3g' f f 3 ?.000 Cron Septic Tank -m ylfay �� 3�' 4,q 3 2-Comp ent with T?sNGos5® EfrIuent Filter w E v j — 1,000 CraIlon Pump Chamber L_F AAM } ( ) Valve Control Box II 5� A . G S • � -a� �f y�� •' 1OO349O i L 1 ` N"' PAULA JOY JOHNSON ':''tL 0� E' q -9 5 y 6-V2(o `�