Loading...
HomeMy WebLinkAboutSWG2021-00622 - SWG As-Built - 6/3/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number sWG 2021-00622 Parcel # 32127-54-00072 Applicant Name Deann Rodius Subdivision (Name/Div/Block/Lot) Applicant Address 710 E Hickory PI LAKE LIMERICK 5 TR 72 City, State, Zip Shelton, WA 98584 Installer Name Villines Excavation, LLC Site Address 821 E Olde Lyme Rd, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ® Other 500 gallon pre-trash tank System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft.from foundation? -- -- - - - - - - - - - - - - - - - - - El N/A AYES NO >50ft.fromwells? - - - - - - - - - - - (} ( { {�-� ❑ 0 El >50 ft.from surface water? - - - - - _ _ U - - l`.J L�1 ❑ A El Z Cleanout between building and tank? - i -MAY-2-T-2mFft ❑ ❑■ ❑ U Tank baffles present? - - - - - - - - - - - -- - - - - - - - - - - - El 0 El - 24" access risers over each compartmCl) UI Ir ?.- - - - - - - - - - - ❑ ❑ W Effluent filter installed?-- - ❑ ❑ Septic tank capacity(working) NuWater 500 gal Manufacturer Infiltrator O D-box water level and speed levelers used? - - - - -- - - - - - - - -- - ❑ N/A ❑ YES 0 NO O Manifold/D-box accessible from surface? - _ _ _ _ _ ❑ 0 ❑ CI Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ O4 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) El 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - — - - ❑ N/A Q YES ❑ NO n >100 ft. from wells?-- - - - - ------- - ---- -- - ❑ U El W >100 ft. from surface water?- - -JUN -a--296- - - - ❑ © El ti >10 ft.from potable water lineVAMP CG U Y�Nu 0NMENTAT HEALTH El 0 ❑ Q > 5 ft. from property lines and easements?- - - - - - - - - - ❑ ❑ W > 30 ft. from downgradient curtain/foundation dram`s` - -- - - - - - - - ❑ Q ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ 0 El Proper cover installed overdrainfield?- -- - - - - - - - - - - - - - - - - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank?- - - - - - - -- - - - - ❑ N/A © YES ❑ NO Y Pump tank capacity(flood) 1,287 gal Manufacturer Infiltrator z Li © ❑ < 24"access riser(s)and accessible from surface?-- - - - - - - - - - - - Alarm or Control Panel Installed? ❑ © ❑ Control Panel equipped with Timer/ETM /Counter - - - - - - - - - - ❑ Q ❑ Pump installed in ® Bucket or ❑ On Block or ❑ Other 0" Pump Make/Model Zoeller EF5 Stage 19gpm, 1/2hp, 115v ❑■ Floats or ❑ Transducer LL Tank draw down -- in/mm Pump capacity 4.0 gpm Squirt Height -- ft Pump on time 7.5 min Pump off time 1.9 hr Daily flow set at 360 gpd Updated 8/21/2018 I Mason County OSS Installation Report pg. 2 Parcel 32 21 ^ 0ö 2 ABANDONMENT RECORD Were existing septic compone nts abandoned as part of this project? - -- --- - - - - -- - - - ❑ YES NO if yes, please describe: Were all components pumped out and properly abandoned per WAC24b-272A-0300? -- - -- - -- ❑ YES O NO RECORD DRAWING enough at the need of m*rtena:ce as ea and faRUre development Typical Recd This is a permanent record and mast be aecurffie and dasc:�tive to re.oce in oraa+ngs cixttain: Drain bald 8 rnanitoid odenton&ayout,SepticJpurn tank iacat a ,North arrow,reserve ranted,ews ng aid proposed tx ltd rigs,I motion a:`weds.water fees, welts,observation pats,ctharrouts,and other rr.aeneeance access points. lncanpiete Record Drawings may cease additoral delays in fsnai instatlaiwn approval and ralaled permits. SL JUN 0 3 20? MASON COUNTY ENVIRONMENTAL HFT'I J� Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/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 clearedlapproved by both the designer shown here have been clearedlapproved 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 1 further certify that all information contained on this I further certify that ali information contained on this form and attached Record Drawing is accurate. fore and attached Record Drawing is accurate. -z� 16 Signature of installer 1e t rtR�l5 \j\L�-1 ,vEs Printed Name of S- nee MASON COUNTY PUBLIC HEALTH l` The undersigned approves this Installation Report and �l Record-Drawing on behalf of Mason County Public PAULA JOY JOHNSON Heat)c/ Li - LiCE#Jsi ₹5b $i8► ` Sig ure vironmental He Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/2'/2018 / /, S By t L t Ld tin L i Je6i}'r d uS �artfr 32127-5'1-OOC72_ Ofd/ '7 /7 LNr�_ c 0 f5 30 4'S Coo 4/ Y / o � / / / APPROVE - JUN 03 2025 / MASON COUNTY ENVIRONMENTAL HEALTH JBW • / / ' \ A / . / d_ __ -_•\ \ t , . �J1�7�1�. m.n �4. PAULA JUY JOHNSON ' O 0 Egy'�. .� aft:, e 1 LiLSti�15Et�}�Lr�# 3° 411 ZP \ \ rY \ ��•: i'` 0 Audio-Visual -*^ \ ` t _� � 2J Cleanout C500 Ga=?on Pre-Trash Tank • V O NuWate=BNR-500 Pretreatment Lij �►� U 1,000 C-a±on Pu=p Chamber 5 Subsurface Drip System HeadworYS