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HomeMy WebLinkAboutSWG2026-00037 - SWG As-Built - 6/15/2026 ..MU THWrtttl RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Owner Name C0\\ . ri QdUroto.ul-4- Assessor Parcel # �a•j aa'50 -OO 2.O 6 Mailing Address 6 C.v_N4 O/M Specialist Name -• �- Vtf City, State, Zip S� ,n, IL Installer Name- 04k\— Site Address e, Designer Name Please complete this checklist to the best of your knowledge. If items are unknown leave blank. INSTALLATION CHECKLIST System Type Oc\P Pretreatment Type N -- tom- c -r n�n�LL00 Drainfield Ln. Ft. L4 Drainfield Sq. Ft. Dl Drainfield depth (,'t M1M.. >5 ft. from foundation? - - - - - - - - - ❑ N/A 1. YES 0 N - - - - - - - - - - - - - - - - >50 ft. from wells? - - - - - - - - - - - y >50 ft. from surface water? - - - - - - - -�F � 4J-I ❑ [� ❑ Z Cleanout between building and tank? - ❑ ❑ Tank baffles present? - - - - - - -- - - _ '� JUL 1.306 _ ❑ mod,/ ❑ 4 24"access risers over each compartme it?- - - - - - - - - ❑ L!J ❑ NEffluent filter installed?- - - - - - - - - -� -y- - - - - - [ ❑ ❑ Septic tank size 1 O 10 gal Manufacturer cr-o�rc r 3N 'cOC7 C D-box water level and speed levelers used? - - - - - - - - - - - - - - - N/A ❑ YES ❑ NO QOManifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ( ❑l ❑ C9Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ L5d ❑ 0< 11 2 Transport Line Size I'l lV�c.L Schedule/Class $L 40 Bedrooms installed (if known) ❑ 2 '3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A dES ❑ NO >100 ft. from wells?- - - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ / ❑ W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ti >10 ft. from potable water lines?- - - - - - - - -- - - - - - - - - - - -- ❑ i ❑ Z > 5 ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - -- 0 G Observation ports present? ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) r-,� Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ tyu ❑ Pump tank setbacks consistant with septic tank?- - - - - - - - - - - -- ❑ N/A YES ❑ NO ZPump tank size ( Old gal Manufacturer f Q 24"access riser(s)and accessible from surface?- - - - - - - - - - - -- 0 ❑ F- Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ a. � Control Panel equipped with Timer/ ETM/Counter- - - - --- - - - - - ❑ o ❑ n - Pump Pump installed in ❑ Bucket or 11❑ On Block or Other a Pump Make/Model 0 re.r c Mtde! PV 1()(O O Floats or ❑ Transducer = Tank draw down,''>a in/min Pump capacity (�'� gpm Squirt Height A ft 0. Pump on time 't Mw 2 kL Pump off time Z�r Dally flow set at _gpd Up. Zed Mason County OSS Installation Report pg. 2 Parcel # 32122-50-00206 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- ® YES NO If yes, please describe: AN EXISTING SEPTIC TANK& FAILED DRAINFIELD WERE DECOMMISSIONED PER CODE. 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: Drainfeld&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. © 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 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 7-2-26 S ature of Inst ller Date ?cth+ t r Printed Name of Signee MASON COUNTY PUBLIC HEALTH Fw The undersigned approves this Installation Report and t c2� Record Drawing on behalf of Mason County Public c ' w Health: Q�..J4ST Q.QQ?FR- 6/15/2026 Signature of Environment 1 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 AS-BUILT DATA: PRE-TREATMENT DRIP IRRIGATION CLIENT: SITE ADDRESS: E } PARCEL: 3j5&L INSTALLED BY: Lc 1Jrk3 ( TkG PHONE. 2S3 2�. - �iZvl PERMIT #: JC- -_22 - DOo 3-7 BACKFILL DATE: INSPECTED BY: ATU TANK: „��; ,, C. t0'O ATU: PUMP TANK: , ' �, u r I0�D PUMP: r ,I6 CONTROL PANEL: HEAD WORKS: ,,, l DRIPLINE: g t ru,M , L -/Z V 560 viz EMITTER FLOW RATE: , TIMER SETTINGS: ON: 't 2 5e � , OFF: 'l4k DOSES: GAL DOSE, ( DOSES PER DAY., 36O GPD SUPPLY LINE: 70 LF 1" PVC RETURN LINE: ______LF 1" PVC LATERALS. L. LF 1.5' O/C: (. 3 TRENCH DEPTH: __ COVER MATERIAL: w RETURN VALVE CLOSED: S,H GALLONS PER MINUTE - PSI PRE FILTER 59 PSI POST FILTER RETURN VALVE OPEN: 1, GALLONS PER MINUTE 6 PSI PRE FILTER PSI POST FILTER _____ PSI RETURN RETURN SET AT 10 PSI: GALLONS PER MINUTE 5 PSI PRE FILTER .57 __ PSI POST FILTER PSI RETURN J COOPER DESIGN INC 1021 S FERRY ST TACOMA, WA 98405 253-576-5937 IMPORTANT NOTICE DATE:7/10/26 THIS ISNOT DERIVEr THE IPUBLIC ECNAND DINNE STATEMWN RECORD DRAWING DATA PRE-TREATMENT SUBSURFACE DRIP AN FI LD DERNED FROM PUBLIC RECORDS,OWNER STATEMENTS. ASDTOACCURACYVWE RECOMMEND THA WIHEN QUESTIONS EXIST EO COOPER DESIGNS BYONESCOOP INC r000vN000srA,orTESESURVEVORPRORTOCONERRUCTIONORRELoANCEONFTHISINFORMARo 12201 OSPREY DR NW THIS INFORMATION IS ONLY INTENDED FOR THE PURPOSES OF SEPTIC S VS TEM CONSTRUCTION AND AS BUILT LOCATING. GIG HARBOR,WA 98332 7 )Iti coopjustin@gmail.com (253)376-0479 �'• CLIENT: COLLEEN BOURGAULT L\ 23013594 ' QL PHONE: 360-490-2484 SITE ADDRESS: 61 E CARDIGAN CT SCALE: 1" = 20' PARCEL: 32122-50-00206 INSTALLED BY: PETTIT LAND WORKS-JAKE PETTIT PO BOX 732186 PUYALLUP,WA 98373 PHONE:253-722-4201 0 20 40 PERMIT NO: SWG-2026-00037 BACKFILL DATE: 616/2026 INSPECTED BY: JUSTIN W COOPER ATU: INFILTRATOR 1070 GAL CM-1060 3 COMP NUWATER BNR600 PUMP TANK: INFILTRATOR 1070 GAL CM-1060 SINGLE COMP PUMP: ORENCO MODEL PF2010 CONTROL PANEL: NUWATER ALARM: TANK ALERT DOSES: GAL/DOSE:30 #OF DOSES/DAY: 12 DRAWDOWN: 25 GAL/INCH 6.4 GAL/MIN GALLONS PER DAY:360 SUPPLY LINE: 67LF 1"SCH 40 PVC RETURN LINE:58LF 1"SCH 40 PVC LATERALS: 450LF TIMINGS: ON TIME 0004:02 "OFF-TIME:020000 TRENCH DEPTH: 6" 911 MAKE/MODEL OF DRIPLINE: NETAFIM 08WRAM.4-12V500 12"DIA DRIP LINE /� DRIPLINE SPACING:1.5'O.C. EMITTER SPACING:12' MIN DEPTH OF COVER: 6"-10" G1 DOSING PRESSURE(PRE-FILTER): 59 G2 DOSING PRESSURE(POST-FILTER):57 G3 DOSING PRESSURE(FLUSH-LINE): 10 / DOSE FLOW RATE: 7.3 GPM ll/ JL PAGE 1 OF 1 0 1r MCI-ID APPROVAL O 010 <Jt G0 PP O6E SOP G� ' G rte\ AIR RELIEF VALVE(SI 0 5 GRAVEL DRIVEWAY PRIMARY DRAINFIELD FI / DRIP IRRIGATION WITH A PRETREATMENT DEVICE C' MEETINGTREATMENTLEVEL'B' .;QP�� 0h / 450LF OF NETAFIM 08WRAM.4-12 112 DRIP LINE 55O/C / 675 SQ ABSORPTION AREA () / -BEGINNING OF LATERAL / -END OF LATERAL PROVED JUL 28 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET _ - Ali1 / : 3 1 ' J / 1 rt e r , I ) ) / 1, / ______ -.. -- \ :- _iThhh1d.\, - ''' - : . - .: ____ jit t : 4 Ala Milam From: DO NOT REPLY <noreply@masoncountywa.gov> Sent: Wednesday,June 10, 2026 10:57 AM To: Environmentalhealth Subject: OSS Inspection request for Colleen Bourgault - SWG202S-00360 Submittal request for:Colleen Bourgault r1 Site Address: LP I C CL#V(-A I Permit Number: $ lv& Parcel Number:321225000206 Installer Name:Jake Petit (l 2O, Installer Phone Number: 2537224201 Installer Email Address:jake@pettitlandworks.com Designer Name:Justin W Cooper Designer Email Address: coopjustin@gmail.com if yam Inspection Request C ,te:2026-06-12 r ' Inspection Type: Full 5,•stem Comment\ Notes: Thank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspection Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation be accommodated by approval prior to backfill of system components. If no contact is made by the health department within the three s of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must � business day royal. be submitted for final installation app ,1 • .ir MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2026-00037 ADDRESS: 61 E Cardigan Ct PARCEL: 321225000206 DATE: 6/12/2026 #`• bra y �.,i-. HOUSE TO DRAINFIELD$w x 1! ' DRAINFIELD TO HOUSE