Loading...
HomeMy WebLinkAboutSWG2025-00183 - SWG As-Built - 6/6/2026 n t Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025 00183 Parcel # 41927 32 00010 Applicant Name Charlotte Wybenga Subdivision (Name/Div/Block/Lot) Applicant Address 4464 SR 108 TR 1 of SW 1/4 City, State, Zip Shelton, Wa 98584 Installer Name Workman Construction Site Address 4464 SR 108 Designer Name Chris Elstrott INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pir-'s'" . 77 Pretreatment Type "✓ A >5 ft. from foundation? - - - - - - - - - - Ti�y�p rTr ❑ N/A YES ❑ NO >50ft.fromwells? - - - - - - - - - - - -- �=-r}{ TI'.'5 ❑ ® Elr Z >50ft.from surface water? - - - - - - - - -rl - ------ ____ - ❑ Q ❑ Q Cleanout between building and tank? -- 4-+i- 3.LL-L Q ZQ1�_ - C I ❑ ® ❑ U Tank baffles present? - - - - ❑ ❑ d24" access risers over each compartment?icy=-- W Effluent filter installed?- - - - - - - - - - - ----- - - - - - - - - - ❑ ® ❑ -- CO) Septic tank capacity (working) 1 Z- C gal Manufacturer' j(-ESA-7.- 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ® NIA ❑ YES ❑ NO O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ O ❑ mZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ © ❑ 2 Transport Line Size 2 Schedule/Class `fC Bedrooms installed (check one) ❑ 2 ❑3 ❑4 V] 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A YES ❑ No >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ 0 ❑ W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ti >10ft.frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ❑ Z > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ ® ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - -- ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ WGraveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ O ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - -- ❑ N/A IZJ YES ❑ NO zPump tank capacity (flood) O gal Manufacturers Q 24" access riser(s) and accessible from surface?- - - - - - - - - - - -- ❑ II ❑ aAlarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Control Panel equipped with Timer/ ETM/ Counter - - - - - - - - -- ❑ ® ❑ Pump installed in ❑ Bucket or 0 On Block or ❑ Other � Pump Make/Model �- r Floats or Q Transducer Tank draw down V2- in/min Pump capacity 2-3 gpm Squirt Height ft Pump on time G `" Pump off time y a /t Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 41927 32 00010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- ES ❑ 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 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date �JGLt�t�{'L 1/O�cTC1�INtC.r. Printed Name of Signee - MASON COUNTY PUBLIC HEALTH $ The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Signature of Environm ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121'2018 VgC�0�n11TV 14 : ti - + -- -� '/- 8O . ;4 tea- G - s�9 ' G/ 91 7).',,E a rp,eE Z O- Gf' ,, SAG�I ,4PP 9- ro i'y54G� #yo y� OVE® y'� ��, " Gni Q s�J ,tea 1Wie-441 ) .eo Fizvm JUL 2 8 ZQ2 � _ MASON COUNE TY NVIRONME RET NTAL HEALTH . THURSTON COUNT'y c 7 DIREC'f'p�uls TO 4i► RECORD) DRAWING , / - ,-wA - s Bedroom residence= �� G.P.D. C riaar )GVOKKm�-;it/ l�NST. � P Y --•---• z ,,,,,; ,. L� �a � [ �( LIB weabI1P I 3- �ae� (primary) 0.6 G.P.D./S.F.= G.P.D. (reserve) >G 4• .D./S.F. /200 C.J/L GANG t•T.P(1/ tC ---- ry Zr3.Z �Gp �` i — \ 1.` DRAII;FIELD. 3. /So GAL. '�O4)e SEPTIC TANK. 4. /SUO Gam. " T- '/K. // Z''5��� Rio PVC DELIVERY LINE. 1 S. 4" PVC ASTU 3034 TICHTLINE. NIN. SLOPE = 2S / 7. 4" PVC CLEANOUT, e' WATERLINE. MUST BE LOCATED MIN. 10' 6Zo FROM ALL SEPTIC SYSTEM COMPONENTS. / Rc9Xl4T_ Gcz' yam/ OWNER: LEGAL DESCRIPTION ADVANCED ENGINEERING ; JOB NUMBER 128 N. River S#reef Cfi�,9E'�Trr wf/c�r.vG.� S:z7 T:/y R:y T-P-# 5'/927- -C6o/o SU , �-6 -Z6 4/56�✓ W S.Z io —���- Montesano, WA 98563 �p SATE 360-249-8447 , y = i sr,, y SCALE:/ SHT OF /