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HomeMy WebLinkAboutSWG2021-00442-ASBUILT - SWG As-Built - 6/30/2026 f ' Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00442 Parcel # 221211400010 221211400010 Applicant Name NICK REYNOLDS Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 2133 City, State, Zip ALLYN WA 98524 Installer Name Site Address 10430 E STATE ROUTE 3 GRAPE Designer Name INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type 4 BEDROOM PRESSURE Pretreatment Type >5 ft.from foundation? - - - � NtA ®Yes ONO>50 ft. from wells? - - - - - - - - , -� >50 ft. from surface water? - - - - - - itf N f 6 ❑ II ❑ Cleanout between building and tank? - --------- --- ❑ ❑ o Tankbaftlespresent? - - - - - - - - - � - - - - - �� ❑ ® ❑ 24"access risers over each compartmh 't ---- ❑ ❑ W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ® ❑ Septic tank capacity (working) 1250 gal Manufacturer HAGGERMAN O D-box water level and speed levelers used? - - - - - - - - - - - - - -- ® N/A ❑ YES ❑ No a0 Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - 0 11 ❑ £QZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑ 04 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A YES [] NO >100 ft. from wells? - - - - - - - -- - - - - - - - - - - - - -- - - - - - -- ❑ S ❑ — >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - -- ❑ ® ❑ W t% >10 ft.from potable water lines?- - - - - - - - - - - - - - - - - - - - -- ❑ ® ❑ eZ > 5 ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑ ® ❑ tl > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ® ❑ © Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ Q ❑ ❑ Graveless chambers or D Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - - .- ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ NIA ® YES ❑ NO Pump tank capacity (flood) 1250 gal Manufacturer HAGGERMAN 2 4 24" access riser(s)and accessible from surface?- - - - - - - - - - - - - 0 K 0 M- Alarm or Control Panel Installed? - - - - - - - - - - - - - ❑ II ❑ a - - - - ❑®❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - a Pump installed in ® Bucket or ❑ On Block or ❑ Other _ $ Pump Make/Model LIBERTY 290 ® Floats or ❑ Transducer a Tank draw down 2 in!min Pump capacity 50 gpm Squirt Height 58 IN ft Pump on time 1:12 Pump off time 4:00 Daily flow set at 480 gpd Updated 8,2112018 Mason County OSS Installation Report pg. 2 Parcel # 221211400010 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? - - - - - - - - ❑ 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 drain field,existing and proposed buddmgs.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 I further certify that all information contained on this form and attached Re ord Dr wing is accurate. I m and attached Record Drawing is accurate. LS Signature installer Date tJAr�I 1c1 Printed Name of Signee MASON COUNTY PUBLIC HEALTH f"' The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: A eot L Signature of Environmental hLalth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212018 r / 1 / / I / / APPROVED JUN 302026 / / r / MASON COUNTY ENVIRONMENTAL HEALTH RET / / / WELL o? ALEXL.PAYSE $ LICENSED DESIGNER - EXPIRES RECO DG 4/ co / I / \ I / I i / / / 71 f 1 / I I j / , / ' I r/ / / 1 / ' SEE PAGE 2 I / / - - - - _ - - _ - - _ - - _ _ _ j CUSTOMER: NICK REYNOLDS SEE DESIGN FOR TEST HOLE INFORMATION (_N\ T II PARCEL: 2 2 1 2 1 - 1 4 - 0 0 0 1 0 ALPINE SEPTI ClSITE: 10430 STATE ROUTE 3 -DESIGN- ALEX L PAYSSE,DESIGNER SHEET:ASBUILT SCALE: 1"=200' DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE.APPLICANT/COUNTY PROVIDED PLATS OR 3089 E MASON BENSON RD SURVEYS,FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. GRAPEVIEW WA 98546 I I PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT 360-507.1546 0 0.5 7 2 RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS. I 1250 SEPTIC TANK ;/ (W/EFFLUENT PUMP i IN 2ND CHAMBE ; APPROVED / JUN 30 0 2026 MASON COUNTY ENVIRONMENTAL HEALTH EXISTING RET SHOP W/ ' BATH / / , DRIVEWAY ;' *CHANGE OF USE FOR SHOP MAY ' TRIGGER REQUIREMENTS FOR ' NEW DRAINFIELD AREA AND ITS ' OWN ONSITE SEWAGE SYSTEM. THERE IS SUFFICIENT SPACE WATERLINE AVAILABLE ON PARCEL TO (1o+) ACCOMMODATE ADDITIONAL DRAINFIELD. , / , 2" SCH. 40 TRANSPORT LINE / / CHANGE IN DESIGNER: DESIGNER INSPECTION i INSTALLED PRIMARY (AS PER DESIGN PERFORMED AFTER BACKFILL. 4-70'LATS,e'O.C.) CONTRACTOR PROVIDED ' © PICTURES OF GRAVEL& FABRIC. 1.5"WASHED ROCK USED. D / O N 100% RESERVE A © / (AS PER DESIGN) (, EXISTING INSTALLED TANKS eL � `' y 5110393 J HOME OA = CLEANOUT LICENSED DESIGNER = CONTROL PANEL EXPIRES ©= VALVE BOX RIEC®RD IDRAWING O= OB PORTS & CLEANOUT(X4) CUSTOMER: NICK REYNOLDS SEE DESIGN FOR TEST HOLE INFORMATION (N\ PARCEL: 2 2 1 2 1 - 1 4 - 0 0 0 1 0 ALPINE SEPTIC SITE: 10430 STATE ROUTE 3 DESIGN- ALEX L PAYSSE,DESIGNER SHEET:AS BUILT 2 SCALE: 1"=50 DISCLAIMER: THIS IS NOT A SURVEY. REFERENCES INCLUDE:APPLICANT/COUNTY PROVIDED PLATS OR 3089 E MASON BENSON RD SURVEYS.FIELD MEASUREMENTS AND COUNTY GIS. DESIGN INTENDED FOR SEPTIC PURPOSES ONLY. GRAPEVIEW WA 98546 I PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER DEPARTMENT/AGENCY REVIEW. DESIGNER NOT I 360-507-1546 0 0 I.5 1 2 RESPONSIBLE FOR SETBACKS UNRELATED TO SEPTIC COMPONENTS.