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HomeMy WebLinkAboutSWG2023-00508 - SWG As-Built - 7/7/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG �6,� --o s 6c Parcel # 421355000047 Applicant Name Jack&Alisha Killman Subdivision (Name/Div/Block/Lot) Applicant Address 16506 N Wylie Drive Nine Mile Fall: City, State, Zip Shelton,WA 98584 Installer Name Bo Russell Site Address 790 W Clear Lake Drive Designer Name Bob Payse INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other System Type Sand lined oressure trench Pretreatment Type >5 ft.from foundation? --- ---- - 1 Fu r-[j '1-,r�- - ❑N/A ®YES ❑ NO >50 ft.from wells? ----------IIJJ- ❑ ❑ Z >50 ft.from surface water? - - --- - - 2-5- O96- - ❑ ® ❑ <Q Cleanout between building and tank? U L--- - - ------------ ❑ ❑ U Tank baffles present? - - - --- - -- - _ ___ - ❑ ® ❑ d24"access risers over each compact tW Effluent filter installed?- - ---- - - -- ----- ---------- - - ❑ ® ❑ Septic tank capacity(working) 1500 gal Manufacturer Sound Precast o D-box water level and speed levelers used? --- -- --- - ----- - ® N/A ❑YES ❑ NO �O Manifold/D-box accessible from surface? - -- - - - -- --- --- - - ❑ © ❑ c, 2 Check valves installed? - --- - - - -- - - - -- ---- - - - -- - - -- ❑ ❑ II 2 Transport LIne Size 2" Schedule/Class Sch.40 Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑■ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- ---- ---- - ---- -- -- -- - -- - - -- ❑ N/A NYES ❑ NO >100ft.fromwelIs?------- - - - -- - - -- ------ - - - - - -- ❑ ® ❑ >100 ft.from surface water? - - -- - - - ----- --- - -- - - - --- ❑ e ❑ >10 ft.from potable water lines?- -- --- - - - - - -- - - - - - - --- ❑ ® ❑ Z >'5 ft.from property lines and easements?- - -- - - - --- - - - - - - ❑ ® ❑ > 30 ft.from downgradient curtain/foundation drains? - - - - - - - - -- ❑ ® ❑ Drainfield level and observation ports present -- - -- - -- - - -- -- ❑ ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?--- -- -- -- ---- --- ---- ❑ t ❑ Pump tank setbacks consistent with septic tank? ------- ----- - ❑ N/A I YES ❑ NO ZPump tank capacity(flood) 1500 gal Manufacturer Sound Precast Q '24"access riser(s)and accessible from surface?------- ----- - ❑ ® ❑ o~. Alarm or Control Panel Installed? -- - - - - -- - --- - ----- -- - ❑ I ❑ Control Panel equipped with Timer/ETM/Counter-- --- -- - --- ❑ 0 ❑ M n- Pump installed in ❑ Bucket or E On Block or ❑ Other Pump Make/Model Zoeller N152 ® Floats or ❑Transducer a Tank draw down 3 in/min Pump capacity 77 gpm Squirt Height 5 ft Pump on time 1.5 Pump off time 4 hrs Daily flow set at 600 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 421355000047 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ----- - -- ----- - - ❑ YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - ----- - - ❑ YES Q 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,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 4{T PPROVE JUL U 7 c0N COU`!lv Fi%iiv/Rn� Jaw Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /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 /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. O,o ar,T.a M 8.Pu„N Bo Russell ORCV9 E-e.eM1•sw O.aue.c w nn `"`°°"° 6/15/2026 or:ro noToo Signature of Installer Date 6IllIt- Bo Russell _ Printed Name of Signee /-;�,••� �•.I•-; , ), MASON COUNTY PUBLIC HEALTH :' The undersigned approves this Installation Report and ::' AD r.1.1 I UNTrR Record Drawing on behalf of Mason County Public .`l• ,He 7,7-;4 .tur o vironmental 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 H SCALE:1'=40FT RESERVE AREA C7 f l DRAFlEL IND VALVE BOX 1W` > / 609.8 150.0 >I FORCEMAIN \ mSEPTIC TANK \ �\ IIIT // , PUMP CHAMBER EXIST( WELL /// //// /// / ////////////// //// //// .0 �. WATERLINE I % //// /5/i I / sTb � eOUT I S INSPECTION PORTS I LAT.cLEANou7s = / (STING DRIVE JY PATIO 1537 573.5 EXISTING 4 BORN RES / LAKE _ C PRESSURE TEST COMPLETED BY INSTALLER: SQUIRT HEIGHT:J (O ,, p`L "� r HUNTER SEPTIC DESIGN CONTRACTOR DRAWDOWN: Z ✓i- S.hh/ /O212 ROSS CONSTRUCTION '7 2201 93rd Ave SW I Olympia,WA 98507 360-890-27781 adarn hunlersepticdesign.com INSTALLDATE.5125125TIMER SETTINGS- � ON: I.S •.••"� �, .. .., SmT MKIRESS/LEGAL0FF ' RECDRD DRAWING FOR, 790W CLEAR LAKE DR y H S �T7 c:•) j ` " BO RUSSELL C .,,,. _ FINAL GA,E 5125/26 � ivi��fit i iiµ '� SITE I PERMIT I: � � � •.+ PARCEI NINABER: 421355000047 SWG 2023-00508 OWNER STATEMENT REGARDING RECORD DRAWING PREPARATION Property Owner: Ian Parnell Parcel Number: 421355000047 Site Address: 790 W Clear Lake Dr Permit Number: SWG 2023-00508 To Whom It May Concern: I am the owner of the above-referenced property. Following completion of the onsite sewage system installation, it became necessary to obtain a record drawing (as-built) for submission as part of the project closeout requirements. The original system designer was contacted regarding preparation of the record drawing but was unavailable and/or did not respond. In order to complete the project and satisfy the documentation requirements associated with the permitted installation, I authorized Hunter Septic Design to prepare the enclosed record drawing based on field observations and measurements of the installed system. The onsite sewage system was installed by Russ Construction in accordance with the approved permit and design requirements. The enclosed record drawing prepared by Hunter Septic Design is being submitted to document the location and configuration of the installed components. I respectfully request that the enclosed record drawing be accepted as part of the project record for Permit No. SWG 2023-00508. Please contact me if additional information is required. SiyYc rely tan Parnell, Property Owner Date: 1 ONE Z4Z