HomeMy WebLinkAboutSWG2024-00011 - SWG As-Built - 5/29/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00011 Parcel# 3202246-90131
Applicant Name Stephanie&Ted Brackett Subdivision (Name/Div/Block/Lot)
Applicant Address 1901 W. Beaver Lake CL SE
City, State,Zip Sammamish,WA 98075 Installer Name Bucky Menke
Site Address 130 SE Femwood Ln., Sheflon Designer Name Dale L.Tahla
INSTALLATION CHECKLIST
❑ Full System Installation ®Tank(s)Only ❑Drainfeld Only ❑Repair ❑Other
System Type Pressure Trenches Pretreatment Type
>5ft.from foundation? - --------------- It �g fr ❑WA ®YES ❑ NO
>50 ft.from wells? - -- - --------- O �4414 FMJ-�-a ❑ e ❑
Z >50 ft.from surface water? -- -- -- -- - -- -- uu ❑ ■ El
Cleanout between building and tank? - -- _ _MAY_L g,�024_ ❑ ❑
Tank baffles present? -- -- -- -- -- -- --- - ❑ El
d 24"access risers over each compartment? gy-- ❑ e ❑
W Effluent filter installed?- - -------------------------- ❑ ❑
0
Septic tank capacity(working) 1.200 pal Manufacturer Premier
0 D-box water level and speed levelers used? --- ----------- - ❑ NIA ❑ YES NO
0O Manifold/D-box accessible from surface?---------------- - ❑ ❑ ❑
rot Check valves installed? - ----- - -- ----- --- --------- ❑ ❑ ❑
DQ
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?---------- ---- -- --- ------- ❑ WA ❑YES ❑ NO
- >100 ft.from wells?- ---------------------------- ❑ ❑ ❑
W >100 ft.from surface water?----------------------- - ❑ El ❑
LL >10 ft.from potable water lines?----------------- - --- - ❑ ❑ ❑
Zq. . >5ft.from property lines and easements?---- --------- --- ❑ ❑ ❑
K > 30 fit from downgradient curtainffoundation drains?- ---- -- -- - ❑ ❑ ❑
Drainfield level and observation pops present --- ----- -- ---- ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?------ ------------- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?-- ------ ---- - ❑ NIA ❑ YES ❑ NO
Y - Pump tank capacity(flood) gal Manufacturer
Z
Q 24"access riser(s)and accessible from surface?------------- ❑ ❑ ❑
~ Alarm or Control Panel Installed? ------ ----- ----- ----- ❑ ❑ ❑
a
? Control Panel equipped with Timer/ETM/Counter-- ---- -- -- - ❑ ❑ ❑
IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
ILPump Make/Model ❑ Floats or ❑Transducer
M Tank draw down in/min Pump capacity Opm Squirt Height ft
a
Pump on time Pump off flme Dally flow set at opd
uQama Nrrzoie
i
Mason County OSS Installation Report pg.2 parcel a 32022-40-90131
ABANOONMENTRECORD
W. )dmng septic components abandoned as part or w.omiem ❑ YEs ® No
If yea please describe:
Vivo all cwW*m pumped out and pmpeny abandoned wWAC2W2T2A-0B00T-------- ❑YEs ❑No
RECORD DRAWING -.
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p.awrNYN pYNwanwauwmNnaYlaASYNNvry W l.wa°wa.mN v..eae+a.NNs W p�Y0Y6tlpbsenaWlMa
MaOraoeM.Gw.b.WaaNSYYYnNmaYiN tmd+.aaa«Nw=.rar,wnram.NarairwnNpw Wnwo.N°.
®Record DraairgAtlacMd
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I tartly that;Installed the system in accordance Wh I certHy that the system has been installed in accoa
the sep6'c desgn stomped'APPROVED*by Mason dance with the septic design stamped-APPROVED-by
County Public Health and that any deviations shown Masco County Public Health and that mydeotaBons
here haw been cleered/appmved by both the designer shown here have been tlearedloppromdbybell,
and Masan County Public Health and meet all State myself and Masan County Public Health and meat all
BM Mason Count'Codes. State and Mason Cwnly Codes
I luffharcendythat all miannatlon t Iakwd onthis Ifurther certify that all leamation wrtalned on this
larrrl and attached Rerortl Drawing is eccurele. Porn antl attached Rec u 40 urete.
tine orinadlar ���/ Dee ,p
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RrhdMNems dsipnee v 4 R'A
MASON COUNTY PUBLIC HEALTH ! ; 9
The undarsi9netl appmwsthis Installation Repprtand f1IS
Reoad Drawing m behallot Mason County Publw oreL MF
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Sigrnatu of Heam spedellst Date (stamp,signature and date)
TNISFORNMAYBESCANNEOANDAVNLABLEFMR BLICVMONUELMa COUN MBSRE
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APPROVED
MAY 29 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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