HomeMy WebLinkAboutSWG2020-00599 - SWG As-Built - 9/17/2025 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00599 Parcel# 324121200140
.Applicant Name Franklin Clark Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 1954
City, State, Zip Silverdale WA 98383 Installer Name Franklin Clark
61 IN RUSTIC RIDGE DR
Site Address 11W WR WA 98555 Designer Name Franklin Clark
INSTALLATION CHECKLIST
■ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type OSCAR II Pretreatment Type
>5 ft. from foundation? ----- - - - ----- - -- ---- -- - ---- ❑ WA ■YES NO
>50 ft. from wells? ----- - - __ _ _ 1�lS V El
2 >50 ft. from surface water? - - - -- �V/ ■ 111444-ooddlll(, Y
Q Cleanout between buildingand tank? ❑
_pV[ 06-202r ❑ ■ d r
O Tank baffles present? - - - - - - - - - - - -- -- -- -- - - -- - ❑ ■ ,( ❑
4 24"access risers over each compartment ______ �1' ❑
NEffluent filter installed?-- - --- - _6T: � ___- ❑ ■
Septic tank size 1500 gal Manufacturer_ Orenc•nfiltrator Systems ❑
0 D-box water level and speed levelers used? --- - --- - - -- - - - - ■ N/A ❑VE3 ❑ NO
00 ManHold/D-box accessible from surface?-___ _ __ _ _ __ _ _ _ _ _-
oZ Check valves installed? --- - - - - - -- - -- - -- - -- - -- - . ■ ❑
Transport Line Size 1-inch Schedule/Class Schd 40 ❑ ❑
Bedrooms installed(check one) ❑ 2 ■3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft. from foundation?- -- - - - -- - - - - -- - - - -- - -- - - -- ❑ N/A ■ YES NO
C >100 ft. from wells?-- - - - - - - - - - ------ -- - ------- -- .t ElJ >100 ft, surface water? ---- - -- - -- - - - - . A�../t�' -..
El
QZ >10ft.from potable water lines?- - - - - - - - - --- -- - - - - - - -- El ❑
K > 5ft.from property lines and easements?-- - -- - -- -- - -- - -- ❑ ■ ❑
> 30 ft. from downgradienl curtainifoundation drains?- -- -- -- -- . ❑ ■ ❑
Drainfield level and observation ports present - - -- - - -- -_ _ _ _ -
❑ Graveless chambers or El Clean gravel used? (check one) ■ Sa❑nd Mound ■ El
Proper cover installed over drainfield?-- - - - - ---- --- - - - - -- ❑ ■ ❑
Pump tank setbacks consistant with septic tank?-- --- _ __- _ __ . ❑ WA ■ YES ❑ NO
ZPump tank size 1200 cal Manufacturer Orenco Infiltrator Systems
F 24"access riser(s)and accessible from surface?-- ---- -__ _ -_- ❑ ■ ❑
4 Alarm or Control Panel Installed? ----- - --- - --- - - - - - - - - ❑ ■ ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - . ❑ ■ ❑
4 Pump installed in ❑ Bucket or
❑ On Block or ■ Other Pre Low RidgeTechnologies Specifications
a Pump Make/Model AY M DOnaldc/ 0S0 A I
f ■ Floats or El Transducer
per, Tank draw down 2.8 gals/min Pump capacity 30 gpm Squirt Height N/A ft
Pump on time 22 secs Pump off time 3.38 mins Daily Flow set at 360 opd
Mason County OSS Installation Report pg. 2 Parcel# 324121200140
ABANDONMENT RECORD
Were any existing septic components abadoned as part of this project? --- - - ---- - - - - -_
YES NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC24-272A-0300? - --- --- - YES NO NO WA
RECORD DRAWING
This is a ps mishin me m.nE mu.t w.,,curia eM Ye.ctlptive emwk a m.oc.a In tll.naM or mtlnanence erhash..M wWn afw Orewinps contain: D2infi&UBmsnwlU ofimatlgnda xil,$epl PUn,ankb®Iim,NwN almr,reaeM beinfiNE,eyl�n 1°Pmsnt Tyryy RsmN
wells,oesonation ports,aeanouls,aw opal manananm.zest ydna. ImampKa Ra¢IU elaxinps may teeale a13Epul Est tl qo<o N LuilEinpa,IrcaEan o/werys,walMires,
-------------
rys In Rnal ineallalbn erpmvg aM Mal y yermilg_
See Attached Record Drawing
Record Drawing Attached
CERTIFICATION OF INSTALLATION
7havebeen
DESIGNER/ENGINEER
I installed the system in accordance with /certify that the system has been installed in accor-
esign stamped"APPROVED-by Mason dance with the septic design stamped APPROVED"by
lic Health and that any deviations shown Mason County Public Health and that any deviations
een cleared/approved by both the designer shown here have been cleamed/approved by both
County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this l further certify that a//information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
L 0� 31June2024
Signature of installer Date
fk") u(,j
Printed Name of Si=Health*
n"
TY PUBLIC HEALTH
d approves this installation Report and . '
g on behalf o/Mason County Public
V1 r�l 1 Q I����Lj31June2024
ironmental Health Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uwiss"Ic$aid
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