HomeMy WebLinkAboutSWG2023-00206 - SWG As-Built - 1/13/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG V�3-0010fo Parcel# 220031490150
Applicant Name Eric Russell Subdivision (Name/Div/Block/Lat)
Applicant Address 5015 N 25fh St
City,State,Zip Tacoma WA 98407 Installer Name Skinner Construction
Site Address 750 E nodh island Dr Designer Name Eric Russell
INSTALLATION CHECKLIST
E Full system Installation ❑Tank(a)ONy ❑DraiMield Only ❑Repair ❑Other
System Type_ pressure trenches Pretreatment Type
>5 it.from foundation? ------------------- ----. ®NIA ❑yes ❑ NO
>50ft.from wells? ---------------------------- - ❑ ® ❑
he >50 fl.from surface water? ------------------------ ❑ ❑
Cleanout between building and tank? ------------------- ❑ e ❑
tl Tank baffles present? ----- --------------------- ❑ ❑
d24"access nsers over each compaMlent?---------------- ❑ e ❑
Wy Effluent fiftermsWled?-------------------------- - ❑ IN ❑
Sepfic tank capacity(working) Premier Plastic
O D-box water level and speed levelers used? -_____________ _ ■IYA ❑yes ❑ W
J
O0 ManNOIdfD-box accesslGefremsurface?-------- -------- . ❑ ❑
C_ Check valves installed? - -------- --- - --- - ----- - --- ❑ ❑
Transport Line Size 2 Schedule/Class 40
Bedrooms installed(check one) ❑2 ®3 ❑4 ❑5 ❑fi ❑CommerdaUGther
>10ft.fromfauMatiOn?-------------------------- ■ NIA ❑ne ❑ W
G >100 ft from wells?- ---------------------------- ❑ ❑
W >100 ft.from surface water?------------------------ ❑ . ❑
W >10ft.from potable water lines?--------------------- - N ❑
a_ >5ft.from property lines and easements?---------------- ❑ ■ ❑
K >30 ft.from downgradlent curtain/foundation drall---------- ❑ ❑
Drainfield level and observation ports present --------------
E Graveless chambers a ❑.Clean grevel wed? (cheek era)
Proper cover installed over drainfield?------------------- ❑ ❑
Pump tank setbacks conslstent with sepde tank?------------ - ❑ WA Dyes ❑ No
2 Pump tank capacity(flood) 1 D00 pal Manufacturer Infiltrator
24`socess riser(s)and accessible from surface?------------- ❑ 0 ❑
a Alarm or Control Panel Installed? -------------------- - ❑ ❑
Control Panel equipped with Timer I ETM/Counter----------- ❑ ❑
rY Purtp installed In ❑ Bucket or ❑ On Bork or E Other Basin
A. Pump Make/Modal Liberty 280 Floats or Transducer
2 RGy/�}�
IL Tank draw down 1.5 in/min Pump capacity 3 ,a v o 2.1 ft
IL
Pump on time 2.7 min Pump off Wne W 350 ppd
ureM.eaarrav
VIASON COUNTY ENVIRONMENTAL HEALTH
- - - - JBw
Mason County OSS Installation Report pg. 2 Parcel n 220031490150
ABANDONMENTRECORD
Ware existing septic oompnnane abendoned as part of this project? --------------- ❑ YES ® NO
If yes, please describe:
Were all components pumped M end propedy abandoned per WAC246-272A-0300? -------- ❑ yEs ❑ NO
RECORD DRAWING
TFY Y�p�YnY4,me wN nut W ks4 rM bMWN�nwaw to MO[tl�F Mw,wY bnd��eYni�aN Fbn�� 1J➢ktl RYME
IhfMaa Mpin: aW,AMa anrnep oMrNtlm A YwKaWrWurry ui Fmtion,rbT ama w.a eeFAd4 a4ai4 wN PeWFtl YaNiP,Mlmm,wlY.wn«ILes.
wN.�+a�Wm Cea4dw.�wY ntl WnmLLYMumn qmY. Fm,eYe gµyp O,My mrycyleeEtlewl tleYry FYeI melYYyn yppnl aM,elYeL pinK.
p � a�� ED
fAN �3 7A2`'
ppSON00UNS� B��'�tA�NFAI.tH
)R .,d Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
l codify that I installed the system in accordance with I caddy Mat Me system has been installed m aocor-
Me septic design stamped APPROVED-by Mason dance with the septic design stamped'APPROVED'by
County Public Heel and that any deviations shown Mason Coumy Public Health and that any deviations
here have been Uearedlapprovad by both the designer shown here have been cleamd/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mas.County Codes. Stale and Mason County Codes
i further coal Mat all Information contained on this I further codify Mat aU information contained on this
form and attached Record Drawing is accurate. form and attached Record Q(e"is accurate.
aCI +pnsna ' I
SmpnNure rArnsfXler Date w2`�'.,
Samuel Skinner '•
Pn'ntad Name of Signal :� •.Ah
MASON COUNTY PUBLIC HEALTH .NA
The undersigned approves this Installation Report and .5100183
Record Drawing on behaMofMason County Public ERIC R. RUSSPJ.L _
:...... ....-o RUS....�...
EXPIRES 021021_
/ Avomweal Health Specialist Data
(stamp, signature and date)
THIS FORM MAYBE SCANNED ANO AVAp.nBLE FOR PUBLIC VIEW ON rl I MASON GOUMY wEB 511E tFtlw'°a'sraoie
|! �
¥
� 4
�