HomeMy WebLinkAboutSWG2023-00135 - SWG As-Built - 3/20/2025 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00135 Parcel u 32104-52-00145
Applicant Name HELEN LEGGETT Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 666
City, State, Zip UNION,WA 98592 Installer Name ARROW
Site Address ARROW EXCAVATING Designer Name CINDY WAITE
INSTALLATION CHECKLIST
Full System Installation ❑Tinkle)Only ❑ Drainfleld Only ❑Repair ❑Other OANA:B'UV
System Type ? Pretreatment Type
>5 ft. from foundation? --- - - ---- __ y- Jiffy ❑wq Oyes NO
>50 ft. from wells? - -- - --- --- 'pl7u II7I \1V7/115[ ❑ ❑� ❑
Z >50 ft. from surface wale/'! - - - - - - - - ❑ ❑
Cleanout between building and tank? -- M
V Tanacess secpres ove - - - - - - - - -ent'BYd 24"access risers over each cempartmen By ❑ 0 ❑
LLI N Effluent filter installed?- -- - -- - -- - -- - -- - - - -- - -- -- - - ❑ 0 ❑
Septic tank capacity (working) _______gal Manufacturer 111114
o D-box water level and speed levelers used? . - - - - - - -- - - -- - - 0 NfA ❑ YES ❑ No
p�pLL Manifold/D-box accessible from surface?- - -- - - - ---- -- -- -- ❑ ❑
I
Check valves installed? - _ _ _ _ _ _ _ _ __ _ _ _ _ ___ _ ______ - ❑ ❑
f Transport Line Size Schedule/Class
Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?---- --- - --- - - -- - ❑ MIA � YES El No
l] >100 ft. from wells?- --- ---------A- -MARI-0-2025-
f TAT ■w ❑ ❑
W >100 ft.from surface water? - -- ----- • �[_ ` O ❑
Z >10ft. frompotablewaterlines?------ ❑
> 5ft. from property lines and easements?------ - --------- ❑
> 30 ft. from downgradient curtain/foundabonA�S�y$Q/-- ENVIRONMENTAL PLTH
Drainfield level and observation ports present ------ '�B W - _- ❑ El El
PGraveless chambers or E1AClean gravel used? (check one) El
Proper cover installed over dreinfield?- ---- -- - -- --- ------ ❑ ® ❑
Pump tank setbacks consistent with septic tank?-- -------- --- ❑ wq Q YES ❑ No
ZPump tank capacity (flood) Y 1.2.0 at Manufacturer x�cA o-vr
F 24-access riser(s)and accessible from surface?--- --- ----- - - ❑ ❑
C Alarm or Control Panel Instilled? -* _ __ _ ___________ __ - ❑ ❑
jControl Panel equipped with Timer/ETM/Counter------ - - - - - ❑ ,� ❑
a Pump installed in ❑ Bucket or ,rOn Block or ❑ Other
IL
L /
Pump Make/Model OL 3,9 au Qp4e-/r.C- & Floats or ❑ Transducer
IL Tank draw down in/min Pump capacity
IL p pa 'ty 2. 3 gpm Squirt Height /lJ"�ft
Pump on time 10 S/r Pump off time Daily flow set at apd
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Mason County OSS Installation Report pg. 2 parcel n 32104-52-00145
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - ❑ YES 0 NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC240-272A-0300? -- -- - - -- ❑ YES ❑ NO
RECORD DRAWING
This Is a Parma...HepM end HUH M eccunH antl descdptivs eno.In W.-Ioceh In in.need H Hshift. ce¢dWlles antl ruWre denlepmsnc Tyyaal RsxM
Drawings wRain'. Dralnteld&modski c srhillon&Hyout,Seplldpump tank bratbn,NMt,epaw,reserve dralMsId,II.Sima end prxx isd wssrys,IpmWn Hwalb,welMlnee.
veils,oJRs RtxR,ports,cleanows and other maintenance access points. IncomplHe RemN pnwinpe maY create eddaionel delays in fmH Innelletion approval and relNed permds.
Q 1 Nf�.l�f.1 NZ M yny /+J /Zl,rexve *st--o.
/Sl f�yyy -4OME- A J /O Ne QCC flJ44 �•a/c.4 �N+�
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✓ew�MENTq/H84 9 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/appmved 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 ell
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 Record D ng is accurate. form and attached Record Drawing is accurate.
Si a
Oature,of installer Date
b -h .//.
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Printed Name of Signee .1p'Wd• ,�.,
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and LWDYE.WAITE
Record Drawing on behalf of Mason County Public LICENSED DESIGNER
Ithl ERVIRES 0 IS,
';�zS
Si re of Environmental Health Specialist Dale (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ulwHed arz+rzo+e
II
j� 1. Residence one bedroom
I 2. Casitan one bedroom
3. BNR 500 in concrete tank
4. 1000 gallon concrete pump tank
(� 5. Audio/visual alarm
6. Clean outs(2)
8 23'x20' Oscar primary
23'x20' Oscar reserve
9. Manifold 1"
10.WaterH
MAR 10 20
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