HomeMy WebLinkAboutSWG2023-00495 - SWG As-Built - 3/14/2025 r MASON COUNTY PUBLIC HEALTH
Mason County OSS Installation Report pg. 1
APPLICANT/PERMR INFORMATION
Permit N:Address
SWG 2023-D0495 Parcel# 32105-2490070
ApplicaGary&Kendra Warner _ Subdivision (Name/Div/Block/Lot)
Applica PO Box 61
City, StUnion WA 98592Installer Name Ma les Exca funSite Ad101 E Autumn Lane Union Designer Name Arrow Se tic Desi n Inc
INSTALLATION CHECKLIST
Full system Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Trench Pretreatment Type
>S ft.from foundation? ------- ----------------- - -- ❑NIA ® YES O
>50ft.from wells? -- -_____ ____ _ ___ ________ ____- ❑ Q ❑
Y >soft.from surface water? -_______ ___ __ _____ _ ____- ❑ ® ❑
Cleanout between building and tank? --- -------------- - - ❑ ® ❑
~ Tank baffles present? -- ____ _ __ __ ______________ _- ❑ ® ❑
U ® ❑
C 24"access risers over each compartment?------- ---- ❑ ❑
IL Effluent filter installed?----- ---- -- - - -- - - -- -- ❑
'� Hagerman
Septic tank capacity(working) 1.250 aal Manufacturer
0 D-0box water level and speed levekra used? --------------- ❑ NIA ❑ YES NO
J El0O Manifold/D-box accessible —
from surface?------------ -- -
❑
o?z Check valves installed? ----- - - - --- - --- - ---- ----- - ❑ ® ❑
�f Transport Line Size 2" Schedule/Clan 40
Bedrooms installed(check one) ❑2 M 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?----- --------- ----------- ❑ N/A MYES ❑ NO
>100 ft.tram wells?-____________ _______________- ❑ M ❑
W >100 ft from surface water? - - - - ------------------- ❑ ❑
a >10ft.from potable water lines? -- --- --- ----------- -- ❑ M ❑
QZ >5ft.from property fines and easements?- ---- --- ------ -- ❑ ® ❑
K >30ft. from downgradient curtain/foundation drains?-------- -- ❑ ❑
Drainfield level and observation ports present - - ---- -- ------ ❑ ® ❑
❑ Greveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfield?--- - - ------------ -• ❑ ® ❑
Pump tank setbacks consistent with sep ro tank?-- ---- - ------ ❑ NIA yes ❑ NO
Y Pump tank capacity(flood) 1000 ga1 Manufacturer Hagerman
2
r 24 access risers)and accessible from surface?- -- - - - - -- - - -- ❑ �
a Alarm or Control Panel Installed? --- --- - -- --- - --- --- -- ❑ M ❑
jControl Panel equipped with Timer/ETM/Counter-- - - - - --- -- ❑ M ❑
Il Pump installed in ❑ Bucket or M On Block or ❑ Other
a Pump Make/Model Zoeller N152 Floats or ❑ Transducer
g
� Tank drew down 2 iNmin Pump capacity 38 gpm Squirt Height fi fi
a
Pump on time 2.3 min Pump o6 time 6 hr Daily flow set at 380 gpd
u�e.we a2.aa:o
Mason County OSS Installation Report pg. 2
Parcel# 321oS - 2`I'-40070
AgANDONMENTRECORD
? _______ _ _______ ■ No
Were existing septic components abandoned as part of Nis project rEs
If yes,plasm describe: El YES No
were ell components pumped out and properly abandoned per WAC246-272A-0300? -'-"""
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I tartly that I installed the system in accordance with /cert/ty that the system has been installed in actor-
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 deared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Meson County Public Hearth and meet ail
and Mason County Codes. State and Meson County Codes
I Nrthorcertify that all inlormat/on contained on this I further ci that all information contained on this
form and attached Record Drawing is accurate. torm and attached Record yawing is accurate.
Slgnabar of installer Date
S(,1e�>rE 1.iMj if
printed Name of Signee
MASON COUNTY PUBLIC HEALTH
s�o s.v
Tna undersigned approves m/s Inste//alion Repoli and Pwuu Gov/o.wsoN'.
Record Drawing on behalf of Mason County Public
:Health
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Sipnerwe of Emoronmente Haatth Specialist Data
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVVV ABIP FOR PUBLIC VIEW ON THE MASON COUNTY WEa SITE oc..u..rsrrsme
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0 Audio-Visual Alarm
Cleanout APPROVED
Q1200 Gallon Septic rank MAR 18 20
2-compartment with
Effluent Filter
MASON COUN7V ENRETNMENiALHFAU
O4 1000 Gallon Pump Chamber
W? 4vtdli-S.p�w`�
OValve Control Box