HomeMy WebLinkAboutSWG2019-00281 - SWG As-Built - 3/17/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Cj — O fit?Uj Parcel# 22336-53-00118
Applicant Name Rd Peabody - Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 565 Lynch Cove Div 3 Lot 118
City, State,Zip Burley, WA 98528 Installer Name lawn Schauer
Site Address 81 NE Burt Ct Designer Name Tom Weaver
INSTALLATION CHECKLIST
Full system tns[allafron ❑iankls)Only ❑ Dramfietd Only ❑Repair ❑Other
System Type Gravtty Pretreatmenl Type
>5 It. from foundation? - _ _ _ _ _ _ _ _ __ _ _______________ ❑W4 ®YES ❑ NO
>50 ft.from welts? - ❑ ® ❑
_ >50 ft. from surface water? . . . . . .........__________ ❑ ® ❑
Cleanout between building and bank? .__________________ ❑ ® El
U Tank baffles present? - - - - - - - - -- - ------- --------- ❑ ® ❑
a24'access risers over each compartmeta?._..... .. . .. ._ ❑ ® ❑
W Effluent filter installed?- - - - - - - - - -- - - -- ❑ ® � ❑
Septic tank see 1.200 Oal Manufacturer Infiftrator IM1060 (l�ti-cJIa.I r�2pTn
^0 D-box water level and speed levelers - - - - ----used? -- - - _ _ _ ❑ NIA YES ❑ No
is
OO Manifold7D-boa accessible from surface?- ........._______ ❑ ❑
OQ Check valves lnsbafled? - __ _ _ _ _ _ _ _ _ _____ _ _ __ _ _ _ __- ❑ ❑ ❑
f Transport Line Size 4- Schedule/class 3034
Bedrooms installed(check one) ❑2 M 3 ❑4 ❑ 5 ❑6 ❑Commerw#omer
>10ft. from foundation?- - - - - -- -- - ---- - - - - - - - - - - - - ❑ WA OYES NO
O >100 ft,from wells?- - - - - - - - --_ _________ __ ___ _ ___ ❑ �` ❑
W >100 ft.from surface wateR -_ _ __ _ __________________ ❑ ❑
M >10ft.from potable water fines?- - ------- ------------- ❑
>6 ft from property lines and easements?-- - - - - --____.__. ❑ ❑
G > 30 ft.from downgradient curtainifoundation drains?- ---____ _, ❑ ❑
Cminfield level and observation ports present - - - - - - - ------ ❑ ❑
U Graveless chambers or ❑ Clean gravel used? (check elle)
Proper cover iutaaed over drainfield? _ _ _ _ _ _ _ ________ __ _ ❑ ® ❑
Pump tank setbacks consistant with septic tank?. _ _ _ _ _ _ __ _ _ - . X1 W4 ❑ YES ❑ NO
2 Pump tank size gal Manufacturer
F 24'access nser(s)and accessible from Surface?- - - _ - _ - _ _ ❑ ❑ ❑
(L Alarm or Control Panel installed' - - - - - - - - - - - - - - - - - - ❑ ❑
aControl Panel equipped with Timer/ETM/Counter- - - - - - - - - - . ❑
_ Pump installed m ❑ Bucket or ElOn Block or ❑ Other ❑ ❑
Q. Pump Make/Model
❑Floats or ❑ Transducer
IL Tank draw do" In1min Pump upacay opm Squirt Heigh ft
Pump on time Pump oft bme Daily flow set at gpci
Mason County OSS Installation Report pg. 2 Parcel# 22336-53-00118
ABANDONMENT RECORD
tame existing rapt¢ componants abandoned as pan of this prolea0 0 YES Gl NO
W
If yes please detUibe
Wert a%camponenla pumped out arq Prvpedy abandoned per WAC2a&272A43001 •-- -_ __- El YES NA O No
RECORD DRAWING
Tn.s.Nm.w.n..n.m m.n w.a..raa.^e d..e.w.«nw.a naxw In w^..e 0 wela..esfrm..«N 0aw P.w.ps ram.n P.vIW t mWtlo.�.Mim• a.Ml.a.aK Tpsy R.fara
.e.>..nr.,nm„ om .w.sin.wnamsxrmwam..n.wnraa..maoww.r.wa�+va.
pYxx eM.rua .n. e�mVnnrarv�.u. pyN.. YSgmy.n Rnn,Peep.m. v.q aplgx w awd+'sn.I wlr.xn....+a....aa.a..^..
See Attached
[X Record Dmwblg Attached
CERTIFICATION OF INSTALLATION
7' ST
R DESIGNER/ENGINEER
at I installed me System in 8000n NIC!,wah I cemry that the system has been insta/kdin accor.
design stamped 'APPROVED'by Mason dance with the septic design stamped'APPROVED-by
blic Health antlthal any deviations shoxvn Mason County Public Health antl Thal any deviations
been clea/ dVaPproved by both the desgner Shown here have been Clearedrappmved by both
County Public Health and meet all State myseaand Mason Co✓nty Publm Health and meet all
County Codes. State and Mason County Codes
I further certify that a#infOlnlalmn contained on this 'further certify that all inrormation contained on this
folrrrtr d attached Recordaccurate form and attached Record Drawing a accurate
fff .
Sth
oaYure a In,twer —�e—wmpis
Jason SChauer
Phnled Na
me a Slgnee
MASON COUNTY PU13LIC HEALTH d
The undersigned approves this Installafron Report and
Record Drawing on behaa o/Mason County Public
Health: THOMAa.E. VI
f7 '.
Sgnaum al Envuomymal Health SpaGYa#st Date (stamp
signature and date)
THIS rORM MAY BE SCANNED ANOAVAIABLE FOR PUBLIC VIEW ON THE MASON COVN'TY WES SITE uew"^s%'xe
22336.53-00118'
Sl/l •o.36 sand L6an
! 366W GW Mgt sand
81 NE Burt Ct
sL/2 Same as Slat 1'=20'
SL/3 Sane asSut
I
675' ni
j 6'
—V —
D4M
ww 9 gal
APPROVED
JW%P 40'XIS' MAR 11 2025
MASON COUNTY ENVIRONMENTAL HEALTH
------- REi
Weia<�
Burt Court