HomeMy WebLinkAboutSWG2019-00282 - SWG As-Built - 3/17/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number swG Parcel# 22336-53-00120
Applicant Name RJ Peabody Subdivision (Name/DivfBloek/Lot)
Applicant Address PO Box 565 Lynch Cove Div 3 Lot 120
City, State,zip Burley, WA g 528 Installer Name Jason Schauer
Site Address 91 NE Burt Ct Designer Name Tom Weaver
INSTALLATION CHECKLIST
10 Full System Installation ❑Tankls)Only ❑OrWMaor Only ❑Repair ❑Other
System Type Pump to Gravity Trench Pretreatment Type
-51t.from foundation? - _ _ _ __ __ __ _______________ • ❑WA YES ❑ MO
>50fr,from wells? . - - -------------------------- ❑ 91® ❑
Z >50ft. from surface water? - -- - -------------------- ❑ ® ❑
Al Cleanoul between building and lank? ------------------. ❑ ® ❑
q Tank baffles present? - - - - - - - - - - ---------------- ❑ ® ❑
1 24'access nsers over each compartmera?--------- ----- - ❑ ® ❑
rW Effluent fitter installed? _ _ _ _ _ _ _ _ _ _ _ ___ ____ _ _ ______ ❑ Qx�� ❑
Septictanksize 1200 gal Manufacturer Infiltrator IM1060 lY'trdkzd mzel-c
OJ 0-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA TES ❑ xo
OOR Manifold/D-box accessible from surface?- - - - - - - _ _ _ _ - _ - . 6a ❑ ❑
oQCheck valves installed? - - - - - - - - - - -- - - - - - - - - - - - - - - ❑ ❑ ❑
f Transport Line Size 2 Schedule/Class SCh 40
Bedrooms nstared(Gyok one) ❑2 913 ❑n ❑ 5 ❑6 ❑Commercral/Other
>tO ft.front foundation?----------- - - - - - - - - - - - - - - - ❑ WA ]YES [3NO
9 >100ry.from"Its?. - - - ------- ----- ----------- - ❑ l4 ❑
W >100Afrom surface water? ---------------------- - - ❑ ❑ ❑
Y_ >10fr.from potable water lines?-- ---- - - - ----------- - - ❑ ❑
2
>S ft.from property lines and easements? - - - - - -------- ❑ ❑
Q > 30 f-from downgradient curtain/foundation drains?--- - ---_-. ❑ ❑
Drainfield level and observation ports present . . ........... ❑ ❑ ❑
X] Graveless chambers or ❑ Clean gravel used? (dock am)
Proper cover installed over drainfield?----------------- -. ❑ ® ❑
[I'LAlarm
ump tank setbacks consistant with seplk balk?__ ___ _ _ ____ __ ❑ WA QJ YES ❑ xo
ump tank sae 1.2DO pal Manufacturer InflltfatOr IM1060
C accessrisers)and accessible from surface' - - - - - - _ _- _ — ❑ IN ❑or Control Panel Installed' — _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ ❑ontrol Panel equipped with Timer r ETM/Counter - -_- - _ _ _ _ .mPinstalledin ❑ Bucket or ® OnBlock or
❑ O her
mp MakerModel Liberty 250
®Floats or ❑ Transducer
4 Tank draw down m!mm Pump capacity Opm Squirt Height ry
Pump on 6" Pump off time Daly Oow set at ood
w..v.s:rta.e
Mason County OSS Installation Report pg. 2 Parcel E 22336-53-00120
ABANDONMENTRECORD
Were e""g beplip codoonents sbandoned as pan of Ins prgeU?
I/yea,please desuibe El YES NO.
Wert all cUnponents pumped out and property abandoned per WAC246-272A-03007 - - - --- - . 0 Yu NA p No
RECORD DRAN7NG
AY 4 Fw+wnl MSY W wwr M a[uw�W W[rMMe wwwea b Mbalr In IM We rwewbee..e
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aeNH Niw�Spb'!W nlrW Ivnar.
See Attached
EX Record Drawing Attached
CERTIFICA710N OF INSTALLATION
INSTALLER
f cen/fythat llnsiaaed the s stem in 1 ca IGNEW ENGINEER
Y accordance with I cenay Mat the system has been installed in eccor-
the seyro design Health Sampad'at dy d.Vi. by Mason dance*an the septic desgn stamped"APPROVED-by
County ve beenchIaand that end y both M shown Mason County Public Heaah and that any deviations
here have been County
Pub approved by both fall State
Shown here have been cteared/approvad by both and Mason Coonty Pub/M Health e/M meet all Sfafe
myself and Mason County public Health and meet all
and Mason County Codas State and Mason County Codes
I further certify that ab information contained on this 1 further candy that all information contained on this
for a d attached Record Drawing rs occur le. form and attached Record Drawing a accurate.
o1o7U
tore of/nSa/br Da
Jason Schauer
Printed N.m!of Sigma /pJ�
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and {
Record Drawing on POWo/Mason County Public
Health:
Spnafraa olfnw:pn SNaaah Speoraibl flafa
(stamp,sgnafure antl date)
THIS FORM MAY BE SCANNEDAWAVMLABLE Too PUBLIC VIEW ONTNE MASON COUNTY WEB SITE
22336-53-00120
Water Main _/ 91 NE Burt Ct
u Water Main Easement
Di
Additional
53'
Y � \
_ t11D%Aeserve D"Box
87.56 CJL#3
1
Three Bedroom
Home 30'
zs'� 36' tran
2 DAV
4025' �_ r
All drain fields to be>25'from bank on South
South
All drain fields to be> 10'from water main
R = 50' No' Tanks 5 feet minimum from property lines and home
Carefully position home to allow for both tanks
Top of tanks must be no deeper than 36"under
SLa 1 -0-12"Loamy fine sand finish grade
12-60"Grey Medium Sand
SLa2 Same as SL#l
SLa3 0-24"Loamy fine sand
24-60"Grey loamy sand
Reserve drain field may require terracing if used
Deep soils will allow this
APPROVED
MAR 17 2025
MASON COUNTY ENVIRONMENTAL HEALTH
RET
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