HomeMy WebLinkAboutSWG2023-00300 - SWG As-Built - 3/27/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00300 Parcel 0 32104-59-00015
Applicant Name CURT EK Subdivision (Name/Div/Block/Lot)
Applicant Address 6405 ISAAC AVE BE C _
City, State, Zip AUBURN.WA 98092 Installer Name .-1�. C!( .�o 1 r✓Ja✓
Site Address 121 E BLACKBERRY Designer Name CINDY WAITE
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other
System Type PRESSURE Pretreatment Type BNR 500
>5 ft,from foundation? ---------- O -• ❑MIA .YES ❑ NO
>50 It from wells? --------- �' - ❑ ❑
Z >50 ft.from surface water? - - - -- v __��_ - ❑ ® ❑
f Cleanout between building and tank? - R�:• ❑ ® ❑
U Tank baffles present? - - - -- - - -- ___ _ _____ _ ❑
24' access nsers over each compert •-- - - -- ❑ ❑
W Effluent filter installed?- - - -- --- - - - --- -- - - ❑ ❑
Septic tank rapacity(working), 1000 tasl Manufacturer
Hagerman
G D-box water level and speed levelers used? --------- - ----- � WA ❑YES ❑ NO
OJ
LL Manifold/D-box accessible from surface?--------- -- - ----• ❑ . ❑
m= Check valves installed? - - - - - -- - -- --- - -- ❑ ❑ ❑
CI
Transport Line Size 2 Schedule/Class SCHEDULE 40
Bedrooms installed(check one) ❑2 0 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation? P Jas.__6A A'__- ❑ WA [] YES ■ NO
G >100 ft.from wells?--- -------------- ❑ ❑
W >100 ft.from surface water?------------------------ ❑ ■ ❑
u. >10ft,from potable water llnes9---- ------------------ ❑ ® ❑
QL >5ft,from property lines and easements?- - -- ------------ ❑ ® ❑
K > 30 ft.from downgradient curtainlfoundation drains?---------• E ❑ ❑
Drainfield level and observation ports present - ------------ ❑ ® ❑
❑ Graveless chambers or ® Clean gravel used? (check ons)
Proper cover installed over drainfield?- -- - - - - ------------ ❑ ❑
Pump tank setbacks consistent with septic tank? ---------- --- ❑ WA AYES ❑ NO
Y Pump tank capacity(floofkc 1250 gal Manufacturer ._4 Hagerman
IC24-access risers)and accessible from surface?—-- - - ---- -— ❑ ❑
aAlarm or Control Panel Installed? --- - -- - - - - ----------- ❑ ❑
Control Panel equipped with Timer/ETM/Counter---------- - ❑ ® ❑ \
Pump installed in ❑ Bucket or ■ On Block or ❑ 011ler t
O. Pump MakelModel Y Liberty 280 ®Floats or ❑Transducer
s 4 ft
d Tank draw down ,� 1•5 iNmin Pump apacky 30_9Pm Squirt Heigh It
Pump on time l min Pump off firmjkd4 hrs Daily flow set at 1u8L---0pd
Mason County OSS Installation Report pg. 2 parcel d 32104-59-00015
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? --------- ------ ❑ YE8 NO
It yes, please descPber
Were all wr ponarts pumped out and property abandoned per WAC246-272A-03OD7 -------- ❑ rts ❑ No
RECORD DRAWING
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APPROVE
APR
JBIA
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 clearediapproved 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 all
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
to nit at ed Record Drawing is accurate. form and attached Record Drawing is accurate
..
11-5-2024
s na are of I ,railer Date
Jack Johnson a° a
Printed Name of Sense t ?
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and a LICENSED sicueR ;
Record Drawing on behalf of Mason County Public
HVn
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Sig to nvimnmenmI Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE U'.:edealw'i
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