HomeMy WebLinkAboutSWG2024-00369 - SWG As-Built - 4/3/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00369 Parcel# 32315-75-00080
Applicant Name NORMAN WALSH Subdivision (Name/Div/Block/Lot)
Applicant Address 9189 N E COUNTRY WOODS LAN
City, State, Zip KINGSTON, WA. 98346 Installer Name OIEN CONSTRUCTION
Site Address 247 N E CAPSTON ROCK RD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑Repair 0 Other
System Type GRAVITY Pretreatment Type
>5 ft.from foundation? - ID
al YES ❑ NO
it-gunn>50 ft. from wells? - ❑ZPE
>50 ft.from surface water? - ElElH between building and tank? -Cleanout -APR_ .1 25 _ ® 0
V Tank baffles present? - 1
- ___ ❑ NI
E24"access risers over each compartme v7 --- - - -- - ❑ 0 ❑
coEl
VE El
W Effluent filter installed?- -
Septic tank capacity(workin 1 Z Sd 0 // ° 0
9) / gal Manufacturer'-//65o 1Ar1 I (j 12SC 5 JTC
o D-box water level and speed levelers used? -
k O Manifold/D-box accessible from surface?- 0 N/A ®YES ❑ NO
-
Ow
CO2 Check valves installed? - 0 NI El
E Transport Line Size 4 Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ®3 ❑4 0 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- - wA
>100 ft.from wells?- El-
® YEs ❑ NO
W >100 ft. from surface water? - - ❑ IN 0
❑ II El
Z >10 ft.from potable water lines?- - 0 ® El
Q
>5 ft. from property lines and easements?- ❑ ® ❑
CC > 30 ft.from downgradient curtain/foundation drains? - - II 0
fa
Drainfield level and observation ports present - ill
0 Graveless chambers or NE Clean gravel used? (check oltilft; 8vi...,i.', -
Proper cover installed over drainfield?- V ie -
Pump tank setbacks consistent with septic tank?- - .: -_ '�k-\b, �P��`\' ❑ YES ® No
Y Pump tank capacity(flood) gal . cturet.F�`1V''
Z
< 24"access riser(s)and accessible from surface?--- '
a. Alarm or Control Panel Installed? - g , -� ElEl 0
2 Control Panel equipped with Timer/ETM/Counter- 0 0
a. Pump installed in ❑ Bucket or ❑ On Block or 0 Other
a' Pump Make/Model
ID Floats or ❑ Transducer 11 Li
a. Tank draw down
0. in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 32315-75-00080
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES ❑■ NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record
Drawings contain: Grainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield existing and proposed buildings,location of wells.waterlines,
wells,observation ports,cleanouts,and other maintenance access points- Incomplete Record Drawings may create additional delays in final installation approval and related permits
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0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
I certify that!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/approved 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
'I form n a ched Record Drawing is accurate. form and attached Record Drawing is accurate.
Signa re of Installer Date
1i.
Printed Name of Signee �'�ti� ° . fa
... •,, -6 We
11 MASON COUNTY PUBLIC HEALTH 'b! �Pt
The undersigned approves this Installation Report and CINDY AITE- �'
r . LICENSED DESIGNER 0
Record Drawing on behalf of Mason County Public 1 / I4
Health: (mat& 05,10,
i 1. L .1i L{ -IL )
Signatu of Ekiionmental Health Specialist Date si nature and date)
(stamp, g
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated821t2018
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