HomeMy WebLinkAboutSWG2025-00088 - SWG As-Built - 4/18/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00088 Parcel # 42204-51-00107
Applicant Name MICHAELENE WILSON Subdivision (Name/Div/Block/Lot)
Applicant Address 70 N HAMMA HAMMA DR E
City, State, Zip HOODSPORT, WA. 98548 Installer Name SCHOENING EXCAVATION LLC
Site Address 70 N HAMMA HAMMA DR E Designer Name CINDY WAITE
INSTALLATION CHECKLIST
JgrFull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other
System Type Pk2 c�-s't, pretreatment Type Sq
>5 ft. from foundation? - ❑ N/A ®YES ❑ No
>50ft. fromwells? - t%N_ _
_ _ a ❑ ❑
>50 ft. from surface water? - �
Z
HCleanout between building and tank? - - - ah_ _ _ _ _ • ® ❑
U Tank baffles present? x -\\e — - - - -
a24" access risers over each compartment? - - - - - - - ❑ ® ❑
LW Effluent filter installed?- 0 _ ❑ ii ❑
Li
Septic tank capacity (working) I as-Q' •al Manufacturer .Qq a 01e1N
`CI D-box water level and speed levelers used? - - II N/A ''{{ ❑ YES ❑ NO
XO Manifold/D-box accessible from surface?- - ill ID CI
m— Check valves installed? ❑ CICQ
2 Transport Line Size 2 " Schedule/Class
Bedrooms installed (check one) IL. 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N!A •YES ❑ NO
C) >100 ft. from wells? - - ❑ lif ❑
-I >100 ft. from surface water? ❑ Iiii ❑
W
Z >10 ft. from potable water lines?- - CINI CI
> 5 ft. from property lines and easements?- - ❑ ❑ El
12 > 30 ft. from downgradient curtain/foundation drains? - ilif Q. ❑
o
Drainfield level and observation ports present - - ❑ Sit ❑
❑ Graveless chambers or El Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ A ❑
Pump tank setbacks consistent with septic tank? - - El N/A gA YES ❑ NO
ZPump tank capacity (flood) (ti j gal Manufacturer_ ' 4eitge,4 ,v
Q 24" access riser(s) and accessible from surface?- - ❑ ® ❑ •
aAlarm or Control Panel Installed? - - ❑ [A ❑
• Control Panel equipped with Timer/ ETM/Counter- - ❑ RS ❑
a- Pump installed in ❑ Bucket or ®'On Block or ❑ Other
0. Pump Make/Model L./b«ttt. 200 ❑ Floats or lip Transducer
a Tank draw down 2l1 in/min Pump capacity G 2..s gpm Squirt Height Si' ft
Pump on time 42SCC Pump off time \is, Daily flow set at tio6 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel # 42204-51-00107
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - Q YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - RI YES ❑ 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: Drainfield&manifold orientation&layout.Septiupump 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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X 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 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
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signatur o nstaller Date .%s 8LPoOtS
ra o\ i �CVCC A r,( ?� toPrinted Name of Signee , 2� J4 $ ��
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
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Signature of Environn ental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated&2112018
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