HomeMy WebLinkAboutSWG2024-00058 - SWG As-Built - 5/8/2025FTMason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00058 Parcel # 22029-34-90061
Applicant Name RYAN DRAKE Subdivision (Name/Div/Block/Lot)
Applicant Address 4209-3RD AVE
City, State, Zip OLYMPIA, WA 98502 Installer Name ACTIVE UNDERGROUND LLC
Site Address 100 SE CANNERY POINT RD Designer Name JAMES MEDCALF
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type PRESSURE BED Pretreatment Type
>5 ft. from foundation? - j�j� -- ❑ N/A [II YES [1] NO
>50 ft. from wells? - c - ❑ IN CI�
Z >50 ft. from surface water? tsgof - - - \ CIII ❑
• Cleanout between building and tank? - NI
�Q - - - ❑ NI
U Tank baffles present? - - - - - - - - - - ❑ ® ❑
d 24" access risers over each compartment' - - - - CI ❑
W Effluent filter installed?- B�- - - - CI III CI
N
Septic tank capacity (working) 1200 gal Manufacturer SPS
D-box water level and speed levelers used? - - ® N/A El YES ❑ NO
O Manifold/D-box accessible from surface?- - IR ❑ ❑
ODZ Check valves installed? - - ❑ IN ❑
oQ
2 Transport Line Size 2 Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - El N/A ® YES ❑ NO
O >100 ft. from wells?- - ❑ It ❑
W >100 ft. from surface water? - - DI II
ILL. >10 ft. from potable water lines?- - ❑ ® ❑
Z > 5 ft. from property lines and easements?- - ❑ It ❑
Q
cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ IN ❑
o
Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or o Clean gravel used? (check one)
Proper cover installed over drainfield?- - CI El ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
• Pump tank capacity (flood) 1250 gal Manufacturer SPS
< 24" access riser(s) and accessible from surface?- - ❑ II ❑
!—
a Alarm or Control Panel Installed? - - ❑ II ❑
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑
a Pump installed in ❑ Bucket or ❑ On Block or Jr Other DUMP SILO INTAKE 18" OFF FLOOF
2 Pump Make/Model LIBERTY 280 Iffil Floats or ❑ Transducer
R. l o Tank draw down 75 in/min Pump capacity 0 gpm Squirt Height S-2 / —ft---
Pump on time-Z M:+� IS S-et Pump off time C , Flo Daily flow set at 3C0 gpd
Updated 8/21/2018
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Mason County OSS Installation Report pg. 2 Parcel# 22029-34-90061
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ❑■ NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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,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.
''Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I certify that I installed the system in accordance with 1 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 an rd ' accurate. form and attached Record Drawing is accurate.
S/7715— •••5
ode
OAS
nat Installer Date or. •
Printed Name of Signee i" �•1�
MASON COUNTY PUBLIC HEALTH i;,�• 1�
The undersigned approves this Installation Report and A ,_ MEDCALF'..A.
Record Drawing on behalf of Mason County Public ar,��. �� `R.•
Health: / " 5/ 7
\Q-Ar-n;AVT -1L?2)
Signature of Environmental Health Specialist Date (stamp,,stam signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018
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