HomeMy WebLinkAboutSWG2023-00263 - SWG As-Built - 5/8/2025 Iiiir
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
. • APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00263 Parcel # 2Z 0 Z-24- el t 0 j L)
Applicant Name MACKENZIE STEVENS Subdivision (Name/Div/Block/Lot)
Applicant Address 7590 SE LYNCH RD.
City, State, Zip SHELTON, WA 98584 Installer Name PROFICIENT EXCAVATION LLC
Site Address 7590 SE LYNCH RD. Designer Name ADAM HUNTER
INSTALLATION CHECKLIST
it Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Pretreatment Type
>5 ft.from foundation? - •- 0 N/A ®YES ❑ NO
>50 ft.from wells? - - ❑ II 0
Z >50 ft.from surface water? - - 0 ® El
HCleanout between building and tank? - - 0 0
U Tank baffles present? - - 0 ® 0
d. 24"access risers over each compartment?- - El MI ID
cW. Effluent filter installed?- - 0 I 0
o
Septic tank capacity (working) 1200 gal Manufacturer sound placement
5 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO
QO Manifold/D-box accessible from surface?- - El IN
o0Z Check valves installed? - •- ❑ ® 0
OQ
2 Transport Line Size linch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- .- 0 N/A ® YES ❑ NO
0 >100 ft.from wells?- - 0 NI 0
W >100 ft.from surface water? - - 0 ® 0
u.. >10 ft.from potable water lines?- - ❑ ® ❑
Z > 5 ft.from property lines and easements?- - ❑ ® ❑
> 30 ft.from downgradient curtain/foundation drains?- - ❑ El
Drainfield level and observation ports present - - 0 ® ❑
❑ Graveless chambers or J Clean gravel used? (check one)
Proper cover installed over drainfield?- •- 0 IN ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A IN YES 0 NO
Pump tank capacity(flood) 1200 gal Manufacturer sound placement
< 24"access riser(s)and accessible from surface?- - ❑ I ❑
H
a Alarm or Control Panel Installed? - - El II El
2 Control Panel equipped with Timer/ETM/Counter- - 0 11 ❑
M
C- Pump installed in II Bucket or ❑ On Block or ❑ Other
EPump Make/Model Liberty 290 II Floats or ❑ Transducer
a Tank draw down 1.67 in/min Pump capacity 77 gpm Squirt Height 5 ft
Pump on time 2min Pump off time 4hrs Daily flow set at 360 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 22032490010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 0 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: Dralnfield&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 Installatlen approval and related permits.
[ .,Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
1 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.
William Cookse ---�• -`
Signature of Installer Date
William Orie Cooksey 49' '1
Printed Name of Signee h� ,,Y w.i :.,,
MASON COUNTY PUBLIC HEALTH ,�: rt •:��
The undersigned approves this Installation Report and ' 5100.112
Record Drawing on behalf of Mason County Public q�'' aonm HUNTER :
1'1M1SL'rl 1SF'S'ii,NCC'
Mr-at-
<-7 46 —
/ZS ).p,i;cs 07,121 .14
Signature of Environmental Health Specialist Date (stamp, 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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