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HomeMy WebLinkAboutSWG2025-00151 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00151 Parcel # 42216-50-00049 Applicant Name KARON WALTER Subdivision (Name/Div/Block/Lot) Applicant Address 12411 NAOMI LAWN DR SE City, State. Zip LAKEWOOD. WA. 98498 Installer Name MAX WALKER Site Address 522 N DOW CREEK DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installatio 0 Ta kis)0 Iv Drainfheid Only •Repair ❑Other System Type----)q - -- Pretreatment Type >5 ft. from foundation? - ❑ N/A ®YES ❑ NO >50 ft from wells? ItiRgEgE- ❑ ® ❑ >50 ft from surface water? -gCleanout between building and tank? - --4.. ?n ❑ © ❑ u Tank baffles present? - -- - -- - - - - dry `U?�- - 0 ® 0 a24"access risers over each compart - ❑ ® ❑ `W ElEffluent filter installed? - - - - - - ❑ 0 Septic tank capacity(working) LDGc, _gal Manufac rer _doer)/,-/ 0 D-box water level and speed levelers use;:? - - • ® N/A ❑YES 0 NO a o - -. __2_4_.r x_-tu.. �_ . 0 MI a?2 Check valves installed? - - - ❑ ® 0 Clot 2 Transport Line Sze 2 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ■❑ 2 ❑3 ❑4 0 5 ❑6 0 Commercial/Other ' >10 ft.from foundation? - •- 0 N/A ❑ YES, LZ a NO >100 ft. from weils?- - - - - - - - - - I � �a5 0 Ci W >100 ft, from surface water? Clia 0 it >10 ft. from potable water lines?• ❑ ® 0 Z > 5 ft from property lines and easements"; - El RI R > 30 ft. from downgradient curtain/foundation drains?- - ® g ❑ Ci Drainfleld level and observation ports present - - 0 le ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield? - - - - 0 116 ❑ Pump tank setbacks consistent with septic tank? - -- - 0 WA a Y 0 NO �C Pump tank capacity (flood) / 'e gal Manufacturer I11m- 1 rn.c- - < 24"access riser(s)and accessible from surface?- - - - - • ❑ II ❑ a Alarm or Control Panel Installed? - ❑ e 0 2 Control Panel equipped with Timer/ ETM Counter 0 ® ❑ m a. Pump installed in ® Bucket or 0 On Block or ❑ Other a' Pump MaketModel � c..7-1 _.- ' N� a Floats or 0 Transducer R. Tank draw down 2, in/min Pump capacity 2...r' gpm Squirt Height ?4 " ft R. - Pump on time ..S't, Sir,_ Pump off time __�._C_)7,,...c Daily flow set at qpd Mason County OSS Installation Report pg. 2 Parcel# 42216-50-00049 ABANDONMENT RECORD • Were existing septic components abandoned as hart of this project? • - 0 YES El NO If yes, please describe ----- -----_, _—.- Were ail 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 dasutptive onough to re-bate in the need of maintenance activities and future development Tyy+eal Romero Drawings rAntal,i Draw lei &tnarrtoia a-.en:a:07 S taye:.t Sb*Ii puma;,lark;castor Noitm,arrow.ese•ve cie0f.e'7 er at,ny ar,d i!opcsad maid:gs,iocatidr of w'„a Waterlines, wens observation pouts cteancuts.and otter ma:rte^arc a:toss po,nts ,nco,np:ela Recm Drawings rrai create additional derye in final Instafator epprovs and related permits ® Record Drawing Attached • CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that l installed the system in accordance with /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 ttached Re rd rawing is accurate form and attached Record Drawing is accurate Signature of Installer Date //'' � 40e, • Printed Name of Signee ^ A MASON COUNTY PUBLIC HEALTH • '�1 sir+ • The undersigned approves this Installation Report and / 51 0418 �F p C'NDY E.WAITE w Record Drawing on behalf of Mason County Public LICENSED DESIGNER Health: Z - • RES 05/10 C/ Jz = Signature of Environment(Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uaaatsd awzole 1 I ti`' O Q / . 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