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HomeMy WebLinkAboutSWG2025-00174 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG2j 24-00 1 144- Parcel 44a200i -* 00 - OWN Applicant Name ears-a Kari of,DOYm u1 Subdivision (Name/Div/Block/Lot) Applicant Address 410t, fOOth►I1 la'. 1t mOCrl, .iCL 4ti TR flfd City, State, Zip PYOVD, UT NU 64 Installer Name crUld1C MAT tCX. Site Address i6121 E TinIOCA lakt west Di. Designer Name INSTALLATION CHECKLIST ❑ Full System Installation "Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type (--1' (G 011.1 Pretreatment Type >5 ft.from foundation? - - ❑ N/A [ YES ❑ No >50 ft. from wells? - -- ❑1 ET45f►,e- ❑ Z >50 ft. from surface water? - - �rN n Q Cleanout between building and tank? - - ❑ 11 "1T ❑ I— U Tank baffles present? - - ❑ [ ' ❑ d24"access risers over each compartment?- - ❑ Lf ❑ W Effluent filter installed?- -- ❑ QJ ❑ Septic tank capacity (working) i 0( 0 gal Manufacturer I n(i 1 fi atQ( C D-box water level and speed levelers used? - ❑ N/A El YES ❑ NO DJ O Manifold/D-box accessible from surface?- •- ❑ ❑ ❑ OOZ Check valves installed? - -- ❑ ❑ ❑ oQ E Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- -- ❑ N/A ❑ YES ❑ NO CZ >100 ft. from wells? - ❑ ❑ III W >100 ft. from surface water? - - ❑ ❑ �Z1 ', t } LL >10 ft. from potable water lines?- ❑ ❑ ►ter N 4,. o i�. > 5 ft. from property lines and easements?- - ❑ ❑ wig > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ Y o ► Drainfield level and observation ports present - ❑ ❑ '� z ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ L 21� m Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO Y Pump tank capacity (flood) gal anufacturer < 24"access riser(s)and accessible from surf e?• - ❑ ❑ ❑ I- a. Alarm or Control Panel Installed? - - ❑ ❑ ❑ E Control Panel equipped with Timer/ETM /Counte - ❑ ❑ ❑ n d Pump installed in ❑ Bucket or ❑ On Block o ❑ Other n' Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm 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# aa00t "' "-g0000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [.i YES ci NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 14 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,Septiclpump 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 1 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. a9Ia0a� Signature of Installer Date Ghee l✓iA,pic Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: ( 1 LD IZ '�r'/l I( t 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 Update°8/2112 0 1 8 RECORD DRAWING (continued) < i irn Vir lie MASON COUNTY 6 2025 wit!it! EN 4RONME ten& RET NTgC HEAL, ti ou Cc 10` 9 NCW IOV0 infi lfi a my SLp,(,7at,n K TimbCirIMa W?6t- Dr. — — — — — — m i 22001-50-00M Mason County WA GIS Web Map . Itt. . • e 1901E TIMBERLAKE WEST DR :, ,..... ,it .. k. 0 ...,...,.., ... ,... , la4 . 5oo497.t 1911 E TIMBERLAKE WEST DR 4Aw 1. Imog.' ,..r. T . . .' ; 'u O'aSG ©�BERL•AK WEST DR 4- Ge 1931 E TIMBERLAKE WEST DR =0TIMBERL1AKE WEST DR Ili . . '-,,,, '1 y 5/12/2025, 10:44:57AM 'A ID 5/12/2025, W • - 1:384 _ ,_ JUN O 2025 0 0 0A 0.1 nil L County Boundary U I r f MASON COUNTY ENVIRONYENTAL HEAL?H 0.01 0.01 0.02 km No Filled RET ° Site Address (Zoom in to 1:3,000) Source Esrr.htaxv.Earthstar Geographies.and the GIS User Community Tax Parcels (Zoom in to 1:30,000) Mason County WA GIS Web Map Application Mason County disclaims accuracy roUabd ty or timeliness of websde info not liable for losses horn re4 nice on it htlps/lwwv masoncountyv.a rfov/diY.tamter php