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HomeMy WebLinkAboutSWG2025-00113 - SWG As-Built - 6/24/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEA LTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00113 Parcel# 32309-55-00023 Applicant Name MAY FAMILY REV TRUST Subdivision (Name/Div/Block/Lot) Applicant Address 1510 N COLONY SURF DR City, State, Zip LILLIWAUP, WA. 98555 Installer Name TJ'S EXCAVATING LLC Site Address 1510 N COLONY SURF DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type OSCAR Pretreatment Type X02 >5 ft.from foundation? - ❑ >50 ft. from wells? -- El N/A ® YEs NO >50 ft. from surfacewater? - �� ❑ 0MI Z �� �ric `} ❑ H Cleanout between building and tank? - - �A- -' - 0 I 0 V Tank baffles present? - 1� _ - _ 1,Q El 1k ❑ a 24"access risers over each compartmen ?- - - - _ - _- ❑ Cl, NI Effluent filter installed?- . _ [3❑ ❑ ❑ Septic tank capacity(working) 12001 gal Manufacturer lewd. fL C. ., D-box water level and speed levelers used? J - ® NIA YES ❑ NO O O Manifold/D-box accessible from surface?- - 0 ® 0 GQ Check valves installed? - _ El El El 2 Transport Line Size SUPPLY AND RETURN Schedule/Class SCHDULE 40 Bedrooms installed (check one) © 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ NIA ® YES ❑ NO >100 ft. from wells? - 0 IN 0 W >100 ft. from surface water? - - 0 © ❑ Z >10 ft. from potable water lines?- - 0 ® ❑ IIE 44 > 5 ft. from property lines and easements?- - ❑ ❑ > 30 ft.from downgradient curtain/foundation drains? - ® 0 ❑ ci Drainfield level and observation ports present - ❑ Graveless chambers or ❑ Clean gravel used? (check one) ose qt Co-•fr Proper cover installed over drainfield?- - 0 ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ NIA ® YES ❑ NO ZPump tank capacity (flood) gal Manufacturer < 24"access riser(s)and accessible from surface?- - El ® [3a. Alarm or Control Panel Installed? - - 0 0 IP Control Panel equipped with Timer/ETM/Counter- - 0 ® 0 4. Pump installed in ❑ Bucket or 0 On Block or ❑ Other t V n' Pump Make/Model 2 ❑ Floats or ❑ Transducer Tank draw down in/min Pumpcapacity acit P Y gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Co-et/'T,--o'i! s74, do`'ti i>4a getcv.tP Updaced8/ is•r, �� Mason County OSS Installation Report pg. 2 Parcel# 32309-55-00023 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 j 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. l=� 111 a 'g PJ r' t. o Ae ro/e. 0 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 1 further certify that all information contained on this I further certify that all information contained on this form and attached ecord Drawing is accurate. form and attached Record D :wing is accurate. IF G-/0 -2-5 '+ Signature of I st Iler Date i�, � � �a'P. � ,/ �f� /��/�5 �� ptt(Ash, 9 V� ova Printed Name of Signee • MASON COUNTY PUBLIC HEALTH y cl eft t TEvoa��/j1 The undersigned approves this Installation Report and : LICENS O SIGNER ' Record Drawing on behalf of Mason County Public " LNPIRLS Health: 'A? 01-AM(011 (2-ci Signature of Environmental Health Specialist Date (stamp, signature and date) 9 ( p g THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 A 98656, USA, We i1lia=®n lbwnshlp, Parcel Id: 323095600023 •a "; ti 0 .,b cA `, IJ `% ', / ��� �yc+ e11 „'tip • j n `.E • G \ `I '��, i q r;.i DESIGNER 4� k` `'� APPROVE- ;, `', JUN 2 4 2025 ` 1 ) MASON COUNTY ENViRGNMEti ,TAL HALTN /IsN'N'''..N.,., • RET --_ • 1 p� ..\d‘milt1,0)E.9 , vl ,..4. ' ES �� i ' O 1 ' LL__...... ' f 1 L ' 1 , , r r 1 n f„ylle... �+1 Iii6' 1 •tip ..�` -- �L-� ,� 1. RV cover 2. X02 treatment tank • ;' l3 3. Discharge tank $(,e . 4. Audio/visual alarm • .' ,9 5. Clean out a 6. 1° supply and return line °' 7. Primary drainfield 3 '.,1__ __ . .4.__ °. ._:�... 8. Reserve drainfield urn P ro o 9. Waterline '. 10.Water hook up ` gai4 Ni -1 ti in : RC n `'N