HomeMy WebLinkAboutSWG2022-00495 - SWG As-Built - 6/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00495 Parcel # 319041190030
Applicant Name HESS, DANIEL & SARA Subdivision (Name/Div/Block/Lot)
Applicant Address SS 3141 LOT3
City, State, Zip Installer Name ANDREW LEHMAN
Site Address 200 SE SISTER MDWS LN Designer Name JIM HUNTER
INSTALLATION CHECKLIST
IN Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type STANDARD PRESSURE TRENWireatment Type
>5 ft.from foundation? - - ❑ N/A ®YES 0 NO
>50 ft.from wells? - BgElIfE-1 ❑ ElZ >50 ft.from surface water? - ❑ II El
Cleanout between building and tank? - - -JUN--2-20-25J-- 0 0 ❑
U Tank baffles present? - - El III
a24"access risers over each compartmen.' y_ - ❑ III ❑
N Effluent filter installed?- -- ElII El
Septic tank capacity (working) 1200 gal Manufacturer HB PRECAST
C D-box water level and speed levelers used? - - ® N/A ❑ YES 0 NO
DOJ Manifold/D-box accessible from surface?- - ❑ El
cc Check valves installed? - - II 0 0
0Q
E Transport Line Size 2 INCH Schedule/Class SCH 40
Bedrooms installed (check one) 0 2 0 3 04 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - 0 N/A 0 YES ❑ NO
>100 ft.from wells?- - ❑ II ❑
o
W >100 ft.from surface water? - - 0 II 0
E. >10 ft. from potable water lines?- - ❑ ❑■ ❑
Z > 5 ft.from property lines and easements?- - ❑ 0 ❑
Ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑
• Drainfield level and observation ports present - - ❑ Igl ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 0
Pump tank setbacks consistent with septic tank? - - 0 NIA li YES 0 NO
• Pump tank capacity(flood) 1200 gal Manufacturer HB PRECAST
< 24" access riser(s) and accessible from surface?- - 0 El ❑
H0. Alarm or Control Panel Installed? - - 0 0 0
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ PI 0
D
a Pump installed in ❑ Bucket or li On Block or ❑ Other
Q.• Pump Make/Model LIBERTY 290 ® Floats or 0 Transducer
0=. Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 2 ft
Pump on time 1:36 MIN Pump off time 4 HR Daily flow set at 480 gpd
Updated 8/2 1120 1 8
Mason County OSS Installation Report pg. 2 Parcel # 319041190030
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ■E 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.
SL
VI,
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
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 Dra ing is accurate
5/29/25 I
Signature of Installer Date -
4
ANDREW LEHMAN $-t�.•.
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
14‘:;‘'
1 Z
Slu;2i3
ER
The undersigned approves this Installation 0 m6It.wolf sLlCENsEb bt pc,NE-R
Record Drawing on behalf of Mason County Pub i7 c yS`pP�`
Health: o S. 03/22/2G
Signature of Environmental Health Specialist (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAI )AfiitErliSilpF,UBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121!2018
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