HomeMy WebLinkAboutSWG2025-00170 - SWG As-Built - 7/11/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLI�TI PERMIT INFORMAtION
Permit Number SWG 2025-00170 Parcel # 42318-51-00075
Applicant Name Adam Peebles Subdivision (Name/Div/Block/Lot)
Applicant Address 18638 NE 65th St. Lake Cushman Div.4 Lot 75
City, State, Zip Vancouver, WA 98662 Installer Name T.J. Goos
Site Address 21 N. Quinault PL, . 6,r_ Designer Name Dale L. Tahja
.Is Mu ATIO4 CHECK sT
Nu Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other
System Type Pressure Trench 'retreatment Type N/A
>5 ft. from foundation? - -- ❑ N/A ®YES ❑ NO
>50 ft. from wells? - 0 - - - ❑ ® ❑
Z >50 ft. from surface water? - � - - ��- 0 ® 0
4 Cleanout between building and tank? - - -,_�&0 - ❑ ® ❑
✓ Tank baffles present? - - -0-- - - - - - - ■ ® ❑
a24" access risers over each cornpartme`' - - - - - - - - ❑ ® El
W Effluent filter installed?- - 0 I 0
cn
Septic tank capacity(working) 1,000 0 ,. Manufacturer Hagerman
o D-box water level and speed levelers used? - - ® N/A I: YES ❑ NO
Ox O Manifold/D-box accessible from surface?- - El El
C.2 Check valves installed? - - 0 ® 0
Q 1.25 Schedule/Class
Z. Transport Line Size Sch.40
Bedrooms installed (check one) ❑■ 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - 0 N/A ® YES ❑ NO
O >100 ft. from wells?- - ❑ ® 0
W >100 ft.from surface water? - - ❑ ® 0
cr. >10 ft.from potable water lines?- - 0 ® 0
Z > 5 ft.from property lines and easements?- - ❑ ® 0
c2 > 30 ft.from downgradient curtain/foundation drains? - - ® ❑ ❑
Drainfield level and observation ports present - - 0 0 0
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 I 0
Pump tank setbacks consistent with septic tank? - - 0 N/A ® YES ❑ NO
Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman
H• 24" access riser(s)and accessible from surface?- - 0 I 0
a Alarm or Control Panel Installed? - - 0 0 0
• Control Panel equipped with Timer/ETM /Counter- - 0 U ❑
a Pump installed in 0 Bucket or In On Block or ❑ Other
n. Pump Make/Model Liberty 280 ❑ Floats or 0 Transducer
d .Tank draw down 1.75 in/min Pump capacity 37 gpm Squirt Height 8 ft
Pump on time 2.5 min Pump off time 5 hrs. 57.5 min. Daily flow set at 180 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg.2 Parcel If LA ,; \%- j \-C (5
ABANDONMENT RECORD .
Were existing septic components abandoned as part at ha project? - - 0 YES 1111 E.
ifs please :
iWere all components pumped out and properly abandoned per Wac B-272a.02.o0)- - Q Yea Q "o
RECORD DRAWING
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Mitiliklei
yob,apaxwaUon pots,doenoid$and our aaliala anon scans Oats. inn:mama Road Onsina may amide addalonsl dMap In lad Mp011rbn.paid and Mated penulta
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r Record Drawing Attached
__ CERTIFICATION OF INSTALLATION
rIt4STALLER I DESIGNER/ENGINEER
I oerdly that I Installed We system In accordance with I certify that the system has been instead in swar-
th*septic design stamped"APPROVED"by Meson dance with the eeptic design stamped`APPROVED"by
County PubUc Health and that any deviations shown Mason County Public Health and that any deviations
here have been deersd/apprcVed by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself end Mason County Public Health and meet ail
and Mason County Codes. State and Mason County Codes
I further certify that aft Information contained on this I further certify that all information contained on this
form and attached
Signature- Id Drawl* ,. . •r m r, -._ form and attached Record e , • is accurate_
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Printed Name Of Slpnee -) /vpb,{Re m III
YAWN COUNTY PUBLIC HEALTH �� -- -.-• 31? �4111
The undersigned approves this installation Report and • 5100214 �{� r1
Record Dtarvbty on behalf of Meson County Public f I Date L.Tahjs 1
Health: : - UCEPISED DESIGNER I
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Signature of Environmental Heei[h Specialist Date (stamp,signature and date)
THIS FORM Mief BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES SITE 14400 earache `
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