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Home My WebLink AboutSWG2023-0055 - SWG As-Built - 7/11/2025 CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUB�,;, ,EALTH APPLICANT/ PERMIT INFORMATION •y Permit Number SWG 2023-00055 Parcel # 32021-56-03004 �� G%j �> Applicant Name JAG Construction Subdivision (Name/Div/Block/Lot) �\.� v-, y �.� 10) Applicant Address 5421 Crane Ave Shorewood Terrace 3rd Addn Blk 3 Lot 4 `\ `f City, State, Zip Port Orchard, WA 98366 Installer Name Tom Weaver `\. 1* • Site Address 61 E Panorama Dr Designer Name Tom Weaver INSTALLATION CHECKLIST UI Full System Installation ❑Tank(s)Only El Drainfield Only ❑ Repair ❑Other System Type Pressure Distribution Pretreatment Type Septic Tank >5 ft. from foundation? - - ❑ N/A II YES ❑ NO >50 ft. from,was? - - ❑ a ❑ Z >50 ft. from surface water? - El II El H Cleanout between building and tank? - - III III CIV Tank baffles present? - - ❑ . ❑ a24" access risers over each compartment?- - CI ❑ L Effluent filter installed?- - CI NI ❑ Septic tank capacity (working) 1,250 gal Manufacturer Infiltrator C1 D-box water level and speed levelers used? - - N/A ❑ YES ❑ NO 0O Manifold/D-box accessible from surface?- - CI III El coCheck valves installed? - - El ❑ III 6Q 2 Transport Line Size 2 Schedule/Class SCH40 Bedrooms installed (check one) ❑ 2 3 ❑4 ❑ 5 1116 El Commercial/Other >10 ft. from foundation? - - ❑ N/A • YES ❑ NO CD >100 ft. from wells?- - ❑ M ❑ W >100 ft. from surface water? - - ❑ IN CI Li >10 ft. from potable water lines?- - ❑ U ❑ Z > 5 ft. from property lines and easements?- - ❑ II 0 Q Cr > 30 ft. from downgradient curtain/foundation drains? - - ❑ Iiil Drainfield level and observation ports present - - ❑ NI ❑ IN Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A YES ❑ NO • Pump tank capacity (flood) 1,250 gal Manufacturer Infiltrator < 24" access riser(s) and accessible from surface?- - ❑ MI ❑ ~ a Alarm or Control Panel Installed? - - CI II ❑ E Control Panel equipped with Timer/ ETM /Counter- - ❑ It ❑ D C- Pump installed in El Bucket or • On Block or ❑ Other a• Pump Make/Model Liberty 290 ll Floats or ❑ Transducer a Tank draw down 2.2 in/min Pump capacity 44 gpm Squirt Height 7 ft Pump on time 1 min 25 sec Pump off time 4 hours Daily flow set at 360 gpd Updated B/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 32021-56-03004 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ❑ YES 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. ❑ 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 a ched Record Drawing is accurate. form and attached Record Drawing is accurate. /77 i /' Signature of Installer Date Thomas Weaver Fr -Printed Name of Signee / •'e °' MASON COUNTY PUBLIC HEALTH �o` • T401.415 E.WEAVER`•. The undersigned approves this Installation Report and i4SED E i a" Record Drawing on behalf of Mason County Public 2-1/2_1 Health: RITV.11‘N 10(1 C Y V) -1 J ( lLc Si nature of Environmental Health Specialist Date (stamp, signature and date) 9 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 r oo Sly �_ �/1 li r�. 51003.33 1 "el E.WEAVER'.' 0 CD L/7V !^ .0 I.,, r N A" I1 v.CC O . Eo a � L/2 F2o Pb o WO II o N s co .--- CDMT.- cu > 50% Reserve N t 0 _ _ a 9'X50' PressureBed o /L�O 0 .r 50% Reserve V : a� CC ! o P o N -0 7' APPROVED m �, b JUL 1 1 2025 _1 .c o MASON COUNTY ENVIRONMENTAL HEALTH f ~I RET 0 0 N TEC5 j lij 25' 0 I Panorama Dr