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HomeMy WebLinkAboutSWG2020-00317 - SWG As-Built - 8/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00317 Parcel # 122077590573 Applicant Name TIMOTHY SCHROEDER Subdivision (Name/Div/Block/Lot) Applicant Address P.O. BOX 191 City, State, Zip ALLYN, WA 98524 Installer Name TONY ROBINSON Site Address 371 E UNDERLINE RD Designer Name ROD LEFT INSTALLATION CHECKLIST Q Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type GRAVITY Pretreatment Type >5 ft.from foundation? - - -- ❑ N/A 0 YES El NO >50 ft. from wells? - Ili�j ❑ ® ❑ • >50 ft. from surface water? - ``� ❑ ■❑ 0 Z Q Cleanout between building and tank? -- El El U Tank baffles present? - ❑ 0 0 d24"access risers over each compartment - -- ❑ 0 ❑ LU Effluent filter installed?- 133,-- --- 0 ❑■ ❑ u) Septic tank size 1 250 gal Manufacturer INFILTRATOR CID-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ 0 ❑ cDZ Check valves installed? - - ❑■ ❑ ❑ c < 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - III N/A 0 YES ❑ NO >100 ft.from wells?- M. 0 ❑ 4 . W >100 ft.from surface water? - i ❑■ ❑ I >10 ft. from potable water lines?- --- ---AUG-01t-ti 5--- • ,,- 0 ❑ Z L. > 5 ft. from property lines and easeme ! 0 ❑ Q AS ON(OUNf EIWIRONMEN AT HE`E O > 30 ft.from downgradient curtain/foun a ion drains. - - u 0 ❑ µ:.:;•;1 Drainfield level and observation ports present - - ❑ ❑ ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) _ Proper cover installed over drainfield?- - ❑ ❑■ Pump tank setbacks consistant with septic tank? - - © N/A ❑ YES ❑ NO Y Pump tank size gal Manufacturer < 24" access riser(s)and accessible from surface?- - ill ❑ ❑ ~ Alarm or Control Panel Installed? - - 0 ❑ ❑ a 2 Control Panel equipped with Timer/ETM/Counter- - ❑■ ❑ ❑ I3 Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑ Floats or m E] Transducer d 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# 122077590573 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES Q■ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES ■0 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. APPROVEtAUG 0 4 202501 MASON COUNTY ENVIRONMENTAL HEALTH JBW 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. Torn.)and attached Record Drawing is accurate. 7 25 2025 Sign ure of Installer Date Tony Robinson J Printed Name of Signeer. It.- lit MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and =o? ., *5-11. t Record Drawing on behalf of Mason County Public I LICE - rESu ER rr�rt�rJ�ut Health: EXPIRES 12/16t Zb 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 Updated 8,21/2018 * * * * * * > 0 0 Z > > r C O r r \ 4� m m 11 x\fi• 41%1 1 , > > rn----i ' ..r_ _..41,z, .`lb., 4*yt:4444:.'t.-W2) "li c oJU O 0— t4;A ws///o• P m z m m rn :///// m ocn 0 • O O z r -1 ' -- --____ m D 0 M x �.� - cn H> xO m m y c m -I • s�.00. m TI -i C Z m �7 m --1 — (� W z m Z m -_ 1 15.00, z iir m m O D C 0 Z ~� f. \ -n * - D0 * m�T 0 Z D D -n m Z N Utilities Utilities •• co ( , z m z -D 00 m ! . •. . n_X Z • OmaCm z m • ' ,0 orz W F 7 N. ......•. . . . . • 0 0 m rn 0 N oc.. •4'X D ,oD > () m E (/) `- •m -n W O �� 0 m ♦n '0 EDrn C can ►- °a, /'� V l 4\ Z Q O U..ie Utilities • 73 C D m 0 CO o 2 \\ g N D m PI- 0 �7 O --� r\ �G' m m — c °�7 7J� -4. •. 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