HomeMy WebLinkAboutSWG2024-00479 - SWG As-Built - 8/26/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00479 Parcel# 223315300022 I
Applicant Name Matteson ET AL Nicholas 8 Kathen Subdivision (Name/Div/Block/Lot)
Applicant Address 201 NE Collins Dr East
City, State,Zip Tahuya, WA 98588 Installer Name Josh Peterson
Site Address Same Designer Name Cindy Waite
INSTALLATION CHECKLIST 1
0 Full System Installation 0 Tank(s)Only ❑Drainfield Only 0 Repair ®Other Add ATV•m loan meamNc
System Type Pressure Pretreatment Type NuWater BNR500
>5 ft.from foundation? -
>50 ft.from Wells? - - 0 WA a vas 0 NO
>50 ft.from surface water? - - ❑❑ � ❑0
F Cleanout between building and tank? - 0 ❑_
ili
V Tank baffles present? - 0 . 0
d24"access risers over each compartment?
W Effluent filter installed?- fs ❑ II 0
is
Septic tank capacity(working) �F/t 2� _gal Manufact 0 0
y Manufacturer
s D-box water level and speed levelers used? a N/A ❑YES ❑ NO
20 Manifold/D-box accessible from surface?- 0 e 0
u.
t9 Check valves installed? - - 0 II
R Transport Line Size 2 '' Schedule/Class Sc A 40 W
Bedrooms installed(check one) 0 2 e 3 ❑4 ❑5 ❑6 ❑Commercial/Other i- n
>10 ft. from foundation?- I
❑ WA IN YES ❑ fp u
0 >100 ft from wells?
W
in 0
>100 ft.from surface water? _ - _ 0 k„ Ill ❑ " 7
Z >10 ft.from potable water lines?. d' e 0
c >5 ft.from property tines and easements?-- - - - AUt}2 g_20-25 0 �i` e 0 I-i-
0 >30 ft.from downgradient curtain/foundation(drains7- _ - - - ❑ e o ALI rL�C/'
Drainfield level and observation ports present - 0
e Graveless chambers or ❑ Clean gravel used? (checkaoneJ'
Proper cover installed over drainfield? 0 in 0
Pump tank setbacks consistent with septic tank? '�// El N/A 12 YES 0 NO
he Pump tank capacity(flood) 1200 gal s"i'Manu{acturer Existing
< 24"access riser(s)and accessible from surface? . 0 9 0
I—
a. Alarm or Control Panel Installed? -
j Control Panel equipped with Timer I ETM/Counter- - 0 0- 0 0
a Pump installed in a Bucket or 0 On Block or ❑ Other
2 Pump Make/Model Liberty29O a Floats or 0 Transducer
ft. Tank draw down 1--,f inimin Pump capacity ivy ) gpm Squirt Height 4--3 ft •
Pump on time Li if Sep Pump off time >(hry Daily flow set at 2-70 qpd
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Mason County OSS Installation Report pg. 2 parcel# 223315300022
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? reVES 0 NO
If yes, please describe: S c-.y p /C r r_Ten—
.
.
Were all components pumped out and properly abandoned per WAC2013-272A-0300? ji'YES 0 NO
RECORD DRAWING
This Is a permanent record and must G accurate and descriptive enough to mleuh In Na need or maintenance activities and Mum d.Wapment Typical Record
Drawings contain: Drainflald 6 manibd orwnsfion 6layout Sept/pump tank bcyyon.Norharrow.reserve&ainfied.outstrip and proyosedaadngs.location o1 wells.wai Mnes.woks.observation pats.dimwit are other maintenance accost points. a Incomplete RerdDrawings may create Wilton*delays in final v4alYln approval and Meld Rennes.
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J BAC 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 actor,
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 i
here have been cleared/approved by both the designer shown here have been clearediapproved 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[I t all information contained on this I further certify that all information contained on this
form and ad tl Record Drawing is aaccurate, form and attached Record Drawing is accurate.
/312,--
Sign of Installer Date e
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es Ssw� 11111
Sled Name of S/gnee Atil
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MASON COUNTY PUBLIC HEALTH .: �W pti II nq'/�
The undersigned approves this Installation Report and 9 e l
Record Drawing on behalf of Mason County Public - j pD4 • ko0 •
Heelf .CO E.WAIT3 I.
(,A7)/[ry,�� [/�A..A�/ LICENSED DESIGNER 11
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Signet : IV vironmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updNaee21m18
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