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HomeMy WebLinkAboutSWG2024-00323 - SWG As-Built - 8/26/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00323 Parcel # 32136-12-90060 Applicant Name NORTON ROSS Subdivision (Name/Div/Block/Lot) Applicant Address 902 S BENNETT ST , City, State, Zip TACOMA, WA. 98465 Installer Name MAPLES EXCAVATION Site Address E DEER CREEK RD Designer Name CINDY WAITE INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type PRESSURE etreatment Type >5 ft. from foundation? - % ��"` `£j El N/A OYES El NO >50ft. fromwells? ��` _ _ _ _ _ _ ❑ [g 0 Z >50 ft. from surface water? - �'�5 _ IR 0 et Cleanout between building and tank? -`Acr, -�V� ❑ 0 0 C) Tank baffles present? - \-:,./ _ - - - - ❑ 0 0 Po. 24"access risers over each compartmen ?- - - - - _ .Q' ■ CI ❑ lu Effluent filter installed?- `� 0 V) - - ❑ • 10, � r: Septic tank capacity (working) _ 12 .a al Mpn urer - : _ 1 5`P1- r `^ V1 0 D-box water level and speed levelers us= .; - - �-L -- ���-- �] N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface? N\Kc- 1- � ❑ 1111 0 QQCheck valves installed? - \s#,S4. SD" - ❑ ❑ 0 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑■ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - 0 0 0 u. >10 ft.from potable water lines?- - ❑ 0 ❑ Z > 5 ft from property lines and easements - - ❑ farl f--1 d > 30 ft. from downgradient curtain/foundation drains? IN 0 0 Drainfield level and observation ports present - - ❑ 0 0 ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 0 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES 0 NO Pump tank capacity (flood) x 12 ,c) gal Manufacturer V 14 — 9 ee'tic'-v1 Z Q 24"access riser(s) and accessible from surface?- - 0 ® ❑ aAlarm or Control Panel Installed? - - ❑ MI 0 2 Control Panel equipped with Timer/ETM/ Counter- - 0 ® 0 dX Pump installed in ID Bucket or g-On Block or 0 Other 1` a. Pump Make/Model Ai 7 oP(l.ec/ r- 1 S -1._ X Floats or 0 Transducer EL a Tank draw down 4( -1- in/min Pump capacity x �c?) gpm Squirt Height ft Pump on time ► 1"-N- "' Pump off time X. 611(5 ® Daily flow set at / bb gpd -1. ,S Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 32136-12-90060 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q YES El 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. ,4 ppRovE . UG 2 6 2025 MASON COUNTYA ENVIRONMENTAL HEALT H JBW ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with /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 D wing is accurate. }�C� yr `c%•�� `Z $� Z 5- Signature of Installer Date . - r sV`C U eo p le 5 44, APrinted Name of Signee MASON COUNTY PUBLIC HEALTH z 5100 p CINDY E..WAITE '7 The undersigned approves this Installation Report and LICENSED DESIGNER • Reco d Drawing on behalf of Mason County Public Exi'iRt.s oalo He It : �t 3 Sign to nvironmental 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 00. le , "* l egg I ••, We 6 I .. .1, ; J NI a L- 1 . • F 1 fql •„, O. , v 0 ° • \i 4 II IR • • 1 l \ ;I 0,,>5) , ncy- ,N,.\‘' , , , , „„ ,, - 1.%- \. ‘ i t.r) il . i •••... '1 �14 9 QV1 ( C • e . / r 4 of e,,, of pes,,, r] 1,F'�"J`4 .0 i C • T,. 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