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HomeMy WebLinkAboutSWG2025-00227 - SWG As-Built - 8/25/2025 m II Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00227 Parcel # 22005-51-00070 Applicant Name Mateo Tomas Subdivision (Name/Div/Block/Lot) Applicant Address 221 Cougar Ln. S. Phillips Lake Div. 2 Lot 70 City, State, Zip Shelton, WA 98584 Installer Name T.J. Goos Site Address 1031 Phillips Lake Lp. Rd. Designer Name Dale L. Tahj INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Trenches Pretreatment Type NuWater BNR 500 >5 ft. from foundation? - - - - ❑ N/A ® YES ❑ NO >50 ft. from wells? - .�.`�- A S - - - - ❑ © ❑ >50 ft. from surface water? - - - - "—:::; �^' \- - - ❑ I ❑ z 1/2\ • H Cleanout between building and to y- - - - • '180�j- - - -- ❑ ® ❑ - U Tank baffles present? - ❑ ® ❑ a24" access risers over each compa ?- - - - - - - - - ❑ ® ❑ w Effluent filter installed?- ?A - ❑ I ❑ Septic tank capacity (working) 1,000 gal Manufacturer Hagerman C3 D-box water level and speed levelers used? - - • N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ ® El co Z Check valves installed? - - ❑ I ❑ OQ 2 Transport Line Size 2 inch Schedule/Class Sch.40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- AN/A IIYES Eli NO >100ft. from wells?- 141 ❑ .,W >100 ft.from surface water? ❑ ti >10 ft. from potable water lines?- - - - - - -.�� 2-5 CO5 - . I ❑ Q > 5 ft.from property lines and easements3,AsoNteu i.\'{NWROLI -M--11''71 ® ❑ ix > 30 ft. from downgradient curtain/foundation drains?- -jar!!- - - - ❑ • ❑ Drainfield level and observation ports present - - ❑ 0 ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO Y Pump tank capacity(flood) 1,200 gal Manufacturer Hagerman < 24"access riser(s) and accessible from surface?- - ❑ ® ❑ a.. Alarm or Control Panel Installed? - - ❑ IA ❑ Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ - Pump installed in ❑ Bucket or 0 On Block or ❑ Other EPump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 2.25 in/min Pump capacity 44 gpm Squirt Height 9 ft Pump on time 2.26 Min. Pump off time 5 hrs. 57.4 min. Daily flow set at 360 gpd Updated 8.21/2C18 Meson County cis Installation Report pg.2 Parcel* .` 5 -7* c oo ,. .R,c Ware I septic components abandoned as part of this project? - - 0 YES I Mo It yes, please doe: Were all components pumped out and properly abandoned per WAC24B 2!2P-OXD?- - Q TES Q No ' ORAL NlG Ms is a penman record and mist bs ammo and dosodpdw wow*to moms in is need of wsLMsssme asaMMea ad Urn daMoponaat. Vital Record Ono**ooaloW DraiMeld d nadtald odods0on 8*wk.6sprorpaep 10*looalon,Honk worn meatus WM"Wag sad pwpand MN"tecMm dumb.wiiarinat, tab,abserwdm paps,tiomoWi,and usher nsdalWanos mein point,. Record CWW101 MY seams Id1MaM dOrillaillistiliwouppovii sad nsidod pencils. PPRov AU& 25 ED MASON COUNTY ENVIRONMEN2025TAL HEALTH JBW ■ Record Drawing Attached a CERTIFICATION OF INSTALLATION. / INSTALLER DESIGNER!ENGINEER !certify that I Installed the system In accordance with 1 certify that the system has been installed in acco& the septic design stamped'APPROVED"by Meson : dance with tiro septic design stamped`APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been clear roved by both the designer eMwn here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Hear and meet all and Mason County Codex State and Meson County Codes I further certify that at information contained on this 1 further certify that all information contained on this form and attached Drawl*is : ;1=1. farm and attached Record 17ta••, r is accurate • `-��' •� .C9 0. iii S�Signaturea/ Date . r V t\l 0 S Prated Name of SbpneeI A b L°i; i r .d �.ii MASON COUNTY PUBLIC HEALTH ��+P 3 � � � � , The undermined approves this Installation Report and © . 5100214 .t i Record Drawing on behalf of Meson County Public :i Cf Dale L.bhp t v - LICENSED DESIGNER t . t4 p qf set‘ ? - ,5-- 5 - :,. . : . � . •: : Health Specialist Date (stamp signature and date) / NM FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW oN THE MASON COUNTY AES srrE aaruaote 1 1 . 1. , r ......\ ...:...)- . ,:.....-4. • ;-_,.(3.1v2 • 1 ..--. ! . _._.., (Ps ,. • . .-.'i .-.&A 5 •• .1' 145 fg r, . , • . il-po.,i It .. . . . ,Ii.% lk k .1;% ii 47- 1,4 .e..... 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