HomeMy WebLinkAboutSWG2025-00256 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00256 Parcel # 221325000045
Applicant Name Ana Cutler Subdivision (Name/Div/Block/Lot)
Applicant Address 5334 N 78th Way
City, State, Zip Scottsdale,AZ 85250 Installer Name Joshua Gunia
Site Address 2120 E Spencer Lake Rd Designer Name Adam Hunter
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑ Other
System Type Oscar •retreatment Type N/A
>5 ft.from foundation? ' - -- ❑ N/A El YES El
>50 ft. from wells? - StI - - - - - ❑ MI El
Z• >50 ft. from surface water? • - - - - - ❑ IN
H Cleanout between building and tank %'\\-.
AUG -7 - - ❑ El El
✓ Tank baffles present? - i ' ° ❑ ❑® ❑
E24"access risers over each compart ei3V- - - „-0'1 - -- - - - ❑ ® ❑
WW Effluent filter installed?- - ❑ 0 ❑
Septic tank capacity (working) 1500 gal Manufacturer Infiltrator
D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO
O Manifold/D-box accessible from surface?- - ® ❑ ❑
00 Z Check valves installed? - - ❑ ❑O ❑
0<
n Transport Line Size Two 1 n pressure Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ['Commercial/Other
>10 ft.from foundation?- - ❑ N/A ❑■ YES ❑ NO
® >100 ft.from wells?- - ❑ 0 ❑
W >100 ft.from surface water? - - ❑ ® ❑
L.T. >10 ft.from potable water lines?- - ❑ ❑! ❑
cr-Z >5 ft. from property lines and easements?- - El ® ❑
o2 >30 ft. from downgradient curtain/foundation drains?- - ❑ ® ❑
• Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ® ❑ ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A C] YES ❑ NO
• Pump tank capacity (flood) 1480 gal Manufacturer infiltrator
< 24"access riser(s)and accessible from surface?- - ❑ NI ❑
H
a Alarm or Control Panel Installed? - - ❑ ® ❑
2 Control Panel equipped with Timer/ETM/Counter- - ❑ IN ❑
n
D- Pump installed in ❑ Bucket or ® On Block or ❑ Other
a• Pump Make/Model 3/4HP AYMCDONALD Z] Floats or 0 Transducer
Q.
Q. Tank draw down N/A in/min Pump capacity gpm Squirt Height N/A ft
Pump on time 72SFC Pump off time 3MIN 3 SFc Daily flow set at 360 _gpd
Updated 8/21,2018
•
Mason County OSS installation Report pg. 2 Parcel# 221325000045
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - El YES ❑ NO
If yes, please describe: Exsisting septic tank demo and filled with dirt
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q 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 drainfleld,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 at d attached ecord Drawing is accurat form and attached Record Drawing is accurate.
tr/cx
ure of ins all r Date
Joshua Gunia 8/25/25
Printed Name of Signec
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
ADAI.J.HUNTERLlik9Ani9 C‘YrA,Health:
C� ' . 26
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 8I21/201e
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