HomeMy WebLinkAboutSWG2025-00153 - SWG As-Built - 9/11/2025 e
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Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00153 Parcel # 22132-33-90090
Applicant Name RUTH HARRISON Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 116
City, State, Zip SHELTON, WA. 98584 Installer Name SCHOENING EXCAVATION LLC
Site Address 1610 E SPENCER LAKE RD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type PRESSURE DIST Pretr--tment Type
>5 ft. from foundation? - t � � ❑ N/A Q YES ❑ NO
>50 ft. from wells? L;T;}t }'1;,�':,,'.1 '` t - ❑ 0 ❑
Z >50 ft. from surface water? - ; :: 2 r3 � -`„, ❑ 0 ❑
Q Cleanout between building and tank? -- -�T-4 - ❑ 0 ❑
✓ Tank baffles present? - `•� --- - - - - - - -
a24" access risers over each compartment?� P.- - - - - ❑ 00
tW Effluent filter installed?- - ❑ NJ ❑
Septic tank capacity(working) 1250 gal Manufacturer HAGERMAN 1250
0 D-box water level and speed levelers used? - - - fj N/A ❑ YES ❑ NO
00 Manifold/D-box accessible from surface?- - - ❑ El ❑
u.
DQ Check valves installed? ❑ ❑ ❑
2 Transport Line Size 2 Schedule/Class SCHEDULE 40
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - - - ❑ N/A ❑■ YES ❑ NO
O >100 ft. from wells?- - ❑ 0 ❑
W >100 ft. from surface water? - - ❑ ❑■ ❑
it >10 ft. from potable water lines?- - ❑ ❑■ ❑
Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑
ii > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑
Drainfield level and observation ports present - - ❑ IR ❑
a Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
• Pump tank capacity (flood) 1455 gal Manufacturer HAGERMAN 1250
< 24" access riser(s)and accessible from surface?- - ❑ IN ❑
dAlarm or Control Panel Installed? - - ❑ 0 ❑
• Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑
- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a• Pump Make/Model LIBERTY 250 ❑ Floats or ❑ Transducer
a Tank draw down 1.25 in/min Pump capacity 31.25 gpm Squirt Height 8 ft
Pump on time 84 SEC Pump off time 6 Daily flow set at 180 gpd
Updated 8/21/2018
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Mason County OSS Installation Report pg. 2 Parcel# 22132-33-90090
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - E■ YES El NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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 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.
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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. form and attached Recor wing is accurate.
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Signature of Installer Date e . *Asti /
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Printed Name of Signee A,
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MASON COUNTY PUBLIC HEALTH o v E 1,
LICENSED DES ER
The undersigned approves this Installation Report and .Z -
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Record Drawing on behalf of Mason County Public
Health:
(41\-12}/1
Signature of Environme tal 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
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