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HomeMy WebLinkAboutSWG2025-00235 - SWG Application / Design - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH :;APPLICANT!PERMIT 1NFORMATI0:. _ Permit Number SWG 2025-00235 Parcel # 32214-52-03003 Applicant Name Glenn &Jennifer Templeton Subdivision (Name/Div/Block/Lot) Applicant Address 16710 145th Ave SE City, State, Zip Renton, WA 98058 Installer Name Josh Peterson Site Address 61 NE Cedar Ln, Tahuya, WA 9858 Designer Name Rod Left Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other •v System Type Drip retreatment Type NuWater >5 ft. from foundation? ��=f - • 3-�� # - - - LI N/A RYES ❑ NO ,T"'-' VVV � `�, 1�s 1; ; y >50 ft. from wells? ,-;�4r i - - - ❑ ❑] ❑ >50 ft. from surface water? - - - - - 7\.- - - 7 1 lai- - j - - ❑ 0 ❑ Cleanout between building and tankt) - ❑ 00 Tank baffles present? - + - - -- - - ❑ © ❑ __ 24" access risers over each compart $iy?___ _- - ❑ El ❑ Effluent filter installed?- - ❑ `` `` II Septic tank size 1000 gal Manufacturer t't uotc Mav‘ . _. D-box water level and speed levelers used? - - Ng N/A ❑ YES ❑ NO _ ' Manifold/D-box accessible from surface?- - 111 ❑ ❑ Check valves installed? - - 111 ❑ ❑ Transport Line Size Schedule/Class Bedrooms installed (check one) El 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO >100 ft. from wells?- - ❑ ❑t ❑ - >100 ft. from surface water? - - ❑ U k ❑ >10 ft.from potable water lines?- - ❑ ❑■ ❑ > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ _- > 30 ft.from downgradient curtain/foundation drains?- - ❑ © ❑ - Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ M ❑ Pump tank setbacks consistant with septic tank? - - ❑ NIA © YES ❑ NO Pump tank size 1000 gal Manufacturer Hagerman 24"access riser(s) and accessible from surface?- - ❑ It ❑ Alarm or Control Panel Installed? - - ❑ © ❑ -= Control Panel equipped with Timer/ETM/Counter- - ❑ I ❑ - Pump installed in 0 Bucket or ❑ On Block or ❑ Other Pump Make/Model Sta-Rite Step 20/30 ❑� Floats or ❑ Transducer -- Tank draw down 2 gallon in/min Pump capacity 22 qpm Squirt Height N/A ft < Pump on time 5 min Pump off time 1 hour Daily flow set at 240 gpd Updated a21/2018 Mason County OSS Installation Report pg. 2 Parcel# 32214-52-03003 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES la NO If yes, please describe: Were all components pumped out and properly abandon perWAC246-272A-0300? - El YES // NO RECQ'0=11RAIIflNG This La a permanent record and must be accurate and descriptive enough • re-loans In!ba teed of maintenance activities and future development Typical Record Drawings contain: Dainfield&manifold orientation&layout.Septic/pump tank I. :'.n,North arrow,reserve dndnfieid,existing and proposed buildings,location of wells,waterlines. wells,observation ports,deanouts,and other maintenance access points. income eta Record Drawings may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIFIC'ATI 11 N.OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that/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 design:I. 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 a ched Record Drawing is accurate. form and attached Record Drawing is accurate. 2//1•- � nature of Installer Date AI Ilk Printed Name of Signee MASON COUNTY PUBLIC HEALTH 7'= The undersigned approves this installation Report an. Record Drawing on behalf of Mason County Public t Health: a' ' ' • t EXPIRES RIThewyyki C? 1i1k3 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 8/21/2018 n z T C SC mm C C 6Rm D 1ir / FL) !!: .. A l\ r • m 7°o y, 1 m 1 • �11m♦v}tCt,,� $ %. m mo i 40° QN its • %/1. die 1 A a o D 0 D 0 0 13 rn N O Z IV O rn N Z `� rn ---1\ r ax r- 0") • p '• 4 . ••.' — D O .•* • D . U) o m ' D • < ,. . p. • ;• • . ' • • . . icti-*4: . . • • • . • .„,—. . . . . ., • ,• . . .. •. 0` . • I n N u u u • 0 z D g om $ O G icnc m -I m f � WF rfl �` p �� Z � O Z cn cn m■ < m D A c r ` • r D c c m N A Z D r > :(1 Zl Z N 3o m Z z z m. o co m n m y O -0 Z O p • U) —I Z 0 ai O m m —I >< > -n �11 D rn rr1 m _ z z z ill fll > m D D Z = O �� II H c o z Z —ir Z tv —1 Iv mm CII) ;a --i rn ? z T ? p p aD p 0 > D m Z nl 7. 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