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HomeMy WebLinkAboutSWG2024-00380 - SWG As-Built - 9/16/2025 Docusign Envelope ID:512E227B-D8CF-4DAE-9167-F1A4CA72A80E Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00380 Parcel # 32225-76-00010 Applicant Name YOl1NG IM Subdivision (Name/Div/Block/Lot) Applicant Address 20708 SF :122Nn ST TR 1 OF Sl IRVFY 4/80 City, State, Zip AUBURN WA 98092 Installer Name Thad Bamford Site Address 10972 E STATF RT 106 Designer Name Micah Halverson INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Glendon Rin-Filter Pretreatment Type >5 ft. from foundation? - - ❑ N/A ® YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ • Cleanout between building and tank? - El ❑ o Tank baffles present? ❑ d24" access risers over each compartment?- - SEP 1 Q ,M 5 ❑ W Effluent filter installed?- - ® ❑ Septic tank capacity (working) 1500 gal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ® NO oO Manifold/D-box accessible from surface?- - ❑ ® ❑ cot Check valves installed? - - ❑ ® ❑ oQ 2 Transport Line Size 1 25" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ® 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - El N/A ® YES ❑ NO O >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water? - - ❑ ❑ u. >10 ft. from potable water lines?- - ❑ ® ❑ z > 5 ft. from property lines and easements?- - ❑ ® ❑ cc > 30 ft. from downgradient curtain/foundation drains? - - ❑ X❑ ❑ Drainfield level and observation ports present - - ❑ X❑ ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield? - ❑ ® El Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES El NO Y Pump tank capacity (flood) 1835 gal Manufacturer SPS < 24" access riser(s) and accessible from surface?- - ® ❑ ❑ ~ a Alarm or Control Panel Installed? - - ® ❑ ❑ • Control Panel equipped with Timer/ ETM/Counter- - X❑ ❑ ❑ IZ Pump installed in ❑ Bucket or ❑ On Block or © Other Orenrn pump vault CI_ Pump Make/Model 3/4HP 1nrPM 230V ❑ Floats or ® Transducer 2 a Tank draw down Glendon in/min Pump capacity GlPndnn gpm Squirt Height Glendon ft Pump on time Glendon Pump off time Glendon Daily flow set at Ann gpd Updated 8/21/2018 Docusign Envelope ID: 512E227B-D8CF-4DAE-9167-F1A4CA72A80E Mason County OSS Installation Report pg. 2 Parcel# 32225-76-00010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ® YES Ell NO If yes, please describe:Pumped and decommissioned in place Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® 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. Initial Owners Initial: C qi ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 forfyggayattached Record Drawing is accurate. form and attached Record Drawing is accurate. 08259025 /,..JOU6113 ,VVu30. Signature of Installer Date 2�s ti it Rarrtford Septic Tbari-Ramford 0 !\41 Printed Name of SigneeOr •1 liIttMASON COUNTY PUBLIC HEALTH it� 141 The undersigned approves this Installation Report and �l 6100409 • Record Drawing on behalf of Mason County Public iNICMTHANELHALWRIPON Ill' Health: t T. 1S1Z1eTS1�1� °I,\I ke 11/ FYPtRFS.Mlle/ Signature of Environmen al 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 Tabloid 11"X17" a O n cooa) ort10 —I co • C ID m o m < LB rncniwy O m 3 �• 41 NDz,g C 6 • O ca O p 0 ,oO0 F A-* -i N m 3 3 O Q Qr+ 5...:1 s< ai = N <OKNat = O ma � � � mlc Fn � d co ci � 3 � � (n v - N a)3a)vitnoT"r- W 8f n ( ► N t3•fll N '(3 Q rt �• 7�l"O N 7 ?O Cj Cpf J �/ No • 3.6 >` LU•� W O a _, (4a 3 0 o n) to Z. -r S z ,. E. m 47 p O (D p O �cy J . -7 11) tE (I) PIO.Q. 3- r,-.... . 1 =,-= o a ai- a) c co \t 0 95 Q to• n (D 7c .» (D (D T ID SD O O (3D N N Q a03 Qo 0 \ LE 6� a � � coco 0-CD cp �tu� �� °D • N l0 r0 >z < _ C 033•0 m 3.Q (0 F.8' nz 3 * O c! ./ Ell (� O S a. m C m n / \ i� (L1 0 'a N .-r (D -i D.r--I N m ax 3 , y � 7 / \ 0 lt3 E. inat cn a, 0 fll O CDcn 2, (0 N 3 Sea m / `f�'` coD co 3 CD r. m 7O 1 3 , i a \ o a ^ I 4,,,,,,,, /// N 'NN . . P... '..°1 IN ., 1 7.#.e Os 1 D fcTkcaN \ ,C ,/ e/11i o -i j j No . ,0 p o' q / iiY O / /R 3 - ��`,((�� o 1 0 n © � Q/ 1 H y �Mt m 397',/ J D r -144a• 41111 • \ ' ' n 2:111 Cr) O 0 I a .� m goy 0 D y Ns " z � lil 0 - c O ill 3 T M CD iiZ \ — z N N i55. D N cn s° o \ o o \ V_2 \\ / cn X 2 _ __ __------- ----- \ \\ 0 / / \ v m / / ri -1) \ g_ > / 0- •,....„, \ \ / i J -i+,tin \ / M.Halverson Design LLC Owner/Applicant' Young Im itH A(trirASS• SHEET NUMBER PO Box 1519 Shelton Wa 98584 20706 SE 322nd St 10972 E STATE RT 106 7 Auburn,, WA 98092 REVISION#