Loading...
HomeMy WebLinkAboutSWQG2021-00153 - SWG As-Built - 10/6/2025 ESR FORM Masai County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00153 Parcel # 220175200021 App icant Name Sara Robbins$Associates Subdivision (Name/Div/Block/Lot) App icant Address 37839 37th Ave TIMBERLAKE#10 TR 21 City State, Zip Auburn, WA 98001 Installer Name Site Address 441 E BUDD DR, Shelton Designer Name Jim Zimny INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure distribution eatment Type >5 ft. from foundation? r, _ - � ;`s'A \� 0 NIA EN YES El NO >50 ft. from wells? - % T-) • >50ft. from surface water? - - - - -' t - - -- - El II z - NI ❑ • Cleanout between building and tank? - - - U Tank baffles present? - l 0 U ❑ d 24" access risers over each compartment?- illy - 0 ® 0 W Effluent fitter installed?- ❑ I ❑ gal al Manufacturer Hage man Septic tank capacity (working) 0 D-box water level and speed levelers used? - - ® NIA ❑ YES ❑ No 0J 9 Manifold/D-box accessible from surface?- - ❑ 0 mz Check valves installed? - ❑ ® ❑ OQ• Transport Line Size 2" Schedule/Class sch 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO CI >100 ft. from wells? - - ❑ ® ❑ W >100 ft. from surface water? - - ❑ II ❑ LL >10 ft. from potable water lines?- - ❑ © ❑ Q > 5 ft. from property lines and easements?- - ❑ NI IY > 30 ft. from downgradient curtain/foundation drains? - ❑ © ❑ cl Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or 1 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 II ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES 0 NO • Pump tank capacity (flood) 1000 gal Manufacturer hagerman < 24" access riser(s) and accessible from surface?- - ❑ LI ❑ H Alarm or Control Panel Installed? - - ❑ 0 El a E Control Panel equipped with Timer/ ETM/Counter ❑ II ❑ - - m a. Pump installed in ❑ Bucket or II On Block or ❑ Other a'• Pump Make/Model liberty L 280 II Floats or 0 Transducer a Tank draw down 1.5" in/min Pump capacity 30 gpm Squirt Height 2' ft Pump on time tmin 30 secs Pump off time 4 hrs Daily flow set at 270 gpd Jpdatea 8I21/2C18 V Parcel# 220175200021 Masai County OSS Installation Report pg. 2 ABANDONMENT RECORD YES El NO Were existing septic components abandoned as part of this project? If yes please describe NO El Were all components pumped out and properly abandoned per WAC246-272A-0300? - I] YES RECORD DRAWING This is r permanent record and must be accurate end descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawing;contain. Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve dramfield.existing and proposed buildings,'ocation of wells,waterlines. wells.of serration ports.cleanouts,and other maintenance access points Incomplete Record Drawings may create additional delays in final installation approval and related permits 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INS FALLER DESIGNER/ENGINEER 1 ce,tify that I installed the system in accordance with I certify that the system has been installed in accor- the ;eptic design stamped"APPROVED"by Mason dance with the septic design stamped`APPROVED"by Cot,my Public Health and that any deviations shown Mason County Public Health and that any deviations herc 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 1 fur'her certify that all information contained on this I further certify that all information contained on this fom i and attached Record Drawing is accurate. form and attached Record Drawing is accurate. VY1 OW kk Signature of Installer Date ll 1 r`^) i1 v Or) oreq iii- `I. Primed ame of Signee 10-51j- do 11niS t1) I9?' MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �2o; �►+ Record Drawing on behalf of Mason County Publica., uc 'SEDDESIGNER + Heath' Qs\-117-VeArq b" / to�c�Zs Signature of Environmental Health Specialist Date (stamp, signature and date) Updated 8f21/2018 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE • . a .4r*- 0\<- vi o CT N OW . . . . . . • I I 1 1 I 1 I 1 0 im If J .a I ro i' APPROVED I j ' OCT 0 6 2025 MASON CGUNTY ENVIRONMENTAL HERLTH RET i i cg 1 1 1- 1, (.0 , N CD C7 a pc C7 n CD 1 ,,`� rD O U (D (D N I--� = 11 n N�' i r Q1c07�� _ II I—I • v1 N ➢ O c' oo ry L7 p, w _ O o rr, Ix rz= O z s_0 0 I