HomeMy WebLinkAboutSWG2025-00327 - SWG As-Built - 10/13/2025 "6
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025 00327 Parcel# 12320-40-0350
Applicant Name Dianna Whitman Subdivision (Name/Div/Block/Lot)
Applicant Address 275 Locker RD SE
City, State, Zip Port Orchard Wa 98366 Installer Name Aaron Shumaker
Site Address 310 Ne Riverside PI Designer Name Jim Zimny
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair 0 Other
System Type Gravity Pretreatment Type
>5 ft. from foundation? - Q _
\1�� ❑ N/A ■YES 0 NO
>50 ft. from wells? - _ ❑ e ❑
>50 ft. from surface water? - - �lfj _ _ _ ❑
z
- — 11 0
Cleanout between building and t - 4��� ❑ ® ❑
U Tank baffles present? - _QC\ ❑ II ❑
d24"access risers over each comps .pint?- - - - - -- ❑ 11 0
N Effluent filter installed?. =�`,-
a ❑ ® 0
Septic tank capacity(working) ,2SO gal Manufacturer Hagermen's
0 D-box water level and speed levelers used? - ❑ N/A II YES 0 NO
p0 Manifold/D-box accessible from surface?- El II ❑
IEZ Check valves installed? - 0 ❑
oQ
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) 0 2 ®3 0 4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - 0 wA 111 YES ❑ NO
CI >100 ft.from wells?- 0 ® ❑
—I >100 ft.from surface water? -
W - 0 IN 0
Z >10 ft. from potable water lines?- - El e 0
cr > 5 ft. from property lines and easements?- - 0 II ❑
>30 ft. from downgradient curtain/foundation drains? 0 I•tQ`}J,'l\v 0
0lllldddd x,{p
Drainfield level and observation ports present - - - 0 v( 0
Q Graveless chambers or ❑ Clean gravel used? (check one) '\t"
Proper cover installed over drainfield?- - ❑ ® \ ❑
Pump tank setbacks consistent with septic tank?- • ❑ ❑
N/A ❑ YES NO
ZPump tank capacity(flood) gal Manufacturer
< 24"access riser(s)and accessible from surface? ❑ 0 0
H Alarm or Control Panel Installed? -
Control Panel equipped with Timer/ETM/Counter- . 0 0 0
O. Pump installed in 0 Bucket or 0 On Block or ❑ Other
a Pump Make/Model
❑ Floats or ❑ Transducer
n, Tank draw down in/min Pump capacity _ gpm Squirt Height ft
Pump on time Pump off time Daily flow set at
gpd
(1,.Jwlwo AI?•1n18
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Mason County OSS Installation Report pg. 2 Parcel n 232010003350
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - -- -- -
U■ YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - a YES
0NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Typical Record
Draw,rgs conta,n• Dralnt:eid d manooid enentaton&layout.Septc/punp tank location North arrow reserve i ainrisid,existing and proposed buildings location of wets.waterlines.
wells.obse,vaoon ports,cleanotuts and other maintenance access ports Incomp
lete Recoml Drawings may voate additional delays m final imtaPalgn approval and related ue:mrts
ill Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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 Record Drawing is accurate.
ZogS
Signature of Installer �/--/Date
Prin ed ame of Signee
` P c/1 Li K441-4."---
2- jjj
MASON COUNTY PUBLIC HEALTH , 'V.i
The undersigned approves this Installation Report and `� j
Record Drawing on behalf of Mason County Public ' L` j ,'a�`: N;jii
Health: :��`lcF _ '; SIGNER la
P,....11\SWA 6171 iolot,c--
i 6 - /-7
Signature of Environment"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 8'11'2°18
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