HomeMy WebLinkAboutSWG2025-00142 - SWG As-Built - 10/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00142 Parcel # 32127-51-00228
Applicant Name DARLENE LOWRY Subdivision (Name/Div/Block/Lot)
Applicant Address 180 E CONNEMARA WAY
City, State, Zip SHELTON, WA. 98584 Installer Name SCHOENING EXCAVATION
Site Address 180 E CONNEMARA WAY Designer Name CINDY WAITE
INSTALLATION CHECKLIST
14
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type 4,pIt- SUJ-e_ t -e, k) P = eatment Type
>5 ft. from foundation? - - ■ N/A `®YES ❑ No
>50 ft. from wells? ��- ,� IN ❑
v
Z >50 ft. from surface water? - t7P-
- -O - - ❑ 2 �tPv' ❑
• Cleanout between building and tank? - \ - - - - %-J- - • �' ( ` 't ❑
V Tank baffles present? - \- -S - - - - -- - - y ® '' ❑
i=a. 24" access risers over each compartment?\` - - ❑ ❑
Cl)W Effluent filter installed?- A - ❑ R ❑
i
Septic tank capacity (working) tOzy) gal Manufacturer 6 ic u-///
0 D-box water level and speed levelers used? - - N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ fif. ❑
u.
mZ Check valves installed? - - ❑ a ❑
C<
2 Transport Line Size a " Schedule/Class -SGk r °Lit 40
Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other •
>10 ft. from foundation?- - ,l:: /A Ei YE t❑ NO
ra
CI >100 ft. from wells?- - �'_ tg --'C P ❑
W >100 ft. from surface water? - - ❑ ® 4V1 CI
LT >10 ft. from potable water lines?- - ❑ ® A .`l ❑
Z > 5 ft. from property lines and easements?- a ❑
ii > 30 ft. from downgradient curtain/foundation drains?- .1 ❑
• Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or 21 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank?- - El N/A ® YES ❑ NO
• Pump tank capacity (flood) /.2 5'7 gal Manufacturer _1 A.,G, / -/•4. kc Z ‘..r,-/
Q24" access riser(s) and accessible from surface?- - ❑ [ ❑
1--
Alarm or Control Panel Installed? - - ❑ 53 ❑
a
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑
a. Pump installed in El Bucket or le On Block or ❑ Other ,..
n' Pump Make/Model 4, 4 47, 23-Zs) ❑ Floats or ® Transducer
2
a Tank draw down /,sue in/min Pump capacity ?.j` gpm Squirt Height �-7 ft
Pump on time 1, 34-t,,, 7Y.ram- Pump off time : Daily flow set at /,•c) gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 32127-51-00228
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 123 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES Ri 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,SepticJpump tank location.North arrow,reserve drainfield.existing and proposed buildirgs,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.
Pule ap moved ; sou
f ple,/..1447,
❑ 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
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
•
Signature of Installer Date i '
iQ- �A
Printed Name of Signee it,js�, _ c4�111�
MASON COUNTY PUBLIC HEALTH Q'fit •
The undersigned approves this Installation Report and 2 n51Q ,tsg
CINDY E WAITE • ,
Record Drawing on behalf of Mason County Public �� LICENSED DESIGNER • +1,
Health: im. - Imewgm
Kmcjiiivt, 60
Signature of Environmental)-lealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8mn0t8
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X1=CLEANOUT/OBS PORTS (
X2=D1B1DX/VALVE BOX(/ ) .s ,, a w .721'L
X3=Check Valves
X4=Flow Control Valves 3 1.v V 4 (ye E:,,e .5-1-)___ p - - L
X5=Soil Logs ().)
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APPRov
OCT 0 7 2025
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