HomeMy WebLinkAboutSWG2023-00435 - SWG As-Built - 10/9/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-435 Parcel# 32214-52-04022
Applicant Name Tracy Gard Subdivision (Name/Div/Block/Lot)
Applicant Address 70 NE. Madrona Ct
City, State, Zip Tahuya, Wa 98566 Installer Name Bamford Septic/Spear Const.
Site Address Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
II Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other
System Type Pressure Pr reatment Type NuWater
>5 ft.from foundation? - - •- 0 N/A ®YES ❑ NO
>50 ft.from wells? - al
--- - ❑ II
Z >50 ft.from surface water? - - - -- Vgl
0 - - - ❑ ® ❑
HCleanout between building and tank? Si...? g ❑ II
✓ Tank baffles present? - - - - - ❑ ® ❑
a24"access risers over each compartment,?---- - -- ❑ II El
tW Effluent filter installed? El all
Septic tank capacity(working) BNR 500 gal Manufacturer Haggerman
0 D-box water level and speed levelers used? - - ill N/A ❑YES El NO
0O Manifold/D-box accessible from surface?- - El I ❑
mZ Check valves installed? - - 0 IN ❑
0<
E Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑D 3 El 4 ❑ 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- •- ❑ N/A ®YES ❑ NO
13 >100 ft.from wells?- - ❑ ® ❑
W >100 ft.from surface water? - - 0 I ❑
Li. >10 ft.from potable water lines?- - 0 e ❑
Z >5 ft.from property lines and easements?- - El III Eld >30 ft.from downgradient curtain/foundation drains? - - ❑ El ❑
• Drainfield level and observation ports present - - ❑ ® ❑
❑ Graveless chambers or El Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A IN YES 0 NO
• Pump tank capacity(flood) 1500 gal Manufacturer Haggerman
< 24"access riser(s)and accessible from surface?- - El I ❑
F-
a Alarm or Control Panel Installed? - - 0 0 0
• Control Panel equipped with Timer/ETM/Counter- - ❑ 0 0
n- Pump installed in ❑ Bucket or ® On Block or ❑ Other
E Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer
d Tank draw down 2" in/min Pump capacity 60 qpm Squirt Height 8' ft
Pump on time 1 min. Pump off time 4 hrs. Daily flow set at 360 gpd
Updated 8/21/2018
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i: so Co:.:,.,':;: 0.SS inszaiiaton Report ;:tii. 2 Parcei 4
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ABANDOMENT RECORD
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I Were eXiStbn SC"IliC COiRrXHIEfILS ab.. iOnij 2iS;i.1,1 ‘.:this ;-::),0•,3? -- - ---:/- - - • - - -- I YES p NO
If yes. please"drle.crine:e..2.,r.or4 1.19Gtc.Pirr...Y.et. ...ei:t erti46. 66-0- 9
Wore:al cornp,Atents pumped out Fold IN epe:iy ationdo.-Tou per WAC,246-272A-0300? - - ;gips Ei NO 1
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,ERTIF;C;ATiO: ::•, :.. ....- .' ....,
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i certify that i::•,-;.--r.'.f..,.:: tiiisteit;.: nccotdance v,-;t1-: i ,ci;•,..,.:• •••-.--or,- ,.,-..".. f.,,..--en ins-ialied in accor- .!
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the sepia. :...:-.,.i.: , •.,,, • .i.:-•:7)RC.:VED-by;viase.; i ....,..... ..i•• ,.,.., ::.-,..,:*;, .:•• •.'g,I Slampeci"A.0PF?0 v'ED'by *-
Comity PtiLd: :i:: i:alit fi.1Zz'1 air./deviations SilOiritl i iiiii.16,:r. ::C...14:: :::1!:::-/..:,%ith•n:;d that any deviations -.
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nore have tx..c.,,•, 1:1redinpproved by both the desil'inc:r I show;i.ce:i.:',F.v.; DOW:;Jeered/approved by nob;
ant-i Meson C......11, Public Health and meet nll Stale
Cr,e... 3 Codes. 1 mysoli An.*r14:•:.c.r.• Ccarriy Public Healin and meet all
;Ind Mnsorr l• Statc.:Ind i.dt:ior, ::.:9ii;,!./Cadtis .
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I further certify that all information cott, if.&c...01 t ilii:: . I/talker ce!iiti the:-all ir. '.uti...)r,contei;led el:ibis
form and attac1 ed necorti Drawingi't:ac,.-ii.rait.-.. f5rtr:i::.-C a:t•••...:.-.1,7 A:c.c....)D f a 1/Vi 1•g 1kt 6tift 2.6.•4 v.7/-lietie .
Signature of Insialle; --- ----Dai--e .--- '
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Ili-Intl:id Name f Signc..i.,
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."... ierlASON COUNTY PUSLIC. miAL.Iii .
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i S. .ROBERT 11 PAYSSE . %a%-!;.';irn..1w.s.igned appr..t.--;.,t':ir.•Inst*ot:o:t ri :,-..:• ••of,>,.' •• 10 . ; "."...'.• --,,••••,'•• ,
1 ker.c.%:;'..rtimi: n .;Ief-,.-;•:'.;.:. -.6.-.,h 'itiai• r• ,.'Cl EXPIRES
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1 Pqi;CIrrire Cir ir...r;watt asv;Ii........ ... -),• •....: ... L.'s: ... 2 "C! ,5/(., (stfor . signature and rta:T; .
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1 DECK I
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SEP 0 5 2025
RECEIVED
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EXISTING l' NUWATER
HOME 1 0 & PUMP TANK.
MAIR 1 ___ �o
1 PUMP 22,E_ __ _7 RESERVE AREA
O� 1 O 22'L - �/
24 `— — INSTALLED
1 -,7, VPRIMARY
I ��, DRAINFIELD
GARAGE
j - I EXISTING SHED
1 ON PIERS
1 DRIVEWAY
1
ii & PARKING ,�>
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OCT 0 9 20 L 5,.,3„
/ MASON25 �,` aeee s�;sse
COUNTY ENVIRONMENT„ MADRONA Cr ' Er
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1 `�' DJA L HEALTH
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CORD DMWG
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TEST HJLE I: TEST HOLE 2 TEST HOLE 3:
CUSTOMER: LRACY GARD 1.}33 Gl s (}32 Gl S 0 36(IS
PIONEER DIGGING, INC PARCEL.#:32214-52-04022 33+11L1. 32+TILL 36+1ILL
ADDRESS: 70 NE MADRONA CT RooTS-33 ROO I;-32 RJJ1 S-36
SEPTIC DESIGNS tir,yr<R TM.PDT A SURVEY.REFERENCES,NCIUO APPLICANT/COUNTY PROVIDED
DESIGNER: ROBERT H.
PAYSSE PLATS ONLY FIELD ROPOSEDDEVELOM`COUNTY MAY BE SU ,EST 10 OTHERSEPTIC
31183E MASON BEN SON D. GRAPEVIEW,23'A 92i5 Ki 1"=20' DEPARTMENT/AGENCY REVIEW DESIGNER NOT RESPCNSISIE FOR SETBACKS LINCO OR TED TO
JFFICE 360-426-1803 FAX 360 272353 SHEET: ASBUILT SCALE SEPTIC COMPONENTS.