HomeMy WebLinkAboutSWG2025-00321 - SWG As-Built - 10/27/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2025-00321 Parcel# 12105-51-01026
Applicant Name Richard Foucht Subdivision (Name/Div/Block/Lot)
Applicant Address 100 E. Detroit Dr.
City, State, Zip Allyn,Wa 98524 Installer Name Trinity Excavation
Site Address 100 E. Detroit Dr. Designer Name Bob Paysse
INSTALLATION CHECKLIST
0 Full System Installation ®Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type Gravity Pretreatment Type
>5 ft.from foundation? - ❑ N/A YES ❑ NO
>50 ft.from wells? - - - '�iiq - ❑ ® 0
z >50 ft.from surface water? - {'— ji ��!! 0 ® ❑
HCleanout between building and tank? -- '4-205- ❑ M ❑
U Tank baffles present? - aCLI III 0
U. 24"access risers over each compartment ----• IN
W Effluent filter installed?- B9- - - - - I 0
Septic tank capacity(working) 1200 gal Manufacturer Haggerman
0 D-box water level and speed levelers used? - - IN N/A ElYES ❑ NO
DO Manifold/D-box accessible from surface?- - 0 e ❑
CQCheck valves installed? - •- MI 0
2 Transport Line Size 4" Schedule/Class SDR 35
Bedrooms installed (check one) 1(j 2 ❑3 0 4 El El El CommerciaVOther
>10 ft.from foundation?- 1 •- El N/A ❑ YES ❑ NO
C >100 ft.from wells?- - ® 0 ❑
W >100 ft.from surface water? - - MI 0 ❑
iZ >10 ft.from potable water lines?- - in ❑ ❑
Z >5 ft.from property lines and easements?- - ® ❑ 0
ii >30 ft.from downgradient curtain/foundation drains?- - ® ❑ ❑
Drainfield level and observation ports present - - I 0 ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - IN 0 ❑
Pump tank setbacks consistent with septic tank?- - II N/A ❑ YES ❑ NO
• Pump tank capacity(flood) gal Manufacturer
< 24"access riser(s)and accessible from surface?- - ® ❑ ❑
aAlarm or Control Panel Installed? - - ® ❑ ❑
2 Control Panel equipped with Timer/ETM/Counter- - e ❑ ❑
m
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a• Pump Make/Model ❑ Floats or 0 Transducer
a. Tank draw down in/min Pump capacity_ gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8R1/2018
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Mason County OSS Installation Report pg.2 Parcel# 12105-51-01026
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ® YES 0 NO
If yes,please describe:existing tank pumped out and filled in
Were all components pumped out and property abandoned per WAC248-272A-0300? - • ®YES (J NO
RECORD DRAWING
Tide is a prrnrwnt record mod ate be accurate and daacripara enough to re-locals M the need of muh,bnr,a aewNMaa and Rehm derabp,nIcd. Typical Record
Drawings=Saks oraknf ld 8~kid ortutelion a layout.Septic/pump tank location,Nonh avow,reNaYN draYrRMA,wising arid proposed butanes,location or with,wete ins,
• welts,observation pc tan daanoule,and oar makn6rnnoa coca s points. Incomplete Record Drawings may create eddfbrW defile In end InetNation porosel and related planets.
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IN
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I 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.
, — /�-24%
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Signature of Installer Date
Keith Chamberlin
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH +', • •
r
The undersigned approves this Installation Report and t, caw
Record Drawing on behalf of Mason County Public •- %- --
EXPRES
Health:
Q...1\1\k"1,7 �b(ti1
Signature orEnvironmental Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE upd.iwtei2 nla
— 110'
1—___ _ _ _____ _ _ ______ _ _ _ _ _ _ ___,
IDETROIT DRIVE
DRIVEWAY/ I
PARKING I
WATERLINE i
(APPROXIMATE) \\
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GARAGE HOME
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4"CLEANOVT
I NEW GARAGE
I SEPTIC TANK GARAGE ADDITION
EXISTING DRAINFIELD p p I
(APPROXIMATE, PER
ONLINE OSS RECORDS) 4i1. ABANONDED TANK
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RECORD DRAWING
PIONEER. DICGNG, INC. CUSTOMER: RICHARD A CFouEL#:12105-51 1-0 026 ci-rr TANK ONLY
SEPTIC DESIGNS ADDRESS.: 100 E DETROIT DR
3083 E MASON BEN.tiON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBER.T H.PAYSSE 01°CUtl1ER TIES IB NOT A SURVEY.REFERENCES INCLUDE GiS MPUCANT/COUNTY PROVIDED
C� [`p�m SCALE
�/y RATS OR SUTVETS.FIELD IEASURE.E MS MID COUNTY GM DESIGN INTENDED FOR SEPTIC
SHEET:: ASBUII T SCALE r-2 DEPARIPURPOSES CPCAGE PROPOSED DES OEVMDT REP WV OR SUBJECT RE TED TO
OFFICE 3Gl}426 I2t03 FAX 36l}427 2353SEPTIC COMPONENTS
RENEW DESIGNER£R MDT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC coNaovns