HomeMy WebLinkAboutSWG2025-00049 - SWG As-Built - 11/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00049 Parcel# 322325014006
Applicant Name COVENANT HOMES LLC Subdivision (Name/Div/Block/Lot)
Applicant Address 12404 137TH AVE E L.07- / .' T M 9/-11g
City, State, Zip UNION, WA 98592 Installer Name BRAD CAMPBELL
Site Address 320 E 4TH ST Designer Name CHRIS ELSTROTT
INSTALLATION CHECKLIST
❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type �(.4cL Pretreatment Type NUWATER e\XSZ)C
>5 ft. from foundation? ----f ❑ N/A YES ❑ NO
>50 ft. from wells? - -Vt-a- ❑ Er ❑
>
f. m surface water? -Z 50 t fro ❑ 1 El
H Cleanout between building and tank? - vo,„,, vir3_ - ❑ g,__,/ ❑
0 Tank baffles present? .4 ❑ lQ ❑
d24"access risers over each compartme t - - - - ❑ ❑
• W Effluent filter installed?- SV- - - ❑ (( 0
U)
Septic tank capacity(working) 1140 gal Manufacturer Evet'crce'L 3 re co.-5 t •1t,ci-tiairy
�a D-box water level and speed levelers used? - - NSA ❑ YES ❑ NO
O Manifold/D-box accessible from surface?- - ❑ [��,/ ❑
co'2 Check valves installed? - - ❑ IV ❑
6< �i
Transport Line Size Sc dule/C)ass SCIi.1(Q
Bedrooms installed (check one) 2 3[ ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ NO
>100 ft. from wells? 0 �� ❑
-.i >100 ft. from surface water? - - ❑ 1 1' ❑
i ' u. >10 ft.from potable water lines?- - ❑ L ❑
Z >5 ft.from property lines and easements?- - ❑ ❑/ ❑
Q >30 ft. from downgradient curtain/foundation drains?- - ❑ [i/ ❑
Drainfield level and observation po present - - ElL4' ❑
❑ Graveless chambers or lEiClean gravel used? (check one) �,
Proper cover installed over drainfield?- - ❑ L_9,/ ❑
Pump tank setbacks consistent with septic tank?- - El N/A E YES ❑ NO
i 1 Pump tank capacity(flood). l cgiiO gal Manufacturer EVERGREEN PRECAST
G 24"access riser(s)and accessible from surface?- - ❑ 'Q ❑
a. Alarm or Control Panel Installed? - - ❑ le [1]t1
2 Control Panel equipped with Timer/ETM/Counter- - ❑ !( ❑
D- Pump installed in ❑ Bucket or ❑ On Block or 0 Other \'�1
lnrit p St.tr6j,
a' Pump Make/Model Lib ec"i-y - FLA&I L 2 Floats or ❑ Transducer
a Tank draw down :7.5'1 in/min Pump capacity G' gpm Squirt Height lit rr ft
Pump on time/,vi>'.`"d .Ef. Pump off time e 'IRS Daily flow set at 3 gpd
All 5 cAT e 16
united8/212018
Odst' C01A-.14 e.- D
1
Mason County OSS Installation Report pg. 2 Parcel# 322325014006
ABANDONMENT RECORD
Were existing septic components abandoned as part`of this project? - - ZS D NO
If yes, please describe: C rUSh roe( MA 4 L d t° p 7 Pup
Were all components pumped out and properly abandoned per WAC246-2 2A-0300? - - [„OYES D 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 Drainlletd&manllold orientation&layout,Septic:pump tank location,North arrow.reserve drainrield,existing and proposed buildings.location 01 wells.waterlines,
wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
ecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with 1 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.
r mw l ( ham s f
Signature of Installer Date,17 0' YlkiN761.14,
BRAD CAMPBELL •
C9 �4a .
Printed Name of Signeect: �Qr
MASON COUNTY PUBLIC HEALTH J�• 2050 c� s.
, S , ..
The undersigned approves this Installation Report and
RHO ��
� +� ,'fSTE
Record Drawing on behalf of Mason County Public UNA t‘—-
Health: •
( 1-1\i2iki),\_CCL°1 „__
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8212018
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