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HomeMy WebLinkAboutSWG2025-00365 - SWG As-Built - 12/5/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2025-00365 Parcel # 22005-51-00028 Applicant Name LOUISE SCHUMOCK Subdivision (Name/Div/Block/Lot) Applicant Address 8801 527TH ST W UNIT 16A City, State, Zip TACOMA, WA. 98466 Installer Name B-LINE CONST Site Address 1160 E PHILLIPS LK LP RD Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ® Drainfield Only 0 Repair 0 Other System Type PRESSURE Pretreatment Type N/A >5 ft. from foundation? - - ❑ NrA ®YES ❑ NO >50 ft. from wells? - I ❑ >50 ft. from surface water? • jiu< Cleanout between building and tank? - - - - ` DEC -, . '3 \Z )i 111 III CIV Tank baffles present? - 1 �I ® 0 d24"access risers over each compartment?- -� r- . . 0 0 tu Effluent filter installed?- -- Sit. _ __ _ _ ❑ II ❑ co Septic tank capacity(working) 1200 qal Manufacturer EXISTING 0 D-box water level and speed levelers used? - MIN/A 0 YES ❑ NO 0� Manifold/D-box accessible from surface?- - 0 II CI oQCheck valves installed? - - - El ® 0 2 Transport Line Size I 2" Schedule/Class 40 Bedrooms installed (check one) © 2 0 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - -1 - ❑ N/A ® YES ❑ NO 0 >100 ft. from wells?- -- -- - - ❑ I ❑ W >100 ft. from surface water? - ❑ IN 0 ti >10 ft. from potable water lines?- - 0 ® ❑ aZ > 5 ft. from property lines and easements?- 0 IN 0 f2 > 30 ft. from downgradient curtain/foundation drains?- IN 0 0 0 Drainfield level and observation ports present - - 0 UI 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over d(ainfield?- - ❑ Ui 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Z Pump tank capacity (flood) 1200 gal Manufacturer EXISTING IQ- 24"access riser(s)and accessible from surface?- - El MI CI0. Alarm or Control Panel Installed? - - ❑ 1E 0 2 Control Panel equipped with Timer/ETM/Counter- - 0 0 0 0 O. Pump installed in 0 Bucket or 0 On Block or 0 Other PUMP VAULT a. Pump Make/Model , LIBERTY 253 ® Floats or 0 Transducer a. Tank draw down 3 fin/min Pump capacity 25 qpm Squirt Height 4 ft Pump on time 54 sec I Pump off time 1.2 ina✓ Daily flow set at 180 gpd -]2 src., Add Updated 8/21l2018 Mason County OSS Installation Report pg. 2 Parcel# 22005-51-00028 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - 0 YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES0 NO RECORD DRAWING This is a permanent record end must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record Drawings contain. Drainfield 8 manifold orientation 8 layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed bu ldings.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. CDr G1—1^/ ICI 2 / rU 7 ere,( t . P-!or_ 'z iP - rA I@-) f'1 a vczl 1-144,Urriki (/x r - ► e cell s, J e 1 -Nei pie..p°4-I , G r -11 Sl a-c vjKi ve w 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify that l 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 att ched Record rawing is accurate. form and attached Record Drawing is accurate. I)- Zs?�` Sig ature of installer Date ,,_. . .• o; az r )e ( F s Print Name of Si ee _ • h �� 0 MASON COUNTY PUBLIC HEALTH y: s NSF The undersigned approves this installation Report and a CINDY E WAITE' 7 • LICENSED DESIGNfR Record Drawing on behalf of Mason County Public ':isi--_ Health: L.,,.r.i S cZ.IL7\9)11(\ � 1-0Signature of Environment)Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 „,, ti ____ t i ,-- )".” li .0 ,, `� O 4 ; t _ , ,... , ,, . , . rr, I . ... \ _ 1 CO • 0 \ 1A fi-4'7;i — r. • Z LI* 0 (N pr Ll� 0 ; '` X r .;.r - ,40. ,, CN CN1 t. 8 • • �� ..--401 ' •• .14 • • a • A. ow.. . 1/ i 114 • V, ' (-Ei 2 C u -1 • 0MIMS CI Z 6dp't. �, -t. al 2 d k • OI�2 `• llc .— zoo•p ... O 1 co 5. CL p. • r� . ' , • , : c,�� _ 1 of "°�:� " p •, i N _N. ..... 7JT0TT71 ! 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