HomeMy WebLinkAboutSWG2025-00117 - SWG As-Built - 12/15/2025 sommimminior
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00117 Parcel # 42216-52-00113
Applicant Name Adam Hunter Subdivision (Name/Div/Block/Lot)
Applicant Address 2201 93rd Ave SW
City, State, Zip Olympia, WA 98512 Installer Name House Brothers Const.
Site Address 20 N Kingsway (I 1 kope-apoiCr Designer Name Adam Hunter
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑Repair El Other
System Type ATU ..t, Pretreatment Type N,i,,.e itk- AP 560
>5 ft. from foundation? - flfl ❑ N/A II YES ❑ NO
>50 ft. from wells? - � } 11V - _ IN 0
Z >50 ft. from surface water? - - - - - NO� �CJ ❑ NB CI
HCleanout between building and tank. - CI IN
U Tank baffles present? - - CI IN ❑
IT: 24"access risers over each compart �tt- _ - - _ CI In CI
Cl)W Effluent filter installed? CI 1. ❑
Septic tank capacity (working) gal Manufacturer Sound Placement
0 D-box water level and speed levelers used? - - V N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- CI
QQ Check valves installed? CICI
2 Transport Line Size 1" Schedule/Class Schedule 40
Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 0 6 El Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
O >100 ft. from wells?- - ❑ It ❑
W >100 ft. from surface water? - - ❑ [I 0
u. >10 ft.from potable water lines?- - ❑ PO ❑
Z > 5 ft. from property lines and easements? ❑ NI 0
> 30 ft.from downgradient curtain/foundation drains? ❑ I ❑
0
Drainfield level and observation ports present - - ❑ 0 ❑
❑ Graveless chambers or o Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES El NO
• Pump tank capacity(flood) 1100 gal Manufacturer HB Precast
Z
• 24"access riser(s)and accessible from surface?- - El U El
d Alarm or Control Panel Installed? - _ ❑ 0 ❑
Control Panel equipped with Timer/ ETM/Counter- - ❑ RI ❑
n- Pump installed in ❑ Bucket or Q On Block or ❑ Other
a PumpMake/Model Liberty 290
� ® Floats or ❑ Transducer
Tank draw down � in/min Pumpcapacity �1
It
a. P Y l�r> gpm Squirt Height ft
Pump on time 1(Y\,t\ Pump off time I hr< Daily flow set at '90 gpd
Updated 821/2018
Mason County OSS Installation Report pg. 2 Parcel# 42216-52-00113
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES `el NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 10
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 onentation&layout.Septicipump tank location,North arrow.reserve drainfield.existing and proposed buildings.location of 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.
-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
for and attached Record Drawing is accurate. form and attached Record Dr wing is accurate.
\At\I
Sig ure of installer Date �,••
SA _.) � ,:.;*
Printed Name of Signee .t .,r
MASON COUNTY PUBLIC HEALTH 1,
t • 510u•U2
The undersigned approves this Installation Report and ADANI J.HUNTER '. :
Record Drawing on behalf of Mason County Public 1. ..CS' `I`li I\Kc3.,' f;�
Health:
KI-NviAtICISYV\ 12 (‘-11-c—
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 8;212018
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