HomeMy WebLinkAboutSWG2025-00205 - SWG As-Built - 12/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION `
Permit Number SWG 2025-00205 Parcel# 42209-51-00071
Applicant Name DENNISNICKI TURNER Subdivision (Name/Div/Block/Lot)
Applicant Address 18125 150TH AVE E
City, State, Zip ORTING,W. 98360 Installer Name kre.a,-ri,_ -r,.4p
Site Address S�i1 t fat VVIA.4.1 f)r' \f Designer Name C,"J.if lekb ,
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type SAND AUGMENTED PRESSURE BED Pretreatment Type
>5 ft. from foundation? • �`--' --
❑ NIA �YES ❑ NO
Y >50 ft.from wells? ' _ict.F'?� ' _Ty - - ® 2 P"c t4 ❑
>50 ft.from surface water? --- - ` C Ly3�'.' 0
Z 1.FQ- Cleanout between building and tank? -�%491 - - ❑ .® vii--A0
❑
a Tank baffles present? - 'A2Nr D�C 0 El 0
a24"access risers over each compartmli[ `.--- -- -;Y s ❑ g ❑
N Effluent filter installed?- . ���__ �r�.� - 0 ® ❑
Septic tank capacity(working) I " 0---- al Manufacturer 5-(40.,2 Pie,.a-,,,r•-1
C D-box water level and speed levelers used? - - EiNIA ❑ YES El NO
QO Manifold/D-box accessible from surface?- - 0 I?! ❑
2Z Check valves installed? - _ ❑ ® ❑
gTransport Line Size " Schedule/Class S f.L'..1r 4'O
Bedrooms installed(check one) Ei 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - 0 N/A -® YES ❑ NO
2 >100 ft. from wells?- _ RI 0 0
>100 ft. from surface water?- 0 E ❑
ii >10 ft.from potable water lines?- - ❑ ® ❑
a >5 ft. from property lines and easements?- - ❑ El® >30 ft.from downgradient curtain/foundation drains?- - 21 MCI- 2 � El
Drainfield level and observation ports present - - ❑ Karl- 121 0
0 Graveless chambers or Eel Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 tT, 0
Pump tank setbacks consistent with septic tank?- - ❑ N/A '®.YES ❑ NO
Y Pump tank capacity(flood) /.-?r gal Manufacturer -S%uti P/ , Dgi•
F24"access riser(s)and accessible from surface?- - 0 21 [3/ a. Alarm or Control Panel Installed? - - 0 Er El
ic Control Panel equipped with Timer/ETM/Counter- - 0 ® 0
j a. ump installed in ge Bucket or 0 On Block or ❑ Other
a.
Pump Make/Modeler Zoeler n152 t1 j
Floats or ID Transducer
d Tank draw down 4e2 in/min Pump capacity, 68 gpm Squirt Height �L 4+ ft
Pump on time.• •45 #7,(AV
I_,
Pump off time a� hours Daily flow set at clod
9 S'.J dJ /PO Gf.t7,a
3 s«
Mason County OSS Installation Report pg. 2 Parcel# 42209-51-00071
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ❑ NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC248-272A-0300? - - ❑ YES ❑ 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! Drainfield&manifold orientation&layout,Septic/pump lank location,North arrow,reserve drainfield,existing and proposed buildings,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.
AAl
❑ 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 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record D ; ing is accurate.
12/08/2025 o I
Signature of Installer Date ,
Scott Johnson l� � 'Fyl, .• �t
Printed Name of Signee 4,
Ir �d
MASON COUNTY PUBLIC HEALTH 51p 448A. 'F�#
-
o CINDY WAIF
The undersigned approves this Installation Report and „. LICENSED DESIGN�R
Record Drawing on behalf of Mason County Public ow. go. %A. iv. 100010.1
EXPiR:S 05/10,
Health:
�2kO(7S
Signature of Environmental Health Specialist Date (stamp, signature and date) ;13
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated anvzata
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APPROV ,.� <
DEC 10 2025 ,./ + ``,
MASON COUNTY ENV1R9, ENTAL HEALTH
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