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HomeMy WebLinkAboutSWG2025-00102 - SWG As-Built - 12/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00102 Parcel # 31909-42-00050 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 1572 Lynch Rd SE Designer Name Adam Hunter INSTALLATION CHECKLIST - ❑ Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑Repair g Other ADU System Type Nuwater OP- ' treatment Type r i l-ci- 9)ia- Si; -. >5 ft. from foundation? StS _. - -- ❑ N/A J YES ❑ NO >50 ft. from wells? ii.\. - ❑ 0 ❑ >50ft. fromsurfacewater? - - - - - _ 6 -��1.43 - ' - - ❑ ® ❑ lEH Cleanout between building and tank - ❑ 0 ❑ V Tank baffles present? >< --- - ❑ IC d24" access risers over each compartment_---- - ❑ NJ ❑ W Effluent filter installed?- - ❑ a ❑ cn Septic tank capacity (working) BNR 500 gal Manufacturer Sound Placement 5 D-box water level and speed levelers used? - - igi N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - ® ❑ ❑ mZ Check valves installed? - - ® ❑ ❑ oQ 2 Transport Line Size 1" Schedule/Class Schedule 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A III YES ❑ NO >100 ft. from wells?- - ❑ © LI 11.1- >100 ft. from surface water? - - ❑ © ❑ ii. >10 ft. from potable water lines?- - ❑ ® ❑ Z- > 5 ft. from property lines and easements?- - ❑ III ❑ a iY > 30 ft.from downgradient curtain/foundation drains? - - ❑ I ❑ • Drainfield level and observation ports present - - ❑ I ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- • ❑ I ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 1100 gal Manufacturer HB Precast < 24" access riser(s)and accessible from surface?- - ❑ I ❑ H a Alarm or Control Panel Installed? - - ❑ I ❑ 2 Control Panel equipped with Timer/ ETM/ Counter- - ❑ II ❑ - Pump installed in ❑ Bucket or • On Block or ❑ Other 2• Hump Make/Model Liberty 290 IN Floats or ❑ Transducer Tank draw down if CI_ 2 in/min Pump capacity 50 gpm Squirt Height NA dr.? - ft Pump on time 2 r'+ •n " Pump off time 2hrs Daily flow set at 240 gpd Updated 8/2112018 Mason County OSS Installation Report pg. 2 Parcel# 31909-42-00050 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 WAC246-272A-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 Grainfield&manifold orientation&layout.Septic/pump tank location.North arrow.reserve drainfield.existing and proposed buildings.location of walls,waterlines, wells.observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 4 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 fo m and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 'al;c • . Installer ,Date - ature ofiAteli-- Printed Name of Signee j.4'v. •..., MASON COUNTY PUBLIC HEALTH '�'r.t- deg f The undersigned approves this Installation Report and ;4 • .� 9 PP tit:,1.112 <; Record Drawing on behalf of Mason County Public (2.,:-!'... ADAM J.HUNTER i'i Health: i`l's.' -i4=>>� �'�.� 111C-)\-(ali )z i 1 q 17..E Signature of Environmentdl Health Specialist Date and date) (stamp, signature THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 UU r• J e Q h 'O I-. i �_ �u >- m J O .� W oE•U`•a�. W ? U 0 is LL a Z �. ��IA 1 v I- 3 o o r F CC 6Q 4 0 0 • a 0_ i 0 i 2 a N � it cz O .1 ail I = �.. \_.. 0 I W ►— L3 2 n W O 7 O ;. S ILJ w a 5 j �-L a \ , < o N Q il(? 4 ir ‘\s,‘,..,,:\ i Y F� Z N O •' C. • 0 IIII , i `.F i ! a i 00000000,00 i .I '