HomeMy WebLinkAboutSWG2025-00387 - SWG As-Built - 12/9/2025 i
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2025-00387 Parcel# 22025-50-90130
Applicant Name PAUL/RUTH LANDERS Subdivision (Name/Div/Block/Lot)
Applicant Address 10110 181 Sl".T AVE E
City, State, Zip BONNEY LAKE,WA. 98391 Installer Name ri /NOM
Site Address 708 E BURGUNDY RD Designer Name CINDY WAITE
I INSTALLATION CHECKLIST
® Full System Installation [Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other
System Type ; PRESSURE DIST P - eatment Type
>5 ft.from foundation? --1 ---- n
wa EYES ❑ NO
>50 ft. from wells? -- - - ---_ 1 . gaW1 E J
0,--,\ 0
cfi \vt,
• ,,.Y`' >50 ft. from surface water? -
1 ' -Rov/-5-206- ill - g, zr 4 c 4 - o
`'.:Cleanout between building a d tank? - ❑ ' 1:-.1
a V Tank baffles present? - ' / __ -_
a24"access risers over each •mpartm= - s,- 0 ❑
vW, Effluent filter installed?--- GIr.
T
;� ; , Se Septic tank capacity(workin•) 12dc gal Manufacturer �� s� r�
O:1 D-box water level and speed evelers used? - - JN/A 0 YES ❑ NO
0, Manifold/D-box accessible r•m surface?- 0 ❑
,�;,ZCheck valves installed? - - 0 ❑
'
2 Transport Line Size 4e Schedule/ Lip
Bedrooms installed (check prje) -R 2 ❑3 0 4 0 5 ❑6 0 Commercial/Other
>10 ft. from foundation?- -_ - ❑ N/A ,®'YES ❑ NO
>100 ft. from wells?- - 0 2r ❑
>100 ft. from surface water? - 0 0 0
f.
uteri. >10 ft. from potable water lines?- - ❑ 2-" El>5 ft. from property lines and easements?- - ElElE
1-011
1>30 ft. from downgradient cu lain/foundation drains? - - )2" 2" ❑
Drainfield level and observation po present - - ❑ 0
v4t 0 Graveless chambers or Clean gravel used? (check one)
Piir;7iy.^
`' p Proper cover installed over drainfield?- - 0 -12-'' ❑
Pump tank setbacks consists t with septic tank? ❑ N/A 0-YEs ❑ NO
. • f Pump tank capacity (flood),Y I t' B gal Manufacturer X it7 t gy
.M4 24"access riser(s)and accessible from surface?- - 0 k' ❑
- ` "' Alarm or Control Panel lnstall?d? 0 ZI 0
Control Panel equipped with imer/ETM/Counter- - 0 El1
,211-ump installed in 0 Bucks or X On Block or ❑ Other i E
'i5:Pump Make/Model i4 X Floats or ❑ Transducer
Tank draw down . I in/ in Pump capacity I p qpm Squirt Height )C 6 ft
Pump on time k t, 0 I (SAS Pump off time.k 1 Daily flow set at I to qpd
Updated 8/21/2018
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Mason County OSS Installa>ion Report pg. 2 Parcel# 22025-50-90130
I, ( ABANDONMENT RECORD
I (
Were existing septic components abiandoned as part of this project? - - YES NO
Dif
If yes, please describe: i
Were all components pumped out and properly abandoned per WAC246-272A-0300? YES ���� NO
III
RECORD DRAWING
This Is a permanent record and must be acctira.e and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record
Drawings contain: Drainfleld&ninefold onentatior layout,Septic/pump tank location,North arrow,reserve draintield,ex'sting and proposed bulldngs,location of wells,waterlines,
wells,observation ports,cleanocts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final Installation approval and related permits.
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N/
Record Drawing Attached
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.*CERTIFI ,TION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the syste) in accordance with I certify that the system has been installed in accor-
the septic design stamped APf OVER"by Mason dance with the septic design stamped'APPROVED"by
County Public Health and that.in deviations shown Mason County Public Health and that any deviations
here have been cl-ared/ap•rove by both the designer shown here have been cleared/approved by both
and Mason Co / Publi' Healthl and meet all State myself and Mason County Public Health and meet all
and M ;• C'f C•.es. State and Mason County Codes
I fu :7 _ •• I informati contained on this I further certify that all information contained on this
fo //�(/ r1, f/ Record Dral4l g is accu e. form and attached Record Drawing is accurate.
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,,. d ' i 11 4 ififW.
f.na '• of Insaller Oath .•/
, i kaki,/ .0.1,0
. ..
Printed Name of Signee `Via'c0ii,t_.
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MASON COUNTY PUBLIC HE�P►LTH \ �4•
The undersigned approves this Irstallation Report and ,� 510.04,18 `�' }t
Record Drawing on behalf of Mason County Public �,�•# LICENSED DESIGNER ITE •Health: aw
bi
1 EXPIRES 05,tOi
, iZ LciIzs ea l3
Signature of Environmental rlealth'SI ecialist Date (stamp, signature and date)
THIS FORM MAY BE S ANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated8212o1s
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