HomeMy WebLinkAboutSWG2024-00451 - SWG As-Built - 12/31/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00451 Parcel# 51908-50-00136
Applicant Name Cynthia Aller Subdivision (Name/Div/Block/Lot)
Applicant Address 617 S.210th St.
City, State, Zip Des Moines,Wa 98198 Installer Name Spear Const.
Site Address 1560 W.Star Lake Drive, Elma Designer Name Bob Paysse
INSTALLATION CHECKLIST
❑ Full System Installation ®Tank(s)Only 0 Drainfield Only ❑Repair 0 Other
System Type N/A Pretreatment Type N/A
>5 ft.from foundation? - ____ •- ❑ N/A ®YES ❑ NO
>50 ft.from wells? - '�l� , ❑ e ❑
• >50 ft.from surface water? - =� �fT' -E=� ❑ ® ❑
• Cleanout between building and tank? -DEC r M 'i ❑ 0 0
✓ Tank baffles present? - i ❑ 0
a ❑ El El
access risers over each corn partm nt?---
W Effluent filter installed?- y — ❑ ® 0
N Sound Placement
Septic tank capacity(working) 1200 gal Manufacturer
C D-box water level and speed levelers used? - - ® N/A ❑YES 0 NO
0� Manifold/D-box accessible from surface?- - PI ID
mZ Check valves installed? - ® 0 ❑
OQ 2 Transport Line Size 4" Schedule/Class SDR 35
Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- •- ® N/A ❑YES ❑ NO
CI >100 ft.from wells?- - i ❑ ❑
W >100 ft.from surface water? - - Ill 0 0
LT. >10 ft.from potable water lines?- - IN ❑ 0
fEl CI
5 ft.from property lines and easements?- - NI
>30 ft.from downgradient curtain/foundation drains? ® 0 0
ct
Drainfield level and observation ports present - - ® El El
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - I ❑ ❑
Pump tank setbacks consistent with septic tank?- - ® N/A ❑ YES 0 NO
Pump tank capacity(flood) N/A gal Manufacturer N/A
Z
Q 24"access riser(s)and accessible from surface?- - II ❑ ❑
.
a. Alarm or Control Panel Installed? - - EU 0 0
O 2 Control Panel equipped with Timer/ETM/Counter- - NI El Elm N/A
C- Pump installed in El Bucket or 0 On Block or El Other
2 Pump Make/Model N/A ❑ Floats or ❑ Transducer
a. Tank draw down N/A in/min Pump capacity N/A qpm Squirt Height N/A ft
a.
Pump on time N/A Pump off time N/A Daily flow set at N/A qpd
Updated 821/2018
Mason County OSS Installation Report pg.2 Parcel# 51908-50-00136
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ® YES 0 NO
If yes, please describe:Tank had no bottom and was empty.Removed tank and replaced wi new
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q YES 0 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&maniold orientation&layout,Septic/pump tank location.North arrow,reserve drainteld,existing and proposed building{,location of wells,waterlines,
wets,observation parts,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in Final installation approval and related permits-
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Record Drawing Attached
0 CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
I certify that!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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Sign re of insta ler Date ,..
I.
Logan Spear II
{{ �, ry
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Printed Name of Signee 1Mi ,..�:i�
MASON COUNTY PUBLIC HEALTH '
The undersigned approves this Installation Report and
w e Ro5PRTH317 titYSGE 'R
Record Drawing on behalf of Mason County Public EXPIRES
Health:
(ZnVIA,119(91/1 i' ).5'i 1 Z—').
Signaturevironmentat Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UPWed erzlnote
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