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Home My WebLink AboutSWG2025-00448 - SWG As-Built - 1/27/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00448 Parcel # \ c;,—S _ pCO\V Applicant Name John Theiler Subdivision (Name/Div/Block/Lot) Applicant Address 14039 SE 237th PL. Lake Cushman Div.12 Lot 42 City, State, Zip Kent, WA 98 42 Installer Name T.J. Goos Site Address 11 N. Cutthroat PL. Designer Name Dale L. Tahja INSTALLATION CHECKLIST ® Full System Installation 0 Tank(s)Only El Drainfield Only 0 Repair 0 Other System Type Oscar OS-50 Pretreatment Type Oscar XO2 >5 ft. from foundation? - \\--:*S � -- ❑ N/A 4 YES ❑ NO >50 ft. from wells? - •- ❑ ® ❑ Z >50 ft. from surface water? - ?VI� ' - - l - ❑ ® 0 HCleanout between building and tank? a �n o Tank baffles present? - - �, - 0 ® ❑ P 24" access risers over each compartment'?`. - - - ❑ ® CI W Effluent filter installed?- _= -.- ❑ ❑ (/) __vim Septic tank capacity (working) 1,000' ' gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - ® N/A El YES ❑ NO ow Manifold/D-box accessible from surface?- - ❑ IN 0 QQCheck valves installed? - - ❑ ® 0 t Transport Line Size \ \'r\j\ Schedule/Class CS" C)(\. IAC) Bedrooms installed (check one) 0 ' I Y, 5 El ❑Commercial/Other >10 ft. from foundation?- �, - - - ❑ N/A 4 YES ❑ NO D from wells?->100 ft. .4 - - �f�- j ❑J -� CI W >100 ft.from surface water? - - - - MOW epUTvENV((Z�2 ❑ ® ❑ i% >10 ft. from potable water lines?- 11 gEro�C HEAL,- ❑ ® ❑ 2 > 5 ft.from property lines and easements?- -PO� ' - ❑ © ❑ ct iX > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ Drainfield level and observation ports present - - ❑ 4 ❑ ❑ Graveless chambers or • Clean — l used? (check one) Proper cover installed over drainfield?- " - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES 0 NO ZPump tank capacity(flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ a. Alarm or Control Panel Installed? - - ❑ FA ❑ Control Panel equipped with Timer/ETM /Counter- - ❑ II ❑ O- Pump installed in ❑ Bucket or ® On Block or ❑ Other a" Pump Make/Model McDonald E-30 GPM � ❑ Floats or 4 Transducer per, Tank draw down 0.1 in/min Pump capacity 30 gpm Squirt Height Drip ft Pump on time 0.48 min. Pump off time 3.52 Min Daily flow set at_240 gpd Updated 8/21/2018 , Mason County WS installation Report pg.2 Parcel t -S -- OCR w r► C0M Were eepdccompany% abandoned as part or this project? - a----- O vas ii N°1 If yes, please describe: Were all compotys pumped out and properly abandoned per WAC240,'M2A 30O?- • O Y68 El NO t RECORDOftW gym►la a penmen rand and rust M manna and InaepQae inane lo"Moan ha the mad at map u lcs WWI,and Una development t 1yplad ieooM Osage aaawrc lerwend a man aaYetadon A Feat,sapMsiarp rack parlor`Honk SIVA%maws dtabled,edging and pnpoaad Menge,ioasloe Male wda,obaurolmr pals,domains,Waanmanlmtnos none pain inane sr►Reooad tundinla may croon Winne drittaa b tad ingindko approval and Wand panMOa. a Record Drawing Attached _I;MitTiFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /certify that 1 Installed the system In accordance voNh I that Me systemthe septic dot stamped APPROVED"by Meson aims with tshe de*, has been installed in O VE f County Public Health and that any demos shown Mason Public Health n y chwi by here have been cleared/approved gproved by both the� ) .sue i�have been Owed/approved�+yde fa ns and Mason County Public Health and meet all State myself end Mason County Public Health end meet ail and Author County Codes. Stole and County Codes ley that al krformatlon contained on this from andoboe/led Drswtr,�Ar 1s acrr.,a�te_ I further certify that all Mi(armaticn contained on this fatni and-attached Record Ns i is aaairrratss S et4�R� 'b ,.1 �s tube s ii . ( ‘ of cam-. MASON COUNTY PUBLIC HEALTH • ►„if {�` ' t The understood appivves this Installation Report and = i Record on behalf of Mason County Public rc` • leil L.T l tt i Health: v Dale L.Tat f v- LICENSED DESIGNER 8.2.4.(16 (i\J u i\e)- -. 1-27 cza, - .--_ , .. M�hlbekh Dhlwa�l (stamp,signature and dais) THIS FORM WISE ScnlSIED AND AVALABLE FOR Pueuc'titEW ON THE MASON COUNTY VIES sire Lvr 1 i 1• i ( - o.... .)::-.. ) S�„( ..,,,,„); „...... ..,:- Oc4 „ CP f / �1 tin \'v j-7 ,,,., _\_.,2,-Icr- •iTe....._ ..... 61 / r y V.\ 0 Z'.'''' / ( i'''' i IA , • :L.; n ,.0 ........ ?........- ti_ -9 ,e.,_ 0 6/1._...-c, -..„..c __ , _ ....., 4--V...." , ./.... Ac\- -4------ki --- ,t, Q.,. -i - ..--i .-.:-. ..,... ..., ---- -....5 cP ......„.430, . ,, , (). ..,...• ,....-- ,... . ( .-i !1 . \/ �' 1 I V l�il . CI 1520-) 'i 1c �' pro 4,a n�`�Q +V = lb, i w` A . yd's - 1 .> , . / .,"