HomeMy WebLinkAboutSWG2024-00408 - SWG As-Built - 1/26/2026 1
CLEAR FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00408 Parcel # 223195000904
Applicant Name Trevor Valey Subdivision (Name/Div/Block/Lot)
Applicant Address 60 E Mountain View Dr WOOTEN LAKE TRACTS TR A
City, State, Zip Tahuya Wa 98588 Installer Name Jack Johnson
Site Address 60 E Mountain View Dr Tahuya Wa 98588 Designer Name Jim Zimny
INSTALLATION CHECKLIST
® Full System Installation O Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Pump To Gravity Pretreatment Type
>5 ft. from foundation? - - ❑ NIA 0 YES ❑ NO
z >50 fl. from wells? fr. - - ❑ ❑❑ 0 ❑
>S0 ft. from surface water? - - - - -- - - r _ -
hQ- Cleanout between building and tank? -/- � .r - z0 ❑ ❑ ❑
U Tank baffles present? - Z6 - , - ❑F 0 ❑
a 24" access risers over each compartm 7- -
LU Effluent fitter installed?- ---4=-=-_ - - CI ® ❑
Septic tank capacity (working) 1200 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO
oO Manifold/D-box accessible from surface?- - CI 0 ❑
u.
Q Q Check valves installed? - CI ill
❑
2 Transport Line Size 2" Schedule/Class sch 40
Bedrooms installed (check one) ❑ 2 El 3 0 4 O 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - •,,,-„T ❑ N/A 0 YES ❑ NO
• >100 ft. from wells? - I• - -6 ❑.,.
0 ❑
J
>100 ft. from surface water? - - O I ❑
W
ti >10 ft. from potable water lines?- - - - - :.._., --J -2 -4- `l-- L.❑ ® ❑
z > 5 ft. from property lines and easements.-- -- D m ❑
Q "'S%COON �11R6I �TA�NE
ce > 30 ft. from downgradient curtain/foundation drains?-;noW-- - - - ❑ ® ❑
o
Drainfield level and observation ports present - - ❑ 0 ❑
t Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - O 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO
• Pump tank capacity (flood) 1200 gal Manufacturer Hagerman
< 24" access riser(s) and accessible from surface?- - ❑ I El
I-
0. Alarm or Control Panel Installed? - - O I ❑
D Control Panel equipped with Timer! ETM/Counter- - CICI0
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
ct.• Pump Make/Model Liberty/1280 No Floats or ❑ Transducer
d Tank draw down 2.70 in/min Pump capacity 67 gpm Squirt Height N/A ft
Pump on time 1 min Pump off time 5 hrs Daily flow set at 270 gpd
Ll µi trcl flf�;1:016
Mason County OSS Installation Report pg. 2 Parcel# ZZ 3 ( q SDC o qt o c,i
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 relocate in the need of maintenance activities and future development. Typical Record
Drawings contain. Drainfiekp&manifold onenlatron&taycrd,Scphclprrmp tank location.North arrow,reserve drainriekf,exishng and proposed buildings.location of wells.waterlines,
weirs.observation pats.Cleanorits.and other maintenance access points incomplete Record Drawings may create aedltkanal delays in final installation approval and related permits
•
i * PPROV !. P
mod'
IAN 26 :r;3
MASON COUNTY ENVIRONMENTAL HE
JBW
g'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 further certify that all information contained on this
for and alt hed Record Drawing is accurate. form and attached Record Drawing is accurate.
/r � — CP '
Sig 7. ure of Installer Date S �I
UG CAC. .J1) 17.4 A
Printed Name of Signee wry k- 2��
'
MASON COUNTY PUBLIC HEALTH !o
The undersigned approves this Installation Report and LICE .-' s GNER
Record Drawing on behalf of Mason County Public / — V •
H�ah: �, J
` V G(M0 ��D -;76Sig atu f Environmental ealth Specialist Date (stamp.signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 82+'20'8
NE Tahuya Blacksmith RD County Stamp
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9� �; Designer Info:
ei 4 Jim Zimny
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7178 Windflower PL NW
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o �; Applicant Info:
' Q Trevor Vellay
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V° 9 ; >i, :-- Lu 60 NE Mountain View Cr
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fcc ma #223195000904
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wel 4, 4, z Date:
`r 1/14/2026
Page
el 422'
Scale
1„ = 50'
Not a survey