HomeMy WebLinkAboutSWG2024-00138 - SWG As-Built - 1/27/2026 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00138
Parcel # 22330-50-00345
Applicant Name JEFF STEPHENS Subdivision (Name/Div/Block/Lot)
Applicant Address 3715 103RD AVE CT NW
City, State, Zip GIG HARBOR, WA 98335 Installer Name SCHOENING EXCAVATION_____
Site Address 40 N E RHODODENDRON BLVD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
5(Full System Installation v3 Tank(s)Only O Drainfield Only ❑Repair ❑Other
System Type Pr ent Type
>5 ft from foundation?
>50 ft. from wells? - -%. N/A ;�'YEs ❑ No
>50 ft. from surface water? - ` \ ❑
Cleanout between building and tank? -___ _il.T3 -
_ ❑❑
U Tank baffles present? - _ �
a24"access risers over each compartment?--_ ___ __ ❑
N Effluent filter installed?- _ --- ❑ zr-- 0
o ❑
Septic tank capacity(working) A,,,:-12,L I qal n'
- 05+
� D-box water level and speed leveler s94t '
DO Manifold/D-box accessible from su ? _ ,�Nia ❑ YES ❑ No
mZ Check valves installed? t ` � El kJ- El
❑ ❑
2 Transport Line Size otFW
ici4likciass S(1,4
lA�°
Bedrooms installed (check one) [�
- 23LI4 ❑ 5 ❑fi IDCommercial/Other
>10 ft. from foundation?
CI >100 ft. from wells?- ❑ WA Z YES El NO
W >100 ft. from surface water? - O 0
al
Z >10 ft. from potable water lines?- ❑ ❑
d > 5 ft. from property lines and easements? 0
> 30 ft. from downgradient curtain/foundation drains? O iz ❑
Drainfield level and observation ports present - - O f��
❑ Graveless chambers or C2/Clean gravel used? (check O O
4a one)
Proper cover installed over drainfield?- - ❑ Zr
O
Pump tank setbacks consistent with septic tank?-
O N/A ',� YES ❑ NO
Z Pump tank capacity (flood).,; 146(0 gal Manufacturer .„,.�!
24"access riser(s)and accessible from surface? e1 q eYtMAr eft-�cc +
a Alarm or Control Panel Installed? - W��1
Control Panel equipped with Timer/ETM/Counter- initc� ❑ ❑
- Pump installed in ❑ Bucket or a On Block or l:] Other 1,0u61. \ou."1a.
Q. Pump Make/Model ..,Lt�,er 7 (O - �'
0 Floats or Transducer l
0. Tank draw down Z in/min Pump capacity E3 gpm Squirt Height 4- ft
Pump on time �kno,‘ Zy 5 Pump off time �LO w.i+n Daily flow set at 1.70 qpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -
If yes, please describe;
0 YES No
Were all components pumped out and properly abandoned per WAC246-272A 0300?
❑ YES O 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: Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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O Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
/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
form and attached Record Drawing is accurate. form and attached Record Dra ing is accurate.
I L2
Signature of Installer Date
" s�
Printed tiame of Signee • .tip t 1
a-
MASON COUNTY PUBLIC HEALTH �4/
The undersigned approves this Installation Report and LICENSED DESIGNER �`
Record Drawing on behalf of Mason County Public •
1- ill
'bt CA\tsiTcN l--2.1.26
Hea EX,IRLS 5O0,Sig ature of Environmental Health Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated e/21/2p1e
•
00 NE Rhododendron Blvd Tahuya, ��°��
WA 98588, USA,Belfalr-Tahuya Township, Parcel ld:223305000346 --
1. Proposed residence .I
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2. Audiovisual alarm '
3. Clean out ' l 5'L-z` �' ��
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4. 1200 gallon septic tank 3r'' Rer ,ci,
5. 1200 gallon LLBpump tank
o 151 6. Schedule 40 2n transport line -� 3 —0.4 L_
z 7. Valve box r
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ti Primary drainfield .7v'' 4.e
c. ' LE Reserve drainfieldi .,: \
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Q } p,, Proposed well y
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o ii. Proposed waterline ' ,.IINCIC 2 „
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EXPIRES o5:,0 JAN z l 2025
MASON COUNTY ENVIRONMENTAL HEALTH
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