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HomeMy WebLinkAboutSWG2022-00633 - SWG As-Built - 2/23/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00633 Parcel # 32424-22-00160 Applicant Name LAURA JOHNSON Subdivision (Name/Div/Block/Lot) Applicant Address 1543 WHITMORE WAY City, State, Zip BUCKLEY, WA. 98321 Installer Name WEATHER TIGHT Site Address XXX N HIDDEN COVE LANE Designer Name CINDY WAITE INSTALLATION CHECKLIST 0 Full System Installation O Tank(s)Only O Drainfield Only ❑ Repair O Other System Type OSCAR COILS Pretreatment Type XO2 >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ IN O >50 ft. from surface water? - z O 0 O H Cleanout between building and tank? - O IDU Tank baffles present? - - ❑ O a24" access risers over each compartment?- O 0 E] la Effluent filter installed?- - ❑ a ❑ co Septic tank capacity (working) / ?av gal Manufacturer L-J,1_, ,9 f di _GI D-box water level and speed levelers used? - - 0 N/A ❑ YES ElNO XO Manifold/D-box accessible from surface?- - 0 ❑ O mz Check valves installed? - a •92cita.,, >.t 12e,�1 0 O O T- r� 2 spod.Li a Size 1 `17. `Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑■ 2 O 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A m YES ❑ NO G >100 ft. from wells?- - ❑ ■❑ O -1 >100 ft. from surface water? - W ❑ 0 ❑ Z >10 ft. from potable water lines?- - ElEl ElQ > 5 ft. from property lines and easements?- - O O O ix > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ O Drainfield level and observation ports present - - ❑ PU ❑ O Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ LU ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) (�O gal Manufacturer /..74 Z 7'c h78'i� < 24" access riser(s)and accessible from surface?- - O ■❑ ❑ a Alarm or Control Panel Installed? - - ❑ © O 2 Control Panel equipped with Timer/ ETM /Counter O 0 ❑ M IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 2 Pump Make/Model ❑ Floats or ❑ Transducer n, Tank draw down in/min Pump capacity gpm Squirt Height ft \, Pump on time Pump off time Daily flow set at 180 gpd Ft,Pity Cvsvj wvl 444 cj7d 41wi e,C.i P1<{ ) 'O2 04. .dar.d�r2v2ois Mason County OSS Installation Report pg. 2 Parcel # 32424-22-00160 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 4 YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 4 YES El 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&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. w.f) ealeol 411 P-e4 v�l ® 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 form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. J 12/20/25 Si nature of Installer Date cott Johnson . �� Printed Name of Signee <4, OF Sh, TA MASON COUNTY PUBLIC HEALTH s ,,ii."' ,.., 18 The undersigned approves this Installation Report and o� DYO WAITEi Record Drawing on behalf of Mason County Public LICENSEp DESIGNER Health: ExPiRts os,o, �7 Signature of Environm ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 . 0.7i 0 r -/rh t- . _ �� ', '; t 1 . c') ____.r._ __* \ ._ , 117,,,,,, ,.,-,a 0 dp , („f",/,-,v, l a d'i?. 2 ..' tom' `;if 1 A)C11 • :�;�v3 'i'Id I�J �' 6:11 1 rra•: de•4.tnre y+•? 6 >3S L n� sly ''► �� f� -;II °tP�>r dam, c,,,7,9?9 t ?S' r 3 .,007 ,� V.- �, .�-' 1,1 '1 1 ( E, a / 4 f S i \. ' ouan saainxa o'r's 1. 81 i r .��a�►�;w ww aw.►w �ww / 1� i Q J t 1 \1 �. N 34 3SN3�Il w, a ..\ Q t �� 11VM A0NI� i III cc. n , 0Z . ,�� B l 71A c> ii_ \\Z I, /try 4- ci.--T..- / �y Or) I:1 VeJ i �,�J,,. r. �Lrby�ysv„Kr i°��int�% i