HomeMy WebLinkAboutSWG2020-00477 - SWG As-Built - 2/23/2026 ,
.Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2 C72a-tt-111 Parcel# ZZ.I Z-'$-- I LI-- SOOZ 0
Applicant Name j O SZ t N eFtSTYYI [V Subdivision (Name/Div/Block/Lot)
Applicant Address 1 I s-EtZWOc crtL 2A tom
City, State, Zip �k.t' L-TbrO U3 , 6155114 Installer Name 1E.SSIA J . t-kOLT
Site Address 41 E•LOTTbN )Oeal) D12... Designer Name Fl-D 1 m t- t. NTE►Z.
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ,❑Repair ❑Other
System Type UV-2P\)11"\ Pretreatment Type K)/141
>5 ft.from foundation? - - ❑N/A ❑YEs ❑ NO
>50 ft.from wells? - .- ❑ Er O
Z >50 ft.from surface water? - - O III-- ❑
Cleanout between building and tank? - - O [l-- O
V Tank baffles present? - - ❑ [.-r ❑
a24"access risers over each compartment?- - U O
W Effluent filter installed?- .- ❑ a- ❑
to
Septic tank size 1Z OC), gal Manufacturer SOOtJD Pts9C {M.E tiT
El D-box water level and speed levelers used? - - ❑ N/A EMS O NO
o0 Manifold/D-box accessible from surface?- - O O
mz Check valves installed? - - p^ O O
O< ��
2 Transport Lint Size Li Schedule/Class '/O
Bedrooms installed (check one) ❑ 2 ❑3 Err ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - O NIA Er Es ❑ NO
ra >100 ft.from wells?- - O Er O
W >100 ft.from surface water? - - O ❑r O
i. >10 ft.from potable water lines?- - O 0-- O
Z >5 ft.from property lines and easements?- - O 2r- O
a2 >30 ft.from downgradient curtain/foundation drains?- - O Er O
® Drainfield level and observation ports present - - O El— O
Graveless chambers or O Clean gravel used? (check one)
Proper cover installed over drainfield?- - O O
Pump tank setbacks consistent with septic tank?- - Era ❑ YES ❑ NO
• Pump tank size N IA gal ===-Manufacturer N/P1'
< 24"access riser(s)and accessible from surface?- - O Er O
H Alarm or Control Panel Installed? - [ O O
a
2 Control Panel equipped with Timer/ETM/Counter- - J O O
I- Pump installed in ❑ Bucket or O On Block or O Other A.1/141
a'• Pump Make/Model P/14 ❑ Floats or ❑ Transducer
a Tank draw down N/F in/min Pump capacity ,✓/iA gpm Squirt Height N/i4 ft
Pump on time kJ (W- Pump off time i•-)/H Daily flow set at i.)/n i.)/n gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel#
- •• ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO
If yes, please describe: eJ /is •
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES [rho
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,cteanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
0 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 nd attache Record ing is accurate. form and attached Record Drawing is accurate.
°1,1"1,21
Signatu e of Ins filer Date
•
• ,•ESS J tiro L—� Z�l el/2-4Printed Name of Signee -
yJnyy' f i
.. f ,
MASON COUNTY PUBLIC HEALTH ;
' {l`
The undersigned approves this Installation Report and ko,,.r.i HUNTER
Record Drawing on behalf of Mason County Public a
Health:KTOVAfrpc194/1
•-
Signature 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 8121/2018
SCALE-1"=200'-0"
248.39'
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-- \ -1171/
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S-UBOUT/CLEANOUT
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p \1. 3O "D"BOX
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SEE DETAIL I I I ' Hi I II I I'. ;.. _:`,`. . .:'.: 1
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— —RESERVE AREA
n — —
PRESSURE TEST COMPLETED BY INSTALLER
SQUIRT HT: NIA
SCALE-1"=30'-0"
DRAW DOWN: N/A
194.56'
TIMER SETTINGS -
ON:
OFF: N/A
APPROVED
FEB 2 3 2026 JIM HUNTER & ASSOC. CONTRACTOR
MASON COUNTY ENVIRONMENTAL HEALTH P.O. BOX 162, OLY, WA 98507 DODGE EXCAVATION
Ot 4 BEDROOM RESIDENCE 753-1226
O DRIVE RET JHANDASSOCIATES@HOTMAIL.COM INSTALL DATE - 2/18/26
SITE ADDRESS I LEGAL
O3 1200 GAL.SEPTIC TANK RECORD DRAWING 41 E COTTONWOOD DR
O DRAINFIELD AREA
OWNER JUSTIN EASTMAN FINAL DATE- 2/18/26
O5 50'DOWNSLOPE ATTENUATION ZONE
6 EXISTING ACCESS EASEMENT/ROAD
TP# 22128-14-50020 SITE# SWG2020-00477
0 WELL