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HomeMy WebLinkAboutSWG2025-00433 - SWG As-Built - 4/17/2026 { Mason County OSS Installation Report pg. I MASON COUNTY PUBLIC HEALTH PPLICAIUT1 PF f IT.INFORIViAT1O Permit Number SWG 2025-00433 Parcel# 42209-54-00059 Applicant Name Keli Lock Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 431 LAKE CUSHMAN#17 LOT: 59&S 1/2 OF 60 S 56/30 City, State, Zip Snogualmie WA, 98065 Installer Name Maples Excavating Site Address 10 N Oxbow PI Hoodsport Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield a1 ❑ Repair ❑Other System Type Gravity Bed treatment Type >5 ft.from foundation? -- ----- - -- sf �,�����-- - _ _ ❑ N/A 0 YES ❑ NO - a >50ft.fromwells? - - - - - - - - - ❑ - - _ - _ _�'-Q�-�-- - ❑ ❑ El - -- - D >50 ft.from surface water? -- - - - - - - Cleanout between building and tank? - - - - - - - _ El ❑■ ❑ Tankbafflespresent? - - -- - - - - - ❑ 0 El 1--. 24" access risers over each compartment? =- -- ----- -- - - ❑ 0 ❑ W W '; Effluentfiltermstailed? -- -- - ----- - - - - - -- - - - - - - - - - ❑ ii ❑ Septic tank capacity(working) 1,250 gal Manufacturer Hagerman El ; D-box water level and speed levelers used? - - - - -- --- - --- ❑ N/A YES NO Manifold/D-box accessible from surface?- - - - - - -- - - - - - -- -- El 0 Check valves installed? - - - - - - - -- - - - - - - -- - - - - --- - - El ❑ 0 0Q Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation? - - - - - - - - - - - - - - - - -- - - --- - - ❑ NSA UIYES NO >100ft from wells?-- -- - - - - - -- ----- - - - - - --- --- -- ❑ II El >100ft.fromsurfacewater?- - - - - - -- -- - --- ----- - - --- El III ❑ = >10ft.frompotablewaterlines?- - - - -- - -- -- -- ---- - - - - - El UI El > 5ft. frompropertylinesandeasements?- - - - - - - - -- -- - - - - ❑ Ii ❑ r > 30 ft.from downgradient curtain/foundation drains?- - - - - - - - - ❑ © ❑ Drainfield level and observation ports present - - - -- - - - - - -- - - ❑ III ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - - --- - - --- -- - - ❑ III El tank setbacks consistent with septic tank?-- ---- - - -- - -- ❑ N/A ❑ YES No Pump tank cap flood) gal Manufacturer H24"access riser(s)and acc le from surface? ---- -- - - --- ❑ ❑ Alarm or Control Panel Installed? - - - - ❑ El El Control Panel equipped with Timer/ETM/Counte - - - - - - - - ❑ El ❑ Pump installed in ❑ Bucket or ock or ❑ 0th Pump Make/Model ❑ Floats r ❑ Transducer Tank draw capacity in/min Pump ca acit gpm Squirt Height ft mp on time Pump off time Daily flow set at Updated 8/21(2018 Mason County OSS Installation Report pg. 2 Parcel# & 12o' — 000 S� ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --- ---------- YES ® NO If yes, please describe: YES ❑ No Were all components pumped out and properly abandoned per WAC246-272A-0300. - 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,erasting and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. ® 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. Signature of installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Repo y: 51 0349 i� Record Drawing on behalf of Mason County Public PAULA JOY JOHNSON � . •. . Heal,h ((/ /lf �p •l:�t� Slwtil5�Sl'�`IaE# � yflff4' , EXPiFaS 917 ?A&047� 2028 r - Si ature of Environmental Health Specialist 8J N/,y� (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE F 'dj (,IC VIEW ON THE MASON COUNTY WEB SITE Updated a2trz°ta (L j M 2 \ V. / \V \ \ 4\ {O \ ar � A } o APR 172026 MASON COUNTY EtAIji"A4EN1•AL HEALTH O =r D.F. Bi<1� �s�u_►1+ W , c t 1 ` Kt 5 V• f�Rr_ .t. 2.2`�-c? 0)Gx► to **Note to installer** H � o®�SQs2T, A8 Sleeve waterline when within 10' �t, of septic transport line.Maintain IIJ 10' minimum between water 5100349 ' line and septic tanks/drainfield. 1��� PAULA JOY JOHNSON s`i� EXFIF7ES 9 15%7i