HomeMy WebLinkAboutSWG2025-00416 - SWG As-Built - 5/27/2026 Mason County OSS Installation Report pg. 1 itiiASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SwG 2025-00416 Parcel# 32006-So -03036
Applicant Name Warden, Lanell Subdivision (Name/Div/Block/Lot)
Applicant Address 490 E Island Lake Dr
City, State, Zip Shelton,Wa 98584 Installer Name Active Underground LLC
Site Address Same as Above Designer Name Dale Tahia
INSTALLATION`.CHECKLIST
❑ Full System Installation ®Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type Pr Pretreatment Type
>5 ft.from foundation? --------- D - J ❑ N/A *1 YES ❑ n o
>50ft.fromwells? ----------- ❑>50 ft.from surface water? --- --- - AA.--- -- ----HHi-
&2 - , - ❑ ❑
Cleanout between building and tank? 4-------- - ❑ ❑
O Tank baffles present? - -- - ----- Ely-_ - --_ ❑ ® ❑
24"access risers over each compartmen - ------------- - ❑ ® ❑
WEfffuentfiilterinstalled?-------------- -- ---------- - ❑ ❑
Septic tank capacity(working) 1200 gal Manufacturer SPS
D-box water level and speed levelers used? ------ -------- - WA ❑ YES ❑ iNO
.02 Manifold/D-box accessible from surface?---------------- -
Check valves installed? - - - - - -- - -- -- - - - - - --------- ❑ ❑
M Transport Line Size 2 Schedule/Class 40
Bedrooms installed(check one) 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?---- - ----- --- ----- -------- ❑ NIA DYES ❑ No
>100ft.fromwells?----------------- --- --------- ❑ ❑ ❑
>100ft.fromsurfacewater?----------------------- - ❑ ❑ ❑
ILL >10 ft.from potable water lines?---- - ---------------- - ❑ ❑ ❑
>5 ft.from property lines and easements?- ---- -- - -- - ----- --- 0 0 ❑
> 30 ft.from downgradient curtain/foundation drains?----- ---- -- ❑ ❑ ❑
Drainfield level and observation ports present -- ------- ------
Graveless chambers or ® ❑❑ ® Clean gravel used? (check one)
Proper cover installed over drainfield?---- ----- - - ----- --- ❑ 0 ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ N/A OF YeS ❑ NO
Pump tank capacity(flood) 1800 gal Manufacturer SPS
24"access riser(s)and accessible from surface?- -- - - ---- - -- -- O t1 ❑
Alarm or Control Panel Installed? --- ----------------- - ❑ ❑
Control Panel equipped with Timer I E T M I Counter- - --------- ❑ ® ❑
Pump installed in ❑ Bucket or ❑ On Block or ® Other silo with intake holes 18"off floor
Pump Make/Model Liberty 280 ® Floats or ® Transducer
Tank draw down .75 in/min Pump capacity 24 p flY gpm Squirt Height ft
Pump on time 2min 30sec Pump off time 6hour Daily flow set a₹ 240 gpd
Updated 81215018
Mason County OSS Installation Report pg. 2 Parcel# 32006-53036
ABANDONMENT RECO
Were existing septic components abandoned as part of this project? -------- - ------ D YES ❑ No
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? -- ------ Yes O No
RECORD DRAW NG
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 drainfeld,existing and proposed buildings,location of wails,waterlines,
wells,observation ports,deanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in rural installation approval and related permits.
Record Drawing Attached
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
1 further certify that all I formation contained on this I further certify that all information contained on this
form and c ed .awing is accurate. form and attached F?ecor¢Drawing is accuri •
Signature of installer Date
Printed Name of Signee
ASA
MASON COUNTY PUBLIC HEALTH
The i
e undersigned approves this Installation Report and �k' .
Record Drawing on behalf of Mason County Public y 5fEf0�14 t►,
Health: 'O Dale,L,Tahja
rrnn �I II LICENSED DESIGNER
Signature of Enviranmen 1 Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 812112018
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