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HomeMy WebLinkAboutSWG2026-00166-ASBUILT - SWG As-Built - 6/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00166 Parcel # 42216-53-00010 Applicant Name Cusick, Daniel & Patricia Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 1019 City, State, Zip Wauna, Wa, 98395 Installer Name Schoening Excavating LLC Site Address 110 N Varden Way Designer Name Not Required (Tank Only) INSTALLATION CHECKLIST ❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity Pretreatment Type >5 ft. from foundation? - - - - - - - - - -- -- - - ❑ NSA ®YES ❑ NO >50 ft. from wells? - - - - - - - - _ _ _ �} ' tl�-'If'I � � ❑ ® ❑ Z >50ft. fromsurfacewater? - - - - - - _ ❑ ® ❑ Cleanout between building and tank? - 4n. -- (3-4 .2 '2. - _l i! _ ❑ ❑ Tank baffles present? - - - - - - - - _ W- - - - - - - - - - - -- _ __ ❑ ® ❑ a 24"access risers over each compartm _ _ _ __ Cl) Effluent filter installed?- - - - - - - - - i..-.,--.--- o - - - _ - - - _ Y ❑ ❑ Septic tank capacity(working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - 0 N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - © ❑ ❑ CIO Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ® ❑ ❑ oa Transport Line Size 4" Schedule/Class Sch40 Bedrooms installed (check one) 2 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A ® YES ❑ NO >100ft. fromwells? - - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ® ❑ W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ Z >10ft.frompotablewaterlines?- - - - - - - - - -- - - - - - - - - - - . ❑ ® ❑ Z > 5 ft. from property lines and easements?- - - - - - - - - - ----- - - - - - - - - - - - - -- ❑ 0 ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - 4 ❑ ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ ® ❑ Pump tank s acks consistent with septic tank?- - - - - - - - _ _ _ - ® k ❑ YES ❑ NO Pump to ca acity (flood) gal an acturer ( 24" ac ess ri er(s)and ac ssibl from surface?-- - - - -- - - - - - 4 ❑ ❑ Alar or Co trolPanel stalled - - - - - - --- - - - -- - - - - -- - ® ❑ ❑ / C ntrol Pa el equip d with Ti en/ETM/ ounter- - - - - - - ® ❑ ❑ ump ins [led in ❑ Bucket or On Block o ❑ her d Pump M ke/ del 'Float / or❑� s� ❑ Transducer" tL Tank dr w wn /min Pump cap ci gpm_ Squirt Height ' ft Pump ime Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 42216-53-00010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- 0 YES NO If yes, please describe:Existing 1000gal tank had a crack and was leakinq. Pumped out, lid crushed and tank filled in Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- Q YES NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate 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. II 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 al/State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes /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. L-4Zb Signature of Installer Date Brayden Schoeninq Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Q)Z'1 /?4 Signature of Environmental ealth 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 Tug Zane . 5=`je,wear a/F: Oc��n�t�1Z ZIA Mt Y ga' APPROVED JUN 29 2026 MASON COUNTY ENVIRONMENTAL HEALTH RET