HomeMy WebLinkAboutSWG2024-00246/ASBUILT - SWG As-Built - 9/4/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00246 Parcel# 22112-78-00150
Applicant Name Joseph Ruffino III _ Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 1731 TR 15 OF SURVEY 4/101 S 401180 S 551165
City, State, Zip Allyn,WA 98524 _ Installer Name TNT Excavating
Site Address 451 E Buckboard Dr.Allyn Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Sand-Lined Pressure Bed t? .i1fPretreatment Type
>5 ft.from foundation? -- - --- -- --- fjj 155`_'I{['{( ty/ �� w^ ❑� YES ❑ NO
>50 ft.from wells? --- - - --- - -- - IS SJf: 4l ❑� ❑
'-4 >50 ft.from surface water? -- - -- - - - -iffi AM-7 70026- - O ❑
Cleanout between building and tank? --- - - El
0 Tank baffles present? -- --- ------ $-' --- -
a 24"access risers over each compartment?-- - - -- ❑ ❑ ❑
y •
w Effluent fitter installed?-- -- ----- - - ------' ❑
to Hagerman
Septic tank capacity(working) 1 200 gal Manufacturer
❑ D-box water level and speedlevelers used? -- ------------- ❑ MA ❑ YES NO
0J
0 Manifold/D-box accessible from Surface?- -- - - - -------- - - - ❑ ® UI❑
mZ Check valves installed? - - - - -- - -- - -- - - - ---- - --- ❑
04 2" Schedule/Class 40
n Transport Line Size
Bedrooms installed(check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑Commercial/Other
,10ft.from foundation?- _ _ _ _ _ _ _____ _ _______ _ ____- ❑ N/A ® YES NO
>100 ft.from wells?---- -- - - -------- --------- --- - ❑ I I ❑
0 w >100 ft.from surface water? - ------- ❑ ® ❑------- ---- - ---- ❑
¢- >10ft.frompotablewaterlines?- - ---- - -- ----- ----- - - ❑
UI z > 5ft.from property lines and easements?---- - --- - - ------ ❑ ® ❑
K > 30ft.from downgradient curtainifoundation drains?---- - --- -- ❑ ❑
O Drainfield level and observation ports present - - - --- - - O Ii
❑ Graveless chambers or ® Clean gravel used? (check one) ® ❑
Proper cover installed overdrainfield?--- --- - -- -------- - ❑
Pump tank setbacks consistent with septic tank?----- -- ---- -- ❑ N/A ® YES ❑ No
Y Pump tank capacity(flood) 1.200 gal Manufacturer Hagerman
Q 24"access nser(s)and accessible from surface?-- ------ - O❑ p O
Alarm or Control Panel Installed? --- - - - - - - - -- - - - - - - --- ❑
(L ❑ ❑
2 Control Panel equipped with Timer/ETM/Counter----- -- - —
-
M
a Pump installed in ® Bucket or ❑ On Block or ❑ Other
Pump Make/Model Liberty FL102 M2-230v ® Floats or ❑ Transducer
`t 5 ft
Tank draw down 2.5 in/min Pump capacity 55 apm Squirt Height
Pump on time 2.2 min Pump off time 6 hr Daily flow set at 460 apd
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Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
0 YES � NO
Were existing septic �mP0nents abandoned as Part of this dmjsG ---
base desaflbe: ❑ YES ❑ NO
If yes,please perly abandoned per WAC246-272A-0300? "--" -
Were e an Components pumped out and pro
RECORD DRAWING _
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• Record Dravring Attached
CERTIFICATION OF INSTALLATION
INSTALLER
DESIGNER!ENGINEER
I ceRXy that!
installed the system in accords nce with I cedify that the system has been installed in aaror-
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 Gearad/approved by both the designer shown here have been Geared/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
that all information contained on this /further certify that all information contained on this
I further attached Record Drawing is accurate.
Sgna[ureW insanc
Dr
Owftc cj3D3r
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
61GJd10
The undersigned approves this Installation Report and C'�. PAULA JOY
Retool Drawing on behalf of Mason County Public
Health:
P 6 N oaM n 6rl 1( (z
(stamp, signature and date)
Signature ofEnvimnma tai Health Specialist Date �aoaN e
THIS FORM MAY BE SCANNED ANO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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•� >AVU JOY JOHNSON'.
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