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Home My WebLink AboutSWG2022-00111 - SWG As-Built - 6/24/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00111 Parcel# 32309-51-06079 Applicant Name Dan Anderson Subdivision (Name/Div/Block/Lot) Applicant Address P.O.Box 386 Colony Surf Div.2 BIk 6 Lot 79 City, State, Zip Lilliwaup, WA Installer Name T.J. Goos Site Address 931 N. Colony Surf Dr., Lilliwaup Designer Name Dale L. Tahja INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressurized Bed Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - , (�' - - ❑ ❑ N Cleanout between building and tank? it b L - -' �d- ` -k-�- --- ❑ II U Tank baffles present? - !IT - - - - -- 0 U 0 d ,r 24" access risers over each compartm:; - -- ❑ 0 0 W Effluent filter installed?- -�� - ❑ 0 ❑ cn Septic tank capacity (working) 1,'1 A .� -gal filfa n acturer Hagerman O D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO oO Manifold/D-box accessible from surface?- - 0 II u. c9Q Check valves installed? - - 0 0 ❑ 2 Transport Line Size 4 inch Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - ❑ II ❑ 11.1 >100 ft. from surface water? - - El ❑ • >10 ft.from potable water lines?- - ❑ 0 0 > 5 ft. from property lines and easements?- - ❑ III ie > 30 ft. from downgradient curtain/foundation drains?- - ❑ 0 ❑ ® Drainfield level and observation ports present - - ❑ ® 0 ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manufacturer <• 24"access riser(s) and accessible from surface?- - ❑ ❑ ❑ E-a. Alarm or Control Panel Installed? - 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ ❑ D a. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a• Pump Make/Model 0 Floats or 0 Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg.2 Parcel# 1f.)C‘— b ABANDONMENT RECORD Were existing septic components abandoned as rt of tit,t proi -- -- - _ --- YES 0 NO Ifyes, please describe: ?yAs-\\ Y- \C ' O i 1GL � Were all components pumped out and property aba doped per WAC246-272A-03013 -? ' YES QNO 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 waterlines,of walla, cord Drawings costa s DtMinified&manifold orientation&layout.Septic/pump tank location,North arm,reserve drainheid,existing and proposed�r gs, walls,observation ports,deanouts,and other maintenance access points. incomplete Record Drawings may create additional delays in anal 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 bath 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 rate. form and attached Record Drawing is accurate. r -4/:,,,-e_17.,. Sicgnatureof'Installer W te . 4 Printed Name of Signee IC k ' o `l'c Is MASON COUNTY PUBLIC HEALTH G 4,, '� 4t. '•J,c- The undersigned approves this installation Report and 51 W 214 F,, Record Drawing on behalf of Mason County Public alCt DALE L. TAHJA , Ll �.rS-,�7 ESlC; iER - Health: ` y) i- Signature of Environmental Aralth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WE SITE update 812112o1e , -----.__________tL cc) D r r t • 4) ; , r < IA 11, 13 i n CO __ �` ' O R O * p 0 z 3 O� O A1 r Z 0 \ xs- 7 A ci' 0 ----c),/,':'V :; 4_� i/ 4izs.‘4"...',..--.-f;:3', ,-,-. ',. -- 1 -t %Ikt r _ 0 ..y ,• , 1„,...,-0... 44,,_., (\_9,,,..,, 5 1 ,T+."> .P. `# ,D Sir'''..10 �1 ' ,- �- Pc3,4 ' ,--< c)