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Home My WebLink AboutSWG2023-00271 - SWG As-Built - 6/30/2023imi J Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00271 Parcel # 322325007003 Applicant Name Teresa Kovacs Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 217 City, State, Zip Union, WA 98592 Installer Name Maples Excavating Site Address 5060 E State Route 106 Designer Name INSTALLATION CHECKLIST El Full System Installation ❑■ Tank(s)Only ❑ Drainfield Only El Repair El Other System Type Standard Pressure Pretreatment Type >5 ft.from foundation? - - ❑ N/A INYES ❑ NO >50 ft.from wells? - U e •- ® ❑ ❑ • >50 ft.from surface water? - � - - - - - ❑ NI CIZ n • Cleanout between building and tank? - - - - - - - - f/�j- -- Li ill CI ✓ Tank baffles present? - By (7. -C- 4 ❑ CI Eld 24"access risers over each compartment?- - - ❑ 0 CI coy Effluent filter installed?- •- CI 0 CI Septic tank capacity (working) 1060 gal ,anufa urer Infiltrator ,` ❑ D-box water level and speed levelers used? - - ❑ N/A El YES ❑ NO J oO Manifold/D-box accessible from surface?- - ❑ El ID 002 Check valves installed? - - ❑ ❑ ❑ ❑Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one) j42 El 3 El 4 ❑ 5 El 6 ❑Commercial/Other >10 ft.from foundation? - - ❑ N/A ❑ YES El NO >100 ft.from wells?- - ❑ ❑ ❑ W >100 ft.from surface water? - - ❑ CI CI LL >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ Q Q > 30 ft.from downgradient curtain/foundation drains? - - CICI❑ Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ 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 4 24"access riser(s) and accessible from surface?- - ❑ ❑ ❑ I— a. Alarm or Control Panel Installed? - - CI El 2 Control Panel equipped with Timer/ETM /Counter- - ❑ El ❑ n a_ Pump installed in El Bucket or ❑ On Block or ❑ Other d• Pump Make/Model ❑ Floats or El Transducer a. 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 # 322325007003 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES El NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - j YES 0 NO 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,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. al 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. /**-h'"� 06/30/23 Signature of Installer Date Shane Maples Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: yt-NUAAf`mil 6(3o /Z3 Signature of Environmental Health 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 - __i-10111kij 03J 1 UU a •' � �qr �0 TWIT-- ] 0 ` u -1l 7 R\X. tNFIS' i vil af b ,— _ _ -, _ . O I tNF. 1$' I Q • , c- �F. 1s� 1 Nouc- c ---.0 s j cA ammo••••ftm...................4"•=00•••••••••••••••••• X 3 5' / 11. 1 bo� r�,t OS\(\' _.tea = i I off ` e 111 L`, �CC�r. Q` Q' i. Ec 4 ,4.... L� K l 4 (i. s. APPROVED APPROVED PPRp D MAS0N COUNTY ENVIRONMENTAL HEALTH RET JUN 3 0 2023 MASON COUNTY ENWRON.MENTAI HEAT RET