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Home My WebLink AboutSWG2023-00214 - SWG As-Built - 11/16/2023 Mason County OSS Installation Report pg. 1 APPLICANT/ PERMIT INFORMATION MASON COUNTY PUBLIC HEALTH Permit Number SWG 2023-00214 Parcel # 51901-50-01052 Applicant Name VICTOR HEBERT Subdivision (Name/Div/Block/Lot) Applicant Address 2401 OLYMPIA AVE NE City, State, Zip RENTON,WA. 98056 Installer Name ANDREW SPEARS CONST LLC,Site Address 1028 W LAKESIDE DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Onl System Type y 0Rep1'r ®Other RV HOLDING TANK Pretreatment Type >5 ft. from foundation? >50 ft. from wells? . I,N/A ❑YES ❑ NO >50 ft. from surface water? a,ij'.t{I$-/DL'i �' ❑ 0 Ff- ❑ ❑ Cleanout between building and tank? ❑ V Tank baffles present? \x - 0 0 d24" access risers over each compartment? IN El ❑ W Effluent filter installed? - 0 ® ❑ en Septic tank size 1250 gal M MI 0 0 Manufacturer SOUND PLACEMENT 0 D-box water level and speed levelers used? - ow O Manifold/D-box accessible from surface?. - - - - _ ❑ NrA ❑ YES ❑ No '9 Check valves installed? - - 0 0 0 - f Transport Line Size ❑ ❑ ❑ Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 >10 ft. from foundation? ❑6 ❑Commercial/Other 0 >100 ft. from wells? - ❑ N/A ❑ YES ❑INO >100 ft. from surface water? - ❑ 0 ❑ al - 0 0 Z >10 ft. from potable water lines?- ❑ w > 5 ft. from property lines and easements? - O ❑ ❑ G > 30 ft. from downgradient curtain/foundation drains? - ❑ ❑ Drainfield level and observation ports present - CI ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) ❑ 0 ❑ Proper cover installed over drainfeld?- ❑ ❑ ❑ Pump tank setbacks consistant with septic tank? - Z Pump tank size gal ❑ N/A ❑ Yes ❑ No Manufacturer H 24"access riser(s)and accessible from surface?- - 0 4. Alarm or Control Panel Installed? - - ❑ 0 = Control Panel equipped with Timer/ETM/Counter- ❑ 0 ❑ 4. Pump installed in ❑ ❑ ❑ 0 - Bucket or ElOn Block or 0 Other d Pump Make/Model kV,0 Floats or aTank draw down ❑ Transducer in/min Pump capacity qpm Squirt Height Pump on time ft Pump off time Daily flow set at gpd Updateeerieme Mason County OSS Installation Report pg. 2 Parcel# 51901-50-01052 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? If yes, please describe: ❑ YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? 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 activmes and future development Drawings contain- DraInfield S manifold orientation&layout.Septic/pump tank location.North avow.reserve dminneid.existing Tis Races. yells.observation Pons,Geanoub,and other maintenance access points Incomplete Record Drawings maye d and proposed i staldinon location a related .rdtpelmes, /-� raata additional delays In final installation approval and related parmnx IS Li /), ,., , --L-Jfidegri CO V/r-/ts //rvskfrrl ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with the septic design stamped "APPROVED"by Mason I certify that the system design has bean p d AP in oVED Y dance with mthy Puse lic at and that "APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations hem 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 and Mason County Codes. myself and Mason County Public Health and meet all 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 accurate. form and attached Record Dewing is accurate. 2�i .ll Si nat(re of lost tier Date r Leg ¢v� Speo ✓ PQ " � Printed Nettie of Signee i�v�'e r -`41/r r MASON COUNTY PUBLIC HEALTH fii, 4 ,ry1�, IA* The undersigned approves this Installation Report and �� s mr ` �t Record Drawing on behalf of Mason County Public LICENSED SIGNER III Health: Ina tx we�os�tm ♦ 1' 1 IIC/23 n/I Signature of Envlronmen I Health Specialist Date v`� (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Umatedaz;c=e ,90„ I tluu %, r . w,„ / ;SP/. 2.5 I • • „0 e P pi ASC leg Y co11 liii ? 11//h.,�0t O CINOY ITE1 mb,I �� '.. i LIgENSED DESIGNER �! lost f G 1, ( EXPIRES OSIW 142P (,v 4ssk)l J1- t O4, h"SS ! ,,,,„ Z / J i III II o pi' u,¢+ r2lriwP APPROV �l3 E , J a laKa'n NOV 16 2023 M;SON CCSNn E4,';Qti4 " itir;!,i,eaLr; 4E T