HomeMy WebLinkAboutSWG2022-00409 - SWG As-Built - 3/26/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00409 Parcel# 32423-50-02004
Applicant Name Legacy View Properties Subdivision (Name/Div/Block/Lot)
Applicant Address 14956 Appalosa Trail
City, State, Zip Prior Lake, MN 55372 Installer Name Bo Russell
Site Address 36790 N US HWY 101 Designer Name Michah Halverson
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Dreinfield Only ❑Repair ❑Other
System Type Pressure bed Pretreatment Type Nuwater
>5 ft.from foundation? --- ---------- - ------- - --- -- ❑ NIA EYES El NO
>50ft.from wells? ---- - - ------ ---------- -- - - -- - ❑ e ❑
2 >50 ft.from surface water? - -- --- - ----- - - --- ❑ e El
f Q Cleanout between building and tank? - ------_______--__- El M El,
U Tank baffles present? -- -------- --- -- -- --- -- ---- ❑ ■ ❑
a24"access risers over each compartment?--- -UJ ❑ ❑
N Effluent filter installed?- ---- --- - - -------- - -------- . ❑ ❑
Septic tank capacity(working) Nuwater gal Manufacturer Infiltrator
O D-box water level and speed levelers used? ------ - ------- - NIA ❑YES ❑ NO
0O Manifold/D-box accessible from surface?---- - - ---- - - --- - - ❑ ❑
C?2 Check valves installed? - - - - - - ----- -- - - - -- - -- -- --- ❑ ❑
OQ
Z Transport Line Size 2" Schedule/Class sch.40
Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?- -- - -- -- --- ---- ------ -- --- [I WA YES NO
>100 ft.from wells?- - --------
----- - - ----- P7 R-D VE
R ❑
J >100 ft.from surface wate ----- - - f�
w
ri >10 ft.from potable water lines?---------- ---MAR 2� . El
> 5 ft.from property lines and easements?-- - - _ 6 ❑
qe_ >30 ft.from downgradient curtain/foundation drai&M 50kl 6DUWT-Y NNW G'N'JD L L ® ❑
Drainfield level and observation ports present - - --- J$1W ❑ e ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over dminfield?--- - --- - - -------- -- ❑ N ❑
Pump tank setbacks consistent with septic tank? - -- - ------ - - - ❑ NIA ® YES ❑ NO
Y Pump tank capacity(flood) 1090 at Manufacturer Infiltrator
Q24"access riser(s)and accessible from surface?----- --- - - - -- ❑ ® ❑
dAlarm or Control Panel Installed? --- - ------------ --- - - ❑ 0 ❑
`i Control Panel equipped with Timer/ETM/Counter- -- --- - --- -
IL Pump installed in ❑ Bucket or e On Block or ❑ Other
1 Pump Make/Model Liberty 290 a Floats or ❑ Transducer
a
Tank draw down 1.6 in/min Pump capacity 36.8 gpm Squirt Height 5ft ft
Pump 0n time 1 min 20 sac Pump off time 6Ir s Daily flow set at 180 ppd
Mason County OSS Installation Report pg. 2 Pencel0 32423-50-02004
ABANDONMENTRECORD
"rvare existing septic componems abandoned as part of this project? --- ---- - -- - ---- ® YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-03DO? ----- --- ® YES ❑ NO
RECORD DRAWING
This m a wnnanenl re xel and mart be accvrM and dnUprlve ari to mi in Me need of Maitenmce Addenda and NWr.dreelopmenL Typnal Rai
LFami contain: D2mfind&mai w¢nletion&layout.iafid�mp unk to on.Ni minx.Immm tlranfieN.miefin'and xexiseib nde,,lw9an of well,wabi
cols,abesn'allm p .dearcub,and Wher mainleneas area p*,ts, Inmmpleb Rem&Mamie msy aside additional Ways in final 4ublbbon Bgaoval and Mead penni s,
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APPROVE
MAR 2 6 2024
MASON CCUN-V EWRO0.VPJAL kEA,--
i WRecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER]ENGINEER
I certify that I installed the system in accordance with 1 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 I further certify that all information contained on this
form and attached Record DraAft is accui form and attached Record Drawing is accurate.
911123
Signature of Installer Date A
So RussellPrinted Name of Signee
MASON COUNTY PUBLIC HEALTHThe undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public Heatt
�� j(-� :3 aV MWZY
Sig to o nvironmental Health Specialises I (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Wdued enlame