HomeMy WebLinkAboutSWG2024-00042 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Parcel # 322334400010
Applicant Name Carrougher Living Trust Subdivision (Name/Div/Block/Lot) gpRo
Applicant Address PO Box 776
City, Stale,Zip Union,WA, 98592 Installer Name Josh Peterson C&II
Site Address 7611 E state Route 106 Designer Name Tank Only
INSTALLATION CHECKLIST
❑ Full System installation 0 Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type 'V w f 4 5��57 . ee rreeatment Type
>5 ft.from foundation? - - - - - - - - - - WZgjs-t•/-Zg ❑ WA ®YES El No
>50 ft.from wells? - - - - - - -- - - - - -- - -- -- -- ❑ N ❑
Y >50 ft.from surface water? -- - - - -- - -
-MR-2 9-924-- ■ d ❑
Z
FCleanout between building and tank? --- ------- ---- ---- ❑ ® ❑
V Tank baffles present? - - - ---- - - - - -- ❑ ® ❑
4 24'access risers over each compartment?-- - - - - -- - - - - - - -- ❑ e ❑
W Effluent filter installed?- - - - - - - - - - - - --- - -- - - -- -- - - ❑ ❑
IN
Septic tank capacity(working) 1250 gal Manufacturer Hagerman ST
O D-box water level and speed levelers used? -- - -- - - - - - -- --- ® WA ❑YES ❑ No
' Ou ® ElManifold/D-box accessible from surface? -- -- -- -- -- ---- -- ❑
EPZ Check valves installed? - -- - - - - - - - - - --- - -- - -- - - - - m ❑ ❑
ca
S Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑3 'R4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - - - - - - - - - - - - - -- - - - -- - - ® WA ❑YEs ❑ No
C >100 ft.from wells?- - - - - --- -- - - - ---- -- - - -- -- -- - - ® ❑ Cl
W >100 ft.from surface water? -- - - - -- - - - - - - ----------- ® ❑ ❑
�y. >10 ft.from potable water lines?-- - - - - - -- -- --- --- ----- ® ❑ ❑
ZZ >5ft.from property lines and easements?- -- -- ---------- - ® ❑ ❑
K > 30 ft,from downgradient curtainlfoundalion drains?- ----- --- - ❑ ❑
Drainfield level and observation ports present -- -- ------ --- - 0 ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-- - - - - - - -- - - - - - - - - ❑ Cl
Pump lank setbacks consistent with septic lank?-- -- - - ---- - -- ❑ NIA YES ❑ No
ZX Pump tank capacity(flood) 3DJ) at Manufacturer Nor u/eyo
Q 24"access rler(s)and accessible from surface?---------- -- - ❑ ❑
~ Alarm or Control Panel Installed? - -- --- -- - - - -- - -- -- - -- El ❑
1 ❑ ■
f Control Panel equipped with Timer!ETM/Counter--- -- -- -- - - ❑
a
Pump installed in ❑ Bucket or ❑ On Block or 0 Other fE R )� :n 1.,�E Por J� P .+k
CL Pump Make/Model 6a 145 6/F 1 5 I 1 W FI 1 1/2 N f j pa�VE Floats or ❑ Transducer
O.
Tank draw down N A in/min Pump capacity NA gpm Squirt Height Al A tt
Pump on time N A Pump off time—A�L— Daily flow set at NA gpd
uwa.a e.,uc,e
Mason County OSS Installation Report pg. 2 Panel# 322334400010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -------- - - ----- ® YEB3151
If yes, please describe: A IIIde I ce v PfGWere all components pumped out and properly abandoned per WAC246-272A-0300? --- - - - - ' 0YES
RECORD DRAWING
This a a p relawnl mind and most M secured and daentlpdve enough to m440e in the mod or maintenance activities and wore de iammont. Typal Rewm
nrawi cnlm: tinmXead d manifold-dread on 6 oyes',se w,Tp tank weem,IGrow,haves morh h.emoting and coursed W dev's teesan et..Is waudi es.
Ile,oomm,ex m de,it..,and mom meinlMance sees pY. Incomes.Rxpd Dovem c say create addihdn d dtlays m rmal'melplation arl-I and r-l—Pmrds
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that I installed the system in accordance with 1 certify that the system has been installed in Sochi
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 deared/approved by both the designer shown here have been clearedapproved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. Slate and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form end atfac d Record Drawing is accurate. fomr and attached Record Drawing is accurate.
at of Installer Date
10 SIB25 N'1
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
`1(31` I
Signature of Environmental Reselth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE anea1ed ai
3 ry MA AP O soN�oG ry A0g10 i a = � N EN�RD 1y
h M
L RBl N ENIA(NEy(T
cx
i
3 �
p t
` 6
i V
'... .,.
I u^ 6
i
isY,}3m Nvwn30vN S1N 3NO5 699[-L89 '09f:1 �WAn9L49999t) 3NONd
v 1-4:1093L 8 d 097E NNO W W6 VM'ONOOtl03111VE MS XO9'Od
s lsosz� 'soszI E 9313"a° �NI JNN33NIJN3 >G
a 31tl0
y - i
3
Q
4
2,
i
e g
e T q
'A
(7 O
o r + a
�7�r5,�°��
43 a nt
a pa
g
a �
o � o
¢ z yy
H 2 U Z i
N
m W ¢ �
vCL= Ji
� ¢ 3
Z ¢ H= � Ya
{ 3 C oz�
oL�Ll ® coi ¢Mm
f >
w
g
� a a
a
a
m
-ec-iv
� N
K
a
tt
w .SIN
m
N Ty
n
-ro 4
? O
s Q
a
_ I
I
0
N
0
N
6
V
N
6
9q itLl rcanaawx S1N 3ttlO5 "W-[49 MCI �XVJ909L-4B MC) '3NOHe
j-d OSz: $ d O9Z� 'N Y'O KN6 VM'°NOO)AO 3Il1tl5160C XO O d
isosz: soszL �NI JNIH22 JNIJN3 Ai l
31bO tIt
1
5 4ST
�d3�4
eE�S}gp`
s$
D
'. L_.i.. _ �- 3....{....y .._..y.._..,.:.............. . —' O �.
rn
+ y-�� t oI _�''_ - i
y i ..{. a -•1 ��� 7�
r--