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Home My WebLink AboutSWG2024-00032 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANTI PERMIT INFORMATION Permit Number SWG 2024-00032 Parcel# 22217-23-00060 Applicant Name Linda Milam Subdivision(Name/Div/Block/Lot) Applicant Address P.O. Box 720 TR 6 OF GOUT LOT 4 AND TAX 1-F FCC F-1 City, Stale,Zip Denair,CA 95316 Installer Name Maples Excavating Site Address 8281 NE North Shore Rd,Salter Designer Name Ami Septic Designs INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Onty ❑ Orainfield Only ®Repair ❑Other System Type Oscar Pretreatment Type X02 >5ft.from foundation? --------------------------' ❑NIA ❑YES NO >50 ft.from wells? -__________ ______ __ __ ____1 ❑ ❑ Y >50 ft from surface water? ---- - - -- --- ---- ❑ ❑ Z ❑ ® ❑ Cleanout between building and tank? ----- ------.-------- U Tank baffles present? --------- -- --- --- - - - ❑ ® ❑ 1- 24"access users over each compartment?--- ---- --- - - ---- ❑ ® ❑ a uJ Effluent filter installed?----------------- -- ------t ❑ ❑ in Roth 2-compartment Septic tank capacity(working) 1 000 gal Manufacturer O D-box water level and speed levelers used? -------- ------- ❑WA ❑YES NO xO0 Manifold/D-box accessible from surface?-- heuc�rUor�Gs ------ ❑ ® ❑ m= Check valves installed? ---------- ---- ------ ---- -- ❑ ❑ 06 2 Transport Line Size 1 Inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑CommemiaOOther >10ft.from foundation?------------------------ -- El NIA ❑ YES NO G __-_ >100 ft.from wells?---------- - - -- ------- ❑ w >700 fL from surface water?----- - ---------------- ❑ El u- >10ft.from potable water lines?- --------�7�� --- ------- ❑ ❑ Q >5ft.from property lines and easements?-- ---- --- ❑ ❑ K >30ft.from downgradient curtain/foundation drains?---------- ❑ ❑ Drainfieid level and observation ports present ----- -- ------- ❑ ❑ Proper cover installed over drainfield?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ WA ® YES ❑ NO Y Pump tank capacity(flood) 1,000 gal Manufacturer Roth 2-compartment 2 r 24'access nser(s)antl accessible from surface?------ ------- ❑ a Alarm or Control Panel Installed? ------------- -"'---- ❑ ❑ Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ 7 a Pump installed in ❑ Bucket or ❑ On Block or E Other bottom of tank p.. Pump Make/Model A.Y.McOonald&30 Floats or ❑Transducer a Tank draw down — in/min Pump capacity 2.3 gpm Squirt Height — ft Pump on time 30 seconds Pump oft 8me 3 minutes Daily flow set at 360 gpd uWmearz+rzo+e Mason County OSS Installation Report pg. 2 Parcel#22211 —Z7J- OOO(a O ABANDONMENT RECORD r -I YES NO Were existing septic components abandoned as part of!his projep? - '- Il12r If yes, please describe: f111A 'I, � r Jv.L) D(d r:�rain 7�.� �. Were all components pumped out and properly abandoned per WAC24e-272A-03007 .----_- . IV YES NO RECORD DRAWING Thu u a ryrmmam rtcoN+M mart%accud O—dove enougfi w M—ft in Me neeE W maintnunce activrtin antl NWn fievNepmmt Tyy®I RecaO rNan OrauYnSa mnla'm: Dninfied&manual!onenbdm 6 laywt Sept,�enklat .ti Nw artaw.rtsem areirRelq ece0n0 anE MposeE Ouiling°,Imdm Nxe➢e,waNdmes. vnlls,eleovadpn pmg,tlaaneula,andOn.'mAimulance a¢2ss poNtl. Inwmp[ele Re DmM,am Yaaa¢addNoiul dtlryein final litaWladm appmval a+d Mettd permin. � D Record Dravoing 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 cieamd/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 1 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 Drawing is accurate. oZl13/ z4 �Sgnatum oflnstaller Dare Printed Name of Signee MASON COUNTY PUBLIC HEALTH p° as The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public ' ++} 51,ocaas ,�: ' Health: PAULA JOY JOHNSON �4 AM V�M— g p Signature of Emu nmentallleelth Specialist Date (stamp, s' a a ate) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE wa+lea amrznia St�C� � yv w'cev ( 1�56U�1 LWDA MILAM 4RRCE 2221 I-23-voo�o ® < < 828( NE NoRrrt sttD�• Ro 38� OI Y1oJ5E w . 6 J .. O CenCol Pane anth Avaio-VS,�ALnn Ory Cleanant © 1.000 Gallon SeP�/Aeretioa TaN� "O O O o i,000 GdWn c�ufra/Pump Tank . a-O,mP„�mt O5 H,aawoth OSOAR X02 Mwna D,unsma w ® otd, A,,.: f�c\d ce7oa ndohe[� wt APPROVED APR 0 3 1014 r MASON COUNTY ENVIRONMENTALHEALTH RET Nv PAULA J�OY3JOHNSON ` ' ICBFISE 1 f103PFD b i ion C> SD k B�� T 7- 5 C Nam!} Wa xis y:J`T si oasas PAULA JUY JCHNSON ; JG tn� curxtX o Qwv�ems. 5 ° Wjven v �� sCaA o s< <o � � s� zo APPROVED .P �# 2zz' � - 23- �� J APR 032024 8281 NF N� S -I� 8e l MASON COV'T""RONMENIALHEALTH REi