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Home My WebLink AboutSWG2022-00234 - SWG As-Built - 2/16/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH =AddressPO PPLICANT/ PERMIT INFORMATION er SwG 2022-00234 Parcel# 42012-52-00022 �S me gGEOFFREY FARRINGTON Subdivision (Name/Div/Block/Lot) 1press OX 1247 ip TON,WA, 66584 Installer Name MANKE EXCAVATINGSLAND LAKE RD Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type GRAVITY Pretreatment Type >5 ft.from foundation? --------------------------- ❑ NIA Q YES El No >50ft.from wails? -_ __ _ ________________________ ❑ El l W >50it.from surface water? -__ ____________________- ❑ ® ❑ FCleanout between building and tank? ------------------- ❑ ❑ O Tank baffles present? - - - -- - - - -- - ---------------- ❑ ❑ 4 24"access risers over each compartment?---------------- ❑ �I W Effluent fitter installed?- _ _ __ _ _ _ __ _ _ _______________ ❑ ❑ ❑ Septic tank size_ 1530 081 Manufacturer INFILTRATOR O D-box water level and speed levelers used? ----- -______ -- ❑ NIA ® YES ❑ NO p0 Manifold/D-box accessible from surface?-- ❑ ElmOQ Check valves installed? - - ---- - ------------------- ® ❑ ❑ f Transport Line Size 4 Schedule/Class 3034 Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/other >10 ft.from foundation?-- --- - ---------------- ---- ❑ N/A ®YES NO C >100 R.from wells?- - --- ------------------------ � ❑ ❑ 0 ft.from surface water?--_____________W-t >10 ® ❑ El >10ft.from potable water lines?.--------------------- ❑ O ID>5ft.from property lines and easements?--- - ------------ ❑ ❑ G >30ft. from oowngradient curtain/foundation drains?------ ---- 0 ❑ ❑ Drainfield level and observation ports present -____ _________ ❑ o ❑ Graveleas chambers or M Clean gravel used? (Check one) O Proper cover installed over drainfield?---- ---- --- ---- ---- ❑ Pump tank setbacks consistent with septic tank?- -----______- ❑ QUA ❑ YES R NO b = Pump tank size pal Manufacturer r - FQ- -------------------- 24"access riser(s)and accessible from surface?-- --- - ______- K ❑ ❑I a Alarm or Control Panel Installed? -__ ___ _ _____________- I _ jControl Panel equipped with Timer/ETM/Counter-- ------- -. ❑❑� ---� rL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other- � Pump Make/Model ❑Floats or ❑ Transducer a Tank draw down in/min Pump capacity opm Squirt Height ft Pump on time Pump off time Daily Flow set at opd W]eW 82 VP I8 Mason County OSS Installation Report pg. 2 Parcel x 42012-52-00022 ABANDONMENTRECORD Were exisang septic components abandoned as part of this project? If yes, please describe: ❑ YES Were all components Pumped out and ProPedy abandoned Par WAC24&272A-0W •----__. ❑ YaB ❑ x0 RECORD DRAWING Tn4 m a grnlanml nape aM moat pa aaumm and.1,11re..Doan b re-laarc In m.meJ p mananana xuviun ana hWn Yrvalopnpc rypktl R vtl IXwd`ga mmaF: Uanggd 6 mYll.M Onenyllm 61By.Yl$apnGpYmO leNt bm40n,Myln envx, aNnm QtalnreNl,en IFI wOM.COa4va6Cn Pyle.dempuu,end anw melMerenq e¢asa a Band popasod nylery&.bNIIm.IwaOa.rNWlinev, 0.vn1a. Inwngk¢flBtpd CreMnpa mayfreale ad]IIiYMI dNBYa In li.el inaAll9tl[n W Wdua qp 1plBdd Oe.nE9 I 0 Record Drawing Attached I 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 actor. the septic design stamped°APPROVED"by Mason dance with Me 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 hate have been cleamd/approved by both and Mason County Public Health and meet all State myseNand Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes /furfhercertify 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. 7�,� Llnsta ler -Date eofSrgnee rR y OUNTY PUBLIC HEALTH d E.LN7PYTE m f12t� igned approves this Installation Report and llLa7osYoo"r�',v1vM�SMM 1 wing on behalf of Mason County Public LICENSED DESIGNER // � 9� . E,IRL5 d],1a /Ja U{/U4�i/ rimerea/H Specialist Date Lvl� (stamp, signature and date) i THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE YcdeNderztnwa ,S ' �fi�l� £sStaelw/ 6 w IDS N dl,d 51 Is Si s, CNOVE 'LOLv E. TE IICENBE00E8gNER �11) �wx.s avro - _ r1 Lo APPROVED CI [ rsla L �kB Rd MM 12 2022 +AsoM fllllNiY rwitctAAENi�'A `.. IYf