HomeMy WebLinkAboutSWG2024-00186 - SWG As-Built - 6/10/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT!PERMIT INFORMATION
Permit Number SWG 2024-00186 Parcel# 32309-53-00005
Applicant Name Marion Kay Petrie Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 150 Colony Surf Div.4 Lots 5-8
City, State, Zip Lilliwaup,WA 98555 Installer Name T.J. Goos
Site Address 20 N. Diamond Head Ct., Lilliwaup Designer Name Deals L.Tahla
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Trenches enl Type
>5 ft.from foundation? - -- - ------ - - - - ❑ NIA ■YES NO
>50 ft. from wells? ------ -- - --- - - -- -- - ------ ❑ ® ❑
Y >50 ft.from surface water? _ _ _ JUN 0 7 2024 - ❑ ■ ❑
2
F - Cleanout between building and tank? - - - ❑ e ❑
Tank baffles present? - - -- -- - - - - - - B-y -- - - - - ❑ ® ❑
C24"access risers over each compartment?- - - - - - - - - - - - - - - - ❑ ❑
.:LU Effluent filter installed?. - ------------ - - - ----- - - - - - ❑ ® ❑
U)
Septic tank capacity(working) 1 000 gal Manufacturer Infiltrator
OD-box water level and speed levelers used? - ------- ------ - ® NIA ❑ YES ❑ NO
000 Manifold/D-box accessible from surface?- - --- - - -- - ---- - - - ❑ ® ❑
rQZ Check valves installed? - - - - - - - - - - - - -- -- -- - - - - -- -- ❑ ® ❑
0<
2 Transport Line Size 2 inch Schedule/Class Sch.40
Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - --- - - - - - - - - - - - - - -- - - - - -- ❑ NIA ■ YES ❑ NO
0 :. >100 ft.from wells?- -- - - - -------- -------- - --- --- ❑ ® ❑
d >100 ft.from surface water? - - - - - - - - - - - - - - - - - -- - - - - - ❑ ® El
LL >10ft.from potablewater lines?- -- - - - - - - - - - -- - --- --- - ❑ ® ❑
Z >51t.from property fines and easements?- ❑. ® ❑
Q
d' >30 ft.from downgradient curtainRoundation drains?- - - - - - - - - - ® ❑ ❑
Drainfield level and observation ports present - - - -- -- -- - - - -- ❑ a ❑
e Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfeld?- ❑ ® ❑
Pump tank setbacks consistent with septic tank? - ❑ NIA ® YES ❑ No ,
. Pump tank capacity(flood) 1.000 at Manufacturer Infiltrator
�.. 24" access nser(s)and accessible from surface?---- - - - - - -- -- ❑ ff El,a Alarm or Control Panel Installed? - -- - - - - - - - - - -- -- - --- - ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ ® ❑
,a Pump installed in ❑ Bucket or ® On Block or ❑ Other
fPump Make/Model Liberty 280 ❑ Floats or Q Transducer
-a Tank draw down 1.5 in/min Pump capacity 33 gpm Squirt Height 8 ft
Pump on time 2.5 min. Pump off time 5 hrs.57.5 min. Daily flow set at 180 gpd
upaama ea,ame
Mason County OSS Installation Report pg. 2 P.,ow t',u.-1�°�Fi�"O��c��l
ABANDONMENT RECORD
Were existing septic co nrents \a>s part of this Proles? -__ a YES ❑ No
If yes. Please describe:
Were all components Pumped out and properly abandoned Pa WA6246-272A-0300'I -_______ E Yes No
RECORD DRAWING
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Record Drawing AMMched
C i TIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I car*Mat the system has been installed in accor-
Me septic design stamped"APPROVEb-by Mason dance with the septic design stemped'APPROVED'by
County Public Health and that any deviations shown Mason County Public Health and Mat any deviations
here have been deared/approved by Oth the designer shown here have been dearedrapproved by both
and Mason County Public Health and Meet all State myself and Mason County Public Health and meet all
and Mason County Codes. IState and Meson County Codes
I further cedily that all information corrt�med on this I furthercertify that all information contained on this
form prip attached Record Drawing is a�Pcyrate. form and attached Record Drawing is accurate.
, '
lgnelme of/nstaNer Defe
QrxL��'LCVI (.7oc� 5
Rintatl me o/Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installs ' n Repot end y5. St 0071
Record Drawing on behalf of Mason Cn my Pudic O ALE L. TAHjA _
Health. llf S D D SIGNER
Y V I�,AMtfc 1l6(ZL� EXI �xS:
Signature Of FJ7VIMMW&Health Spedsiist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE u�--a
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