The URL can be used to link to this page

Home My WebLink AboutSWG2021-00074 - SWG As-Built - 6/5/2024 (2) Mason County OSS Installation PLIort MASON COUNTY PUBLIC HEALTH A CANT/ PERMIT INFORMATION Permit Number SING 2021-00074 Parcel# 42205-51-01017 Subdivision (Name/Div/Block/Lot) Applicant Name Byran Twvman LAKE CUB-MAN #18 BLK: 1 LOTS 17 8 PTN OF 18 Applicant Address 1246 SE Henry St Installer Name Jamie Workman d Or 97202 City, State, Zip Portlan Micah Halverson Site Address 761 N Duckabush Dr N Designer Name INSTALLATION CHECKLIST Repair ❑Others System Type Pressure DrainUeld Only ❑ p Septic Tank Q Full System Installation [ITank Only El Pretreatment Type ssure Trench Na YES ❑ _ _ ____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___- Q ❑ ❑ >5 ft,from foundation? -- - NIA ® ❑ ,50 ft.from wells. . _____ _ _ _� __ _ _ _ _ _ _ __ _ _ _ _ _ _ ___ _ __.- ® ❑ ❑ Y >50 ft.from surface water? - - - - - -- - - - - _ _ __ _ _ _. ® ❑ ❑ Z ® ❑ FQ- Cleanout between building and tank.? . _ _ _ _ ___ _ _ _ _ _ ___ ❑ Tank baffles present? - - - - - - - - - - -- ❑ 0 ❑ J ❑ a 24" access risers over each compartment?-- - - --_________ _ ❑ _ _ ___ W Effluent filter Installed?- --- - - - -' - - - Sound Placement N 1250 gal Manufacturer Septic Tank capacity(working) ❑ No O 0-box water level and speed levelers used? - -- - --- - - ® NIA ®ves ❑ ❑ ® ❑ p0 Manifold/D-box accessible from surface?-____________ __ _ ❑ °aZ Check valves installed? - - - CQ Schedule/Class 40 z Transport Line Size ❑ 5 ❑6 ❑CommerciallOther Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ® NIA ❑ YES ❑ NO >10ft.from foundation? - - - - - - - - - - - - - -- - - - - -- ® ❑ ❑ _ _ 0 1100 ft.from wells?- - - - - - - - - ❑ W >Ico ft.from surface water? - - -- - - - - - - - - - -- - - ❑ ® ❑ LU >10 ft.from potable water lines?- - - - -'-_ ❑ ® ❑ Z > 5 ft.from property lines and easements ® ❑ ❑. Q > 30 ft.from downgradient curtain/foundation drains? - - - - -' - ❑`. In Grainfield level and observation ports present - - - - - - 0 Graveless chambers or ❑ Clean gravel used? (check one) ❑ ® ❑ Proper cover installed over drainfield?--- - ❑ No ❑ NIA ® YES Pump tank setbacks consistent with septic tank? - --- ----- - Sound Placement 1585 gal Manufacturer ❑ Y. Pump tank capacity(Flood) ClIt Q24" access riser(s)and accessible from surface?- ___- ❑ IN ❑ ~ Alarm or Control Panel Installed? - - - - --- -- - - - - --- - Control ❑ ❑ Il ed with Timer I ETM I Counter- - - - - - - -- - - S Panel equipped Orenco PVU 7 r ❑ On Block or Other IL Pump installed in ❑ Bucket o P ® Floats or ❑Transducer 0. VA 5005 Pump Make/Model gpm 42 Squirt Height 5' ft Tank draw down L5 inlmin Pump capacity 3hrs Daily flow set at 360 gpd li 1.05 Pump oR time Waama amrzme Pump on time Mason County OSS Installation Report pg. 2 Parcel4 42205-51-01017 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - -- - -' ❑ YES NO If yes, please describe'. Were all components pumped out and properly abandoned per WAC246-272A-0300? -- - - - --' YES NO RECORD DRAWING This Is a permanent petard and must be acarffi¢and a¢scr tai ce enough to re.luoat¢in the need at maintenance activities and mtur¢deaaluymenl Typical Recut drawings contain Drail ld 6 manifold om¢nlation 8layoul"produced rank location,Nonh arrow,reserve dimprmld adsling and proposed ma ng,location of wells,waredlmes. wells,onddrymsl pods,plaid—Up and other maint¢nanca antes points. Inmmpl¢te Record Tema ngs may create addressed unless in final installation approval and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION rdesign T ESIGNER/ENGINEER I installed the system in accord certify that the system has been installed in accor- esign stamped"APPROVED"bdance with the septic design stamped"APPROVED"by lic Health and that any deviatioMason County Public Health and that any deviations een cleared/approved by both shown here have been cleared/approved by both County Public Health and meetmyselfand Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information containeI further certify that all information contained on this form and attached Record Drawing is accurate. J form and attached Record Drawing is accurate. Signature of Installer Date 1 Jamie Workman Printed Name of Signer, �yeo y�y �. =COUNTYPUBLICY PUBLIC HEALTH approves this Installation Report andon behalf of Mason County Public °tl�r,N�TH.fi�of�p�� .,�� EXPIRES:Mile onnme to HY Health Specialist ,Date/ 11 (stamp, signature and date) Updated amrzote THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB 3ITE