HomeMy WebLinkAboutSWG2021-00074 - SWG As-Built - 6/5/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00074 Parcel# 42205-51-01017
Applicant Name Byron Twyman Subdivision (Name/Div/Block/Lot)
Applicant Address 1246 BE Henry St LAKE CUSHMAN#18 BILK: 1 LOTS 17&PTN OF 18
City, State, Zip Portland Or 87202 Installer Name Jamie Workman
Site Address 761 N Duckabush Or N Designer Name Micah Halverson
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfleld Only ❑Repair ❑Other
System Type Pressure Trench Pretreatment Type Septic Tank
>5 ft.from foundation? - - - - - ----------------- -- --- ®NIA ❑YES ❑ NO
>50ft.from wells? - --- - - - - -------------------- - e ❑ ❑
Z >50 ft.from surface water? - - - -- -- -- -- ------- -- -- -- ElEl
r Cleanout between building and tank? ----------------- -- ❑ ❑
L) Tank baffles present? - ------- -- -- -- - - - ---- ---- -- ❑ ❑
1 24"access risers over each compartment?--------------- - ElM El
W Effluent filter installed?---- - - - ------------------- - ❑ ❑
U)
Septic tank capacity(working) 1250 gal Manufacturer Sound Placement
G D-box water level and speed levelers used? -------------- - . NIA ❑YES ❑ NO
OJ
LL Manifold/D-box accessible from surface?- --- - --- - ❑ e ❑
O0Z Check valves installed? - - - - - - - - -- -- -- - - - -- ❑ ® ❑
GQ
S Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 M 4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- - - - - - -- -- -- - - - -- -- --- --- . NIA ❑ YES ❑ NO
G >100 ft.from wells?-- - ---------------- ---------- ❑ E?p
W >100 ft. from surface water?-- --------------------- - ❑ ® [}:
LL >10 ft.from potable water lines?- - - - -- --------------- - ❑ [,-J ��tt
Z >5ft.from property lines and easements?- - -- -- ------- --- ❑ 0 Ej
>30 ft.from downgradient curtain/foundation drains?- -------- - ® ❑ ❑
Drainfleld level and obse"afion ports present - - -- -- --- ----- ❑ e Ell
I
e Graveless chambers or ❑ Clean gravel used? (check one) �
Proper cover installed over drainfleld?--------------- - --- ❑ ® El
Pump tank setbacks consistent with septic tank?--------- -- - - ❑ NIA ■ YES ❑ No
Y Pump tank capacity(flood) 1585 at Manufacturer Sound Placement
Q24"access riser(s)and accessible from surface?------ - - - - - -- ❑ ® ❑
IL Alarm or Control Panel Installed? -- ------------- -- - - - - ❑ 0 ❑
Control Panel equipped with Timer I ETM/Counter- -- - - - - - - - - ❑ e ❑
a Pump installed in ❑ Bucket or ❑ On Block or 0 Other Orenco PVU
a- Pump Make/Model PVA 5005 e Floats or 2 ❑ Transducer
:3 Tank draw down 1.5 in/min Pump capacity 42 Opm Squirt Height 5' ft
IL
Pump on time 1:05 Pump off time 3hrs Daily flow set at 360 apd
ure.w ernrsore
Mason County OSS Installation Report pg. 2 Parcel4 42205-51-01017
ABANDONMENTRECORD
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-03DO? ------ -- ❑ YES ❑ NO
RECORD DRAWING
Thla la a prmanant Ni add muar be aa..add daacrlgWe anwga to n4xda In as,mw M nodandaanm adNilisx and NWn dawbpnand. Tyµ' I ftacaN
Doi wrMin'. DreIMINd S mentlold onenla ord a Irywt.Said axona tank location.Nord a—.nwve drandeN,etlatly and ararwad WIN4gs,bwlion of walls,-darlMa.
w a.olaavatim lsons,danrouK,and odor maintmanw a.y'adi. NwmOlate RemN Draamgs may create addNmal delays in fimlimlallatlm elriovad aM mated li..
R Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that 1 installed the system in accordance with 1 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 clearedlapproved by both the designer shown here have been clearedlapproved 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
I further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
e�
Signature of Installer Date
Jamie Workman 4'
Printed Name of Signs `
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and stolNoq i0
Record Drawing on behalf of Mason County Public uuHTaalrtwtvgRsorl
Health: oESIraNFA
Signature o/Environmental Health Specialist Data (stamp, signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uaeawd.....
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OWN RAPP 1 .ANT B ron T man SRF INF°� Parcel # 42205-51-01017 sXecr Nuueea
M.Halverson Design LLC v Wv
PO Box 1519 Shelton We 98584 1246 SE HENRY ST 761 N DUCKABUSH DR N
Halversondesi nllc outlook.com PORTLAND OR 97202 AEIIMI