HomeMy WebLinkAboutSWG2024-00131 - SWG As-Built - 6/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00131 Parcel# 42214-76-00040
Applicant N me Don Collette Subdivision (Name/Div/Block/Lot)
Applicant A ress P.O. Box 134
City, State, ip Hoodsport, WA 98548 Installer Name T. J. Goos
Site Add 291 N. Szolomayer Ln., Hoodsport Designer Name Dale L.Tahia
INSTALLATION CHECKLIST
❑ Full S m Installation ❑Tank(s)Only E Drainfield Only ❑Repair ❑Other
S tern Type Grsvity Trenches Pretreatment Type
>5 ft. foundation? -- -- ------- --- ----- ---- ---- ❑WA YES NO
>50 ft. wells? ---- --------- T�7T��7� yp�yg - ❑ ❑
1GM EQ�'1.14
_ >50 ft. msudace water7 - - - ----- ❑ � ❑
F Cleanou between building and tank? --- -F1AY"0'r2024' ❑ ■ ❑
U Tank as present? - ----- - --- - - ❑ ❑
a24"a s deers over each comparbnent -BY--� ------- - ❑ ❑
W Effluent her installed?--- -------- �--- ❑ ❑
to 250 Hagerman(existing)
Septic to k capacity(working) 1. gal Manutactrlrer
C D-box w ter level and speed levelers used? ------------- - ❑WA vies NO
CJ ■ ❑
LL Manifol 0.box accessible from surface?---------------- - ❑
92 Check Ives installed? - -- - - - - - - -- ------ ❑ ❑ ❑
0f Transpo Line Size 4 inch edutelClass 3034
Sch
Bed installed(check one) ❑ 2 03 ❑4 ❑5 ❑6 ❑CommerdeUOther
>10 ft. mfoundation?- ------------------------- ❑ WA . YES ❑ NO
>100ft. mwells?- ---------------------------- ❑ ❑
W >100 fL msurface water? --- --------- ------------ ❑ ■ ❑
T >10 ft. pmable water lines?-------- -- ----------- - ❑ ❑
2 >Sft.fro property lines and easements?----- ----------- ❑ ❑
6' >30 ft. m downgradient curtain/foundation drains?---------- ❑ e ❑
G Drainfiel level and observation ports present - - - - - - -- - -- - -- ❑ ❑
e Grev less chambers or ❑ Clean gravel used? (check ore)
Proper ver installed over drainfield?--- ---- -- -------- -- ❑ ❑
Pump to k setbacks consistent with septic tank?---- -- ------ - ❑ WA ❑ ves ❑ No
Y Pump to k capacity(flood) gal Manufacaver
24' sdser(s)and accessible from surface?--- ---------- ❑ ❑ ❑
H
d Alarm or ontrol Panel Installed? --- -- ---- ----------- ' ❑ ❑
f Control nel equipped with Timer I ETM/Counter---------- - ❑ ❑ ❑
M
a Pump in lied in ❑ Bucket or ❑ On Block or ❑ Other
1 Pump M ke/Model ❑ Floats or ❑Transducer
0. Tank dra down in/min Pump capacity pm Squirt Height ft
a
Pump on time Pump off time Daily flow set at gpd
upa.i,e arzvmre
Pg.2Pence,
Meson County()SS installation �rtANDONMENT RECORO
Were axielplg aetik rornPonenla abandoned as P�of this ao�7 YES * No
ttWereM mmpwoo Wnped out and ProPgN w1na°1d PWW WAC2W272A-U'd0�! ____. �YES
NO
RECORD DRAWING
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Record Dmwtrtp Attached
CERTIFICATION OF MTALLATION
DESIGNER!ENGINEER
INSTALLER I cat*that the system has been installed in 0000r-
1 at*that I installed dre system In accordance with
the septic daslgn stamped-APPROVEO'by Meson tlerwe wRh the sapHe design stamped"APPROVEL7"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
hero have been tleeredlopproVed by both the designer ahown here have been ctesradrepproved by both
and Mason County Public Health and meet all Stale myself and Mason County Public Health and meet all
and Mason C my Codes. Slets,and Mason County Codes
1 further cefttry Met all udonnadon contained on this
furtherceffay that as(nrametion contoured on MIS form and attached Record Dfawag IS aecurefe.
form end efteched Record Drawlrfc
•l
spneaae IMtaae Daft �4Q
Adrded Name of Slpnee
MASON COUNTY PUBLIC HEALTH
si one
The undersigned approves this Installatlon Report and Or_ DALE L.TAHIA
Rama Drewfry on behal/of Mason County Public ltC SEA CEStGNER
-A
Syytamre ifty H Specialist � (stamp, signature and date)
TWSmRMMAY BE SCANNED PND AVAIUSIE Ft'MPl1eLIG VIEWON THE MASON COUNTY IAEe SITE uoeaae¢o+age
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