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Home My WebLink AboutSWG2018-00456 - SWG As-Built - 7/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2018-00456 Parcel# 42212-51-04005 Applicant Name Ruth Beavan Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 2146 City, Stale, Zip Belfair,WA 98528 Installer Name T.J. Goos Site Address 24240 US Hwy 101 Hoodsport Designer Name Dale L. Tahia INSTALLATION CHECKLIST ❑ Full System Installation Q Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? _ ❑NIA ®YES ❑ NO >50ft.from wells? -- - - --- - - -- - - - -- - - --- - - --- -- ❑ e ❑ Y >50 ft.from surface water? -- - - - - - -- -- — _- - - - -- ❑ ® ❑ Z -__ _ _ ______ __ _ _ ___. ® ❑ Cleanout between building and tank. ❑ ❑ tl Tank baffles present? - - - -- -- -- -- - - - - ' ❑ a 24"access risers over each compartment?-- - - - - -- -- - - - --_ ❑ W Effluent filter installed?- - - - -- - - - — - — - -- - - - ® ❑ El to Hagerman -traffic rated Septic tank size 1500 _gal Manufacturer O D-box water level and speed levelers used? - - - -- - --- - - - - -- ®NVA ❑YES ❑❑ NO J ❑ ❑ rl 0O Manifold/0-box accessible from surface?- - -- - - - -- - -- -- __: ❑ ❑ mZ Check valves installed? --- -- - - - -— - - - - - - - - -- - - ❑ ca Schedule/Class Se Transport Line Size Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 Commercial/Other >10ft.from foundation?- -- - - - -- - -- —- - - - -- - -- - - -- NIA YES ❑ No >100 ft.from wells?--- --- --- - - - - - - - -- - -- --- - - - -- ❑ ❑❑ ❑ O ❑ J >100 ft.from surface water? -- ----- --- -- - - - - - -- - -- - - W El ❑ ❑ a >10ft.from potable water lines?-- - - - - - - - ----- - - - - - - -- ❑ ❑ > 5ft.from property lines and easements?-- - -- -- - - - - - - --" ❑ ❑ > 30 ft.from downgradient curtain/foundation drains? -- - - - - -- -- ❑ ❑ ❑ Drainfield level and observation ports present - - -- - - - - - - - -- - ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) El El cover installed over drainfield?- - ----- - - - - ---- -- - ❑ Pump tank setbacks consistent with septic tank?--- - --- - -- --- ❑ NIA ❑ YES ❑ NO Y Pump tank size 1 500 pal Manufacturer Hagerman-traffic rated 2 ❑ Q 24" access dser(s)and accessible from surface?---- - - - ---- - - ❑❑ O ❑ ~ Alarm or Control Panel Installed? - - ---- - - - - --- - - --- - - Il ® ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter- - - - - - - - - -- M Holding Tank a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 03 0- ❑ Floats or ❑ Transducer t 6 0 0- Pump Make/Model ; f M 6=. in/min Pump capacity gpm Squirt Height ft a Tank draw down r Dail flow set at r Pd > Pump on time Pump of time y 1 1 r Mason County OSS Installation Report pg. 2 Parcel a 42212-51-04005 ABANDONMENT RECORD ❑ Were existing septic components abandoned as part of this project --- - --- -- - - --- - Q YES NO If yes, pleas describe: Old septic tank was abandoned Were all components pumped out and property abandoned per WAC246272A-03009 - ---- - -- YES ❑ NO RECORD DRAWING Tide Is .p.rmanam score and must ow accurate and descriptive enough m remcat.In me need m mmmeoaom actmmes and future dawleement Typical Record Dravengs mntein: Dminflald 8 manlrop onommod,syout Soodpi mp tank lomtion,NwN ammx,resmva drainflNd,etlgin9 and propo[e!Wlldnga,loadm NwMa.'.vatadwas, was,asservmbn pme,dmnouts,and Wnermantenznm acrosa xame, Immnwase RewN Dmaings may seem ad6dWl units In final translation daptoval and related Permits. Record Drawing Attached NALAOOCERTIFICATIONFS N INSTALLER DESIGNER/ENGINEER 1 certify that I 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 cleared/appro✓ed by both the designer shown here have been cleared/approved 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 1 further certify that all information contained on this I further certify that all information contained on this form and attache Re�wing is accurate. form and attached Record Drawing is accurate. )'-21-/1 Signature of Installer Date DPW TP 'T S ZTOCS Printed Name of Signee s MASON COUNTY PUBLI7HEALTH 51'rr >_14The undersigned approvetion Report and 2' DALE L. TRecord Drawing on behalunty Public " p �pESIGNER Healthr�� ] 17.�� EXPiriEi: 111\g--�m• / / I � � /Signature ofEnvironmentalst Date (stamp, signature and date) uPdat.d srztrzpta THIS FORM MAY BE SCANNED AND AVAIL EW ABLE FOR PUBLIC VI ON THE MASON COUNTY WEB SITE r r $ rz;g C Z,5 VAV 01 EEI O I O I5k IQ I APPRQVED - \ JUL 1112024 L MASON COUNTY ENVIRONMENTALREALTR . 1 REt 5)