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Home My WebLink AboutSWG2024-00022 - SWG As-Built - 6/26/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLI ALTH APPLICANT/ PERMIT INFORMATION c Permit Number SWG 2024-00022 Parcel# 12207-75-00510 4Applicant Name Name JUAN RIVERA Subdivision (Name/Div/Block/Lot) � F Applicant Address PO BOX 1326 City, State, Zip BELFAIR,WA. 98528 Installer Name SCHOENING EXCAV G Site Address 1952 E RASOR RD Designer Name CINDY WAITE INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑Other System Type PRESSURE DIST Pretreatment Type >5 ft. from foundation? - - ---- - ❑ NIA ®YES ❑ NO >50 ft. from wells? -------- ❑ ❑ _ >60ft. from surface water? -- - - - - - - - ------ - ❑ IN ❑ HCleanout between building and tank? - -- - - -- - --- - - - - - - -_ ❑ ® ❑ U Tank baffles present? - - - - - -- - --- - ❑ ® ❑ a24"access risers over each compartment?- - - - - - - -- -- ----- ❑ ® ❑ N Effluent filter installed?- - - . ❑ 11 ® ❑ Septic tank capacity (working) 12, gal Manufacturer v. . i �O D-box water level and speed levelers used? E NIA ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ ® ❑ OQZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ Se Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑ 2 E 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - - - - - - ❑ NIA EYES El No p >100 ft. from wells? - ❑ E ❑ W >100 ft. from surface water? - - -- - -- - -- - E] ® ❑ W >10 ft. from potable water lines?- -- -- -- --- - ❑ E ❑ Z > 5ft. from property lines and easements?- - - -- - - ---- ---- - ❑ ❑ > 30ft. from downgradient curtain/foundation drains?-- ------ - - e ❑ ❑ Drainfield level and observation ports present - - - - - ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? ❑ E ❑ Pump tank setbacks consistent with septic tank?---- - - - - - ---- ❑ NIA E YES ❑ NO ZPump tank capacity(flood) /aJi-U at Manufacturer �11 �F . „, .,_ 24"access riser(s)and accessible from surface?- ❑ ® El Alarm or Control Panel Installed? - - - - - - - - - -- - - - - - - - - - - Control Panel equipped with Timer/ETM/Counter - ❑ E ❑ IL Pump installed in ❑ Bucket or 0 On Block or ❑ Other d Pump Make/Model L b�,,/„ ��?j ❑ Floats or E Transducer � I d Tank draw down 1, "!,� in Pump capacity gpm Squirt Height N I ft Pump on time / ,2 ,,u Pump off time 4AO Daily flow set at pd Mason County OSS Installation Report pg. 2 Parcel# 12207-75-00510 ABANDONMENT RECORD ry.. pl, .. eptic components abandoned as part of this project? -- - - - - - - - -- - - -. YES ® NO scribe: ents pumped out and property abandoned per WAC246-272A-0300? - - - - - - - - YES NO RECORD DRAWING This b e permamnr--did am must be ecaurM and Encnpllve enough W nN.M.In am need er maintenance seuvil and ruWre development Typical RmoN WexMgawnbin Om mld&menibldomnl nBlry tSeplldpumpInkbttim,None al adus"dremf Id,evidleneM pmpnM buildings,loulimdensils,wtalnn, wells,obNNHoalq n p rJeenMe,and aner na inlmnu dirges pains InwMOWGRecord creel may tmssft addHlmal dens n fNel Inedellelbn apponl am needed parl NU QeJ'r 0A✓ 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER I certify that I installed the system in accordance with I 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/approved 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 I further certify that all information contained on this I further certify that all information contained on this form/and daattttached Record Drawing is accurate, form and attached Record Drawing is accurate. ley-) � .•j Z4 Signatu of installer Date Printed Name o/Signee ' 1 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and s' rs G . CIND WAIT E� Record Drawing on behalf of Mason County Public ucENsm DEsICNER Health: Signa ure ofEnvironm ntal Health Specialist Date (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated e21i2®8 Y 93 M C pp CMCS CC6 S �N �j 4 m 9 0 .22 O O O a m oimo, a m x C C C $+ mm W OI yyCpp Z' � � C CC R N $a = p W x� RN N . 'C W W C� Z .- .- N 10' y W QU � R t v@�o� y spy �y w�oao n ®•. Z- toad v o APPROVED rN ti, j, JUN 26 2024 3 Ear Rasp, = h MASON COUNTY ENVIRONMENTAL HEALTH f 6� �➢ RET 3• 3 61 x Glear du 0,6d AIV k-0 V E n MAR 0 5 2024 Lf MASONCOJNTYENWRON''JENT,l HrW,l j JBW 1 F�w,p CRa.� Cp1DY F.BEppQ&ONsim LICEN FII G// � CRWIfS LLY16 Nark IaJe�lr SoK/� ". Y COGyryFI�6I011,�4C) Qay,Nd r.d