HomeMy WebLinkAboutSWG2023-00266 - SWG As-Built - 7/1/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT] PERMIT INFORMATION
Permit Number SwG Z O 2 32024-22-90011
Applicant Name Fal n Austin p24u &ion (Name/Div/Block/Lot)
Applicant Address 200245th St Ct JUN 2
City, State, Zip Gig Harbor,WA g 5 Installe Name Josh Peterson
Site Address 101 E. Lizzy Lane, eslgner Name Rod Left
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Oscar X02 Pretreatment Type
>5 ft.from Foundation? --------------------------- ❑raA ■YES E] NO
>50 ft.from wells? ----------------------------- ❑ 0 ❑
Y >50ft.from surface water? -- ---------------------- ❑ x ❑
Z
HCleanout between building and tank? ------ ❑ ❑M ❑
O Tank battles present? --------------------------- ❑ ■ ❑
a 24'access risers over each compartment?---------------- ❑ 0 El
W Effluent fitter installed?---- -------------- ❑ ■ ❑
to
Septic tank size 1500 pal Manufacturer Hagerman
0 D-box water level and speed levelers used? --------------- ■ Nu ❑YES E] NO
0J
0 Manifold/D-box accessible from surface?-- --- 0 ❑ ❑
q°Z Check valves installed? ----- --- ■ ❑ ❑
GQ
� Transport Line Size WA Schedule/Class N/A
Bedrooms installed(check one) ❑2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?-------------------------- ❑ WA DYES ❑ NO
>100 ft.from wells?----------------- ❑ ■ ❑
J >100 ft.from surface water?------------------------ ❑ ® ❑
W
u- >10 ft.from potable water lines?---------------------- ❑ ❑� ❑
Z >5 ft.from property lines and easemenis?---------------- ❑ x ❑
W >30 ft.from downgradientcurtain/foundation drains?---------- ❑ ■ ❑
Drainfield level and observation ports present ----- ❑ ■ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?------------------- ❑ ■ ❑
Pump tank setbacks consistent with septic tank?----- ❑ WA ■ YES ❑ No
Y Pump tank size 1000 at Manufacturer Hagerman
Q24"access risen(s)and accessible from surface?------------- ❑ ■ ❑
aAlarm or Control Panel Installed? ------------ --------- ❑ 0 ❑
Control Panel equipped with Timer I ETM/Counter----------- ❑ ■ ❑
a Pump installed in E Bucket or ❑ On Block or ❑ Other
a Pump Make/Model AY McDonald/2205OE2AJ ■ Floats or ❑Transducer
E
a
Tank draw down 7/8 in/min Pump capacity 20 ppm Squirt Height NA ft
Pump on time 22sec Pump off time 3:38 Daily flaw set at 4WO glad
1111— nms
Mason County OSS Installation Report pg..2
Parcel#
ABANDONMENT RECORD ❑ No
'ect7 .- "- '-- ""-'- YES
Were existing septic components abandoned as part of this prof
If yes,pleas.describe: 11 YES NO
were it components pumped out and.properly abandoned per WAC246272A•03007 • -- - ' '-'
RECORD DRAWING
.ea oYmme,wauen or wend wYemnee.
mb a.pwmene,rt nmN M,tl nxnl W eacu,eM entl dwcriDiNe stank to ry1NG in 1M 4'end e 6 epNry e�Fntl fNen neMepneeE Typrai RecoN
lank kcanon,NaM anew, YeM rYaletl DennNe..
maian P
Diewi,N pea.
an r BnynndtlpFYa6PnyFyoN,eepai ua lnc PHle Rewrtl cn`*n` ematcreel.NdlboNl tlelsyeFMel FeleneYkR ePP°•
wda, da e.ewY+.emansmemleuna exeu w
Record Drawing Attached
CERTIFICATION OF INSTALLATION
DESIGNER)ENGINEER
INSTALLER I earthy that the system has been installed In 8000r-
1 certify that 1 installed the system in accordance with
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
shown here have been cleamd/appmved by both
here have bean cleared/approved by both the designer mysetf and Mason County Public Health and meet all
and Mason County Public Health and meet 80 State State and Mason County Codes
and Mason County Codes. 1 further certify that all information contained on this
I further certify that all information contained on this form and attached Record Drawing is accurab'L
form and a had Record Drawing is accurate.
5 ?
5'l9n oflnstailer
Da e
\ S
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Me.R e.eR
Record Drawing on behaN of Mason County Public UF1REe tzrest
• Heal�tthN ��Q� 1 I ) k I
" "' ' (stamp,signature and date)
reture orEnviroa ntal Health SPeGalist Date uonY.Dem�zP,e
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIeN ON THE MASON COUNTY WEB SITE
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