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HomeMy WebLinkAboutSWG2022-00403 - SWG As-Built - 6/27/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SwG 2022-00403 Parcel# 32235-43-90162 Applicant Name Phillip Simons Subdivision(Name/D'((ppB M) Applicant Address 300 E.91h Ave Apt 1-303 V City, State, Zip Moses, Lake 98837 Installer Name Pa Is Z�Z Site Address 1290 E.Timber Tides Dr, Union,W, Designer Name ad L INSTALLATION CHECKLIST BY 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type --- >5 ft.from foundation? ------------------ El WA AYES E] NO � >50ft.from wells? ---- ------------------------. ❑ 0 ❑ Y >50ft.from surface water? ------------------------ ❑ Z HCleanout between building and tank? ------------------- ] `l7 ❑ 'J'. V '.Tank baffles present? --------------------------- ❑ ❑ a' a 24"access risers over each compartment?---------------- ❑ p ❑ IL Effluent filter installed?----------------- ---------- ❑ ❑ N Septic tank size 1250 gal Manufacturer Hagerman 1 O D-box water level and speed levelers used? --- ------------ ❑ WA MYES E] NO 00 Manifold/D-box accessible from surface?----------- -- ---- ❑ ® ❑ Yyj F� mZ Check valves installed? -- ---------------- - - ----- N ❑ ❑ OQ 2 Transport Line Size 4" Schedule/Class 3034 ' Bedrooms installed(check one) ❑2 ❑3 X 4 ❑5 ❑6 ❑Commercial/Other F ' >10ft.from foundation?-- ------------------------ ❑ NIA YES NO 0 >100 ft.from wells?---------------------------- 0 ❑ W >100 ft.from surface wateR-----------------------. ❑ `/ LL >10 ft.from potable water lines?---------------------- [��]® ❑ QZ >5ft.from property lines and easements?--------------- ly'�I� ❑� 1-1K >30ft.from downgradienl curtainRoundation drains?---------- Vy ❑ Drainfield level and observation ports present -------------- ❑ ❑ Graveless chambers or K Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?--- N NIA El we ❑ No Y Pump tank size at Manufacturer Q24"access riser(s)and accessible from surface? - ❑ ❑ ❑ H � a Alann or Control Panel Installed? --------------------- ❑ ❑ ❑ Control Panel equipped with Timer I ETM/Counter--- -------- ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑Floats or ❑ Transducer a Tank draw down in/min Pump capacity span Squirt Height ft Pump on time Pump off time Daily flow set at gpd uie erzi Mason County OSS Installation Report pg. 2 Parcel# 32235-43-90162 _ ABANDONMENTRECORD T 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-MOO? `----` El YES ❑ NO r,.REC.ORD.URAWING;` a t This is a permanent record and must de accurate and d1"eipM*anauph b r9aaoate In Me neeC ofmahlanana aetividn and fdive(IM16paeN, lypkal aaend or., Wigs contain: orainr.:m a man*ma a enWlbn a layout Saptltlpumpbnabcerpn;NaM anoM,r®ervedrelneeltl.e+t wp�ardpropoeed Mditllrge.beadmavelb;wAenu�es weE;oesnrcadm oonc waroucs.aaaan;er malntme�a�uao'ma. lrnvmpleb PicoA orewxma^urwmmmaw.l a.l»+Aanal m.enaroey4'aw.wrsleraa apmiq: 1 El 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 deeredlapproved 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 I further certify that all information contained on this f and attached Record Drawing isaccurate. form and attached Record Drawing is accurate. Signature oflnsteher Date PAM M BUSEK Printed Name of Signs g"e MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public r °i L5EH9E eNER Health: EXPIRES 121151Zq Signature:ofEnvinernmeIldial Health Specialist Data (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upew arzirzma . r a D O O Z a D D m m fin z -I O Oc 3 m m T m F D o r OD A A Z G mo N m o A O K F O O N 9 z lv N y0> z m Z m m m m O m m o y N O r 00 Z N f p N D O m m y O ---- „�------R---------,00'S9i- D z A m D A _ sc VOS, ImD -1 c x m - ________--im------------------ _ A O a) Z m Z timmZZp O lJid m y G) O 6d�N I&� m � D z x z -< Z - H 'Ho 'a C) MnI o y A z =r VJ al r : O F m� ! 3na3s3a Z D D r m Z �'1 %ool. ;0� p O D O m -ZI Zm �iii �m� G] Z 7D.I T 0 �� O p D N m 3 �� ij m Z m O r 'OI r m Gr) Z �Z ]7 D O m ,m, O A m A C � i O m m o o P p m —{C � m n mo 0 In� 1N�3 3$V3 O m m= 8�111 lip AI. � Z `m lry3 3jV3 Z qui ILLP a m 3snOH ae-v OOO w! n II II N' do in r r I I I I , m K Z rooW G) Or In m m OC m D p C Z ., -.. l Wol a p LDI n p CN y 3 z D a m /J x /. cn y--1 Z y v m X > Di n m o m m 1 D a r• I _C m A o o m w N =1 N A co z N C I m °' O m o � 0CDom Qo m N A - ---------- ----------— ——— —------- --- -- --- ----- ---------------`_ - W y 0 v -- --- ------ y---------------- I-- -- -------"' ------------ m 3niba s301l 832INU 3 C D QQ €€ o m o m Owi m A R7 % 9 C') 0) i nk . .• v CO W Ill N y 91 Io l 3� 3I a� 0