HomeMy WebLinkAboutSWG2024-00300 - SWG As-Built - 8/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00300 Parcel # 42333-51-02916
Applicant Name Stuan&Carol Vannerson Subdivision (Name/Div/Block/Lot)
Applicant Address 4033 Foxhall Dr NE
City, State, Zip Olympia, Wa, 98516 Installer Name Schoening Excavating LLC
Site Address 5787 N Lake Cushman Rd Designer Name N/A
INSTALLATION CHECKLIST
❑ Full System Installation N Tank(s)Only ❑ Drainfield Only Repair ❑Other
System Type Gravity/Conventional Pretreatment Type
>5ft. from foundation? - - - - - - -- - -- - - - - - - -- - - - -- - -- ❑ NIA YES NO
>50ft. from wells? --- - - -- -- - - - -- - -- -- -- - -- - -- - - ❑ e ❑
2 >50ft. from surface water? -- - - - - - - - - - - - - - - - - - - - - --
❑ ❑
- Cleanout between building and tank? - - - - - - - - -- -- -- - - - -- ❑Fm
❑
V Tank baffles present? - - - - - - - - - - - - - - - - - - - - - -- - - - - ❑ ■ ❑
C 24"access risers over each compartment?- - _ _ _ _ _ _ _ _ _ _ _ _ _ - ❑ ■ ❑
NEffluent filter installed?- _ _ __ __ __ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ - ❑ ■ ❑
Septic tank capacity (working) 1060 gal Manufacturer Infiltrator
�o D-box water level and speed levelers used? -- - - - - - -- - - - -- - NIA ❑ res NO
DO Manifold/D-box accessible from surface?-- - - - - - -- -- - - - - - - ® ElCQ Check valves installed? -- - - - - - - _ _ _ _ _ _. ® ❑ El
❑
S f Transport Line Size 4" Schedule/Class
3
s° Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - - - - - - - - - - - - - - - - -- - - -- ❑ WA � vEs ❑ No
>100 ft. from wells?- - - ❑ ❑
F W >100 ft.from surface water? - - - - - - - - - -- - - - -- - - -- - - - - ❑ ® El
j M >10ft.from potable water lines?-- - - - -- - -- - - - - - -- - -- - . El ■ ❑k Z > 5ft.from property lines and easements?- - - - - - --- - - - - - -- ❑ ® ❑
1
> 30 ft.from tlowngradien[curtainRountlation drains? - - - - - - - - - - ❑ ® ❑
Drainfeld level and observation ports present - - - - e ❑ ❑
o ❑ Graveless chambers or E Clean gravel used? (check one)
WProper cover installed over drainfield?- - -- - - - - - - -- -- -- --- ❑ ❑
Pump tank setbacks consistent with septic tank? - -- - -------- - ENIA ❑ YES ❑ NO
ZPump tank capacity (flood) gal Manufacturer
Q 24"access dser(s)and accessible from surface?- - - - - -- -- -- -- ❑ ❑
CAlarm or Control Panel Installed? - - - - - - - - - - - -- - -- -- -- - ❑ ❑
2 Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - -
IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
d Pump Make/Model
� P ❑ Floats or ❑ Transducer
CTank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
UN..amrzore
Mason County OSS Installation Report pg. 2 Parcel a 42333-51-02916
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- - - - - - - --- - - -- ® YES NO
If yes, please describe:Existing septic tank was cracked.
Were all components pumped out and property abandoned per WAC246-272A-0300? -- -- -- -- Q YES NO
RECORD DRAWING
This Is a paemansid nteN and mint In aem,M and demo s m.soups to rHxale In IM naad er maaNmllca 41 tl 1966 and fNun Uawlapnnnl Typical Ra-ptl
Dmrviys mnlain'. DalnfieM 8 menil0ltl anenlatlm S I6yout Seel'1W�nD lank locelun,NOM enmv,reserve dninPeld eahlltp ard pngpatl bu9dlnpa kxac.n MdsId.,dd Ine9,
walls,obeervelpn pxb,usMWts,and olM1al mainWmrm access p arM. Inmmp we R M Dm Ns may ueale WdN fti delays in final ine can appmvel aN n'aletl FemIN.
Exttltrwy 1V6%Vtgie1a is w o\k ary wttl 4,4yk o� uvhywNva 9;7A. QYcria"s
`ptptr}g 4,4t J0,6} 6� MyVatu\ oftv a" q} irW"$ \"Y"•
pvto'u -.4A SFrY 'Am— a % " o� d.Yacvr la. s6•b-2o2¢
E Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/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 deared/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
attached Record Drawing is accurate. form and attached Record Drawing is accurate.
T1l 8-6-2024
Signature of Installer Date
Bravelen Schoening
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
21D� rvo`�
Signature of Environments Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upeem enlrzme
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TOPOGRAPHY PROFILE:
it
D"action
: Scale: rorrceu
3uiltling Permit number' Building: _-
�wnerfApPlicanC _ _ ___ Date of
Planning: _.
a Env. Heallh:
'arcel Number: