HomeMy WebLinkAboutSWG2023-00207 - SWG As-Built - 8/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Permit Number SVVG 2023-00207 Parcel# 42135-50-00025
Applicant Name Rick&Gina Phillips Subdivision (Name/Div/Block/Lot)
Applicant Address 4111 NE 92nd St CLEAR LAKE TRACTS
City, State, Zip Vancouver,WA 98665 Installer Name Failed &Sons Landworks
Site Address 490 W Clear Lake Dr, Shelton Designer Name Arrow Be. tic Designs
INSTALLATION CHECKLIST
Q FUII System hstallafion ❑Tank(s)Only ❑ Drainheld Only ❑ Repo, ❑ Other
System Type Sand-lined Pressure Bed Pretreatment Type
15 ft.from foundation? ---- - - - -- - - -- - - - -" - - " - - " - - ❑ Iv!A AYES ❑ No
>50ft. from wells? -- - - -- - - -- - - - - - - -- - - - - - - - - - El El
Z —
>50ft.from surface water? - - - - - - - - - - - - - - - - - - - - - - - ' ❑ 11
Q Cleanout between building and tank? - - - - - - ------- - - - - ❑
P
O Tank baffles present? - -- - - - - - - - - - - - - - -- - -- - -- " - ❑ ❑-
r 24"access risers over each compartment?-- - ---- --- - - - -- ❑ ® ❑
a ❑ ® ❑
W Effluent filter installed?- --- - - - -- -- - - - - --- - - - - -- - -
W Sound Placement
Septic tank capacity (working) 1,200 gal Manufacturer
O D-box water level and speed levelers used? -- - - - - - - --- - - - ❑ NIA ❑YES No
00 Manifold/D-box accessible from surface?-- - - - - - - - -- - - -- - -
❑ ❑
m- Check valves installed' - -- - - - " - ❑ 9 ❑
�Q 21nch Schedule/Class 40
2 Transport Line Size
Bedrooms installed(check one) ❑ 2 ❑3 X 4 ❑ 5 ❑S ❑Commercial/Other
>10ft. from foundation? -- - - - - - - - - - - - - ---- - - -- - - - ❑ NIA AYES NO
>100N from wells?- - - -- - - - - -- E M1E � _ ❑ ❑
>100 ft. from surface water?---- - - - - - --- - --- - - -
W ❑ ® ❑
M >10 ft.from potable water Imes?----- -��t 3 02074 ❑ ❑ ❑
Q > 5 ft.from property lines and easement - -- -/- y- - - - - - - - ❑ ® ❑
K > 30 ft from downgradient curtain/found ti n drain A71C1J- - - - - - Ellu El
Drainfield level and observation ports or -- !Yi- - - - -- -- ❑ 0 ❑
❑ Graveless chambers or IN Clean gravel used? (check one)
Proper cover Installed over drainfield?- - - - - - - - - -- - - - - - - -- ❑ ® ❑
Pump tank setbacks consistent with septic lank? - - - - --- - - - -- ❑ NIA IN YES ❑ No
Y Pump tank capacity (flood) 1,200 qal Manufacturer Sound Placement
2El
Q 24" access user(s)antl accessible from surface?- - - -- - ---- - - ❑
~ Alarm or Cortrol Panel Installed? - -- - - - - - - - - -- -- - - -- - - ❑
a
`d Control Panel equipped with Timer! ETM /Counter - - - -- - -- - - ❑ � ❑
7
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a Pump Make/Model Liberty FLH61M Floats or ❑ Transducer
a
Tank draw down 2 5/8 in/min Pump capacity 58 gpm Squirt Height 5.6 ft
Pump or,time 1.5 minutes Pump off time 6 hours Daily flow set at 360 gptl
-xs.d__ I re
Mason County OSS Installation Report pg. 2
Parcel# 4 00025
ABANDONMENT RECORD
Were ex sting septic components abandoned as part of this project? - - - - - - - [:I YES
NO
If yes.. please describe.
Were all coaponents pumped out and Properly abandoned per WAG24fi-2]2A-0300
_ _ _ __ _ El NO
� . - �
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 installed the system in accordance with I certify that the system has been installed in accer-
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 shocm here have been cleared/approved by bath
and Mason County Public Health and meet all Stale myself And Mason County Public Health and meet ail
and Mason County Codes. State and Mason County Codes
I further ce.Yity that all information contained on this I scans,certify that all information contained on this
IF agd,ait held Record Drawing is accurate form and attached Record Drawing is accurate-
f�71/l01'l/hLll 7/25/2024
Sigrrelore of Installer Data
Pat Hatten os
Printed Name of Signae
MASON COUNTY PUBLIC HEALTH
The undersigned approves this installation Report and
Record Drav✓ing on behalf of Mason County Public �'QZ .PAULA JOY JOHNEON ;
�/y'r f�CFS61fSEDUiGNEfi"
Health:
B7IYL�/1'if,d0"7 9 /6/Lt, ? - Zf. -Z`f
Signature of En viromnent Healtb Specialist Date (stamp, signature and date)
THIS FORM MAYBE SOANNFD AND AVAILABLE FOR FOBLICbI ,,l ON THE MASON COUNTY lNES S17E
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