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Home My WebLink AboutSWG2024-00132 - SWG As-Built - 8/21/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2024-00132 Parcel# 22007-51-00060 Applicant Name Mark Carter Subdivision (Name/Div/Block/Lot) Applicant Address 4623 77th Ave Ct W TIMBERLAKE#8 TR 60 City, State,Zip University Place WA 98466 Installer Name Mark Carter-owner Site Address 90 E Tahuya Or,Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Greedy Bed Pretreatment Type >5ft.from foundation? ------------------ --------- ❑WA AYES E] NO >50ft.from wells? ----------------------------- ❑ ❑ Z >50ft.from surface water? ----------------------- ❑ ❑ Q Cleanout between building and tank? ------------------- ❑ ❑ ~ ❑ ® ❑ C1 Tank baffles Present? ---------------- --" ---'-- r 24' access risers over each compartment?----------------Q. ❑ ❑ W Effluent filter installed?--------------------------- ❑ ® ❑ rn Hagerman Septic tank capacity(working) 1.000 pal Manufacturer O D-box water level and speed levelers used? --------------- ❑ WA ®YES NO �J DO Manifold/D-box accessible fromsurface?------------ ----- ❑ e g]Z Check valves installed? -------------------------- ❑ ❑ OQ 2 Transport Line Size 4 inch Schedule/Class 3034 Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?---------------- w ❑ WA ■YES ❑ NO >100ft.from wells?---------- _� a /p� ❑ w >100%from surfacewate(7------------- ---A-I,'�(��- �ITT�=JJ E ❑ aL >70 ft.from potable water lines?---------- - --"�1T1-� ❑ 2 _ q ® ❑ >5ft.from property lines and easements?---- rOUNiV tY > 30 ft.from downgradient curtain/foundation drains?------ Eyl'1RDNUN7A(NE4Li ® ❑ O Dreinfieltl level and observation ports present -- -- ------�W❑ Ng ❑ ❑ Graveless chambers or E Clean gravel used? (check one) Proper cover installed over drainfield?---- --------------- ❑ ® ❑ tank setbacks consistent with septic tank?------------- ❑ WA ❑ YES NO `S Pump tank ca food) pal Manufacturer 213 r 24"access risers)and a Is from surface?-------- -- ❑ d Alarm or Control Panel Installed? -- ------------' 2Control Panel equipped with Timer/ETM/Coun - - ------ ❑ ❑ ❑ 7 ❑ a Pump installed in ❑ Bucket or ock or p_ Pump Make/Model ❑ Flo r ❑ Transducer 0. Tank draw In/min Pump capacity gpm Squirt Height ft a mp on time Pump off time Daily flow set at IlpleW Vf,YeDiB s coo6o Parcel k Mason County OSS Installation ReABANDONMENT RECORD NO Were existing septic components abandoned as part of this project'r If yes, please describe: YEa NO Were all components pumped out and property abandoned per WAC246-2T2A-0300? -- - ---- - RECORD DRAWING Tna la a yam-am"ncdN and mum O,m, un a and asaadw ,ms t m ra.wun In Na ma=m m.imarun=e acpvidu sN pu�a'mp:.IW Wn dwe9s.waterlines, piwnnya ymtan pnlmI.s m.n.one,.n a lry ,.SePWWmP unx louden.N=T arrow.r�tK dnln atlYEMa detri nnMelmsa9ngn appm amnW�ed pannns. walla.a,mam pPa. aamm u.and=Ner mamanan.x a a Pdmrs. InaanNne Remrd Drvnn mq data .See A AUG 2 1 2024 MASON COUNTY ENVIRONMENTAL HEALTH J13W Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER I certify that I installed the system in accordance with 1 certiry that the system has been installed in the septc design stamped'APPROVED°by Meson dance with the septic design stamped'APPROVED'by VE 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 State and Mason County Codas Health and meet all and Mason County Codes. 1 further certify that all Of, ti contained on this f frm and attachedtRecord Drawing is accurte.this to a ch Rn i is accurate. ig ture o Installer Date MAori CHKrER a Printed Name of SIgnee i MASON COUNTY PUBLIC HEALTHL The undersigned approves this Installation Report '7 FAUTA JOY 10NNSON''. Record Drawing on behalf of Mason County Public " �11 EXPIRES � B - i�-z�F(stamp, signature and date) aN Envirnmental Health Specialist Date THIS FORM MAV BE SCANNEW ON THE MASON COUNTY WEB SITE WA-TFR �C SOM-t Xf-5Q, 0 5 Se 45 W a 8 L) J 1` Mrt2k ARITERI- a� anw PRR E,-i�'2��1��1-OOOIYO \t ao E -168uvA Lk SHEO ' 9 IS' sod<� aged o / I L 'Co I j \\ '� wij'�n^b S d � "!;. y V \ CCPa(fi �,oUSL� o �f 17�q'":Sy�yacK Max i 15G'wctlan# Sctlottct� \ 2os,54� 201.93 �51 New. c OClemnout O2 1,000 Gallon Septic Tank . 2-Comparbrent with Effluent Filter >.. ® D-Box with speed-Ievei0.*5 RO'� „PpULA JOY JONNSON'•. . YC S and cover to sw-face A� Mp5pNC0UNTV J�B�NMENTpIHEALTN g -('f- y�