HomeMy WebLinkAboutSWG2023-00518 - SWG As-Built - 9/9/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLI EALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2023-00518 Parcel# 42216-52-00093
Applicant Name Michael Leo Arndt Subdivision (Name/Div/Block/Lot) ♦♦♦ y v�
Applicant Address 31755 Rancho California Rd. Lake Cushman Div. 12 LOW
♦
City, State, Zip Temecula, CA 92592 Installer Name T.J. Goos
Site Address 61 N. Kingsway S.,HoodsPort Designer Name Dale L.Tahla
INSTALLATION CHECKLIST
❑ Full System InstaKabon E Tank(a)Ordy ❑DraiM'iekl Only ❑Repair ❑Other
System Type RV Holding Tank Pretreatment Type
>5fL from foundation? --------------------------- El WA Eves ❑ No
>50ft.from wells? ------------------------------ ❑ e ❑
2 >50fL from surface water7 ------------------------ ❑ E El
FCleanout between building and tank? ------------------- ElEl®
tl - Tank baffles present? --- --- --------------------- ❑ E ElF- 24"access risers over each compartment?•------ ❑
WEffluent filter installed?- ------------------------- - E ❑ ❑
N Hagerman
Septic tank capacity(working) 1.250 pal manufacturer
O D-box water level and speed levelers used? -------------- - ❑ WA ❑Y ❑ No
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O Manifold/0-box accessible from surface?---------------- - ❑ ❑ ❑
mZ Check valves installed? - -- ----------------------- ❑ ❑ ❑
G Transport Line Size SchOdu
Bedrooms installed (check one) ❑2 ❑3 ❑4 ❑5 ❑6 ❑CWWnerddlO*W
>10 ft.from foundation?-------------------------- ❑ NA ❑YES NO
>100 ft.from"Its?----------------------------- ❑ ❑ ❑
W >100 ft.from surface"ter?----------------------- - ❑ ❑ ❑
LL >10ft.from potable water lines?--------------------- - ❑ ❑ ❑
Za >5ft.from property lines and easements?---------------- ❑ ❑ ❑
0� >30 it.from downgrat lent curtain/foundation drains?---------. ❑ ❑ ❑
G Drainfield level and observation ports present -------------- ❑ ❑ ❑
❑ Greveless chambers or ❑ Clean gravel used? (dledk One)
Proper cover installed over dreinfield?---- - -------------- ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ WA ❑ vEs ❑ NO
Y Pump tank capacity(flood) gal Manufacturer
24"access riser(s)and accessible from surface?------------- ❑ ❑ ❑
~ Alarm or Control PanelInstalled? -------------------- - ❑ ❑
Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ aV` ❑
7
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
ZPump Make/Model ❑ Floets or ❑Transducer
6 Tank draw down in/min Pump capacity Opm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
upeme.'.0
Umon County OSS In WWtIon Report p8. Y Pmcd Y
AgMWDON RECORD
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Record Drew ft Attached
=Code&
ERTIFICATION OF INSTA"TION
DeswNeru ENGOMM
1 nr�ned the system in ecaordance wnh I cattily that the g2fam has been hrstaned In socon
aiQrt eta APPROVED'by Macon derrca wNn(ha agoaadsayn amrnped APPROi/ED'by
nc HedM and Mat any davistions shown Aram Ocuny p�i, a and that any deviations
een deaaduapproved by both the designer W*Wm hem have been deared Wmved by boM
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MASON COUNTY PUBLIC HEALTH r -
The unders�red 8 �dug InstaNetlon Repot and 51002
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Record Dnaha6p - LICENSED DESIGNNNNNNEEEEEERRRRRR
Health:
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L �TAHIA _
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APPROVED
�^ SEP 10 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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