HomeMy WebLinkAboutSWG2024-00036 - SWG As-Built - 9/16/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INPORMATION
Permit Number SwG 2024-00036 Parcel # 42204-50-00094
Applicant Name Ron Coone Subdivision (Name/Div/Block/Lot)
Applicant Address 231 Forest Or. Lake Cushman Div. 5 Lot 94
City, State,Zip Bnnnin WA 98320 Installer Name Payton Goos
Site Address N.Mt Jupitor Ct. Designer Name Dale L.Tanis
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other
System Type Sandlined Pressure Bed Pretreatment Type Sand Augmentation
>5 ft.from foundation ---- -- -- ❑ NIA ®YES ❑ NO
>50 ft.from wells? - - � �- ❑ ® El
Z' >50 R from surface w - ❑ ■ ❑
ta- Cleanout between bulif"Ipn�G24- -----------
U Tank batfies present? --" - ❑ ■ ❑
n24" access users ovepnt?--— ❑ ■ ❑
W Effluent filter installed. --- ❑
N. 50 pal Manufacturer ❑
Hegerrnan
Septic tank rapacity(working) 1.250
O D-box water level and speed levelers used? -------------- - EWA ❑YES El me
J ❑
DO Manifold/D-box accessible from surface?--------------� - ❑
mZ Check valves installed? -- ------ -- ----- ❑ ❑
OQ 2-inch Schedule/Class Sch-40
f Transport Line Size
Bedrooms installed(check one) ❑ 2 03 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 fL from foundation?- ___ __________ _ _ _ ___ ___ __- ❑ NIA YES No
>100 ft.from wells?---------------------------- - ❑ ❑
W >100 ft.from surface water?- --- ❑ S El
LL >10ft.from potable water lines?----------- -- -
❑ El
2 > 5 fL from property fines and easements?-_ ______ ______ _- ❑ ® ❑
Q
W > 30 fL from downgradiant curtaintfoundation drains?- - ------- - ❑p El
level and observation ports present ---- -- El�
❑ Graveless chambers or ® Clean grew[used? (check one) ® ❑
Proper cover installed overdreinfiekl?---------- ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ wA YES
NO
Y Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman
Q . 24"access riser(s)and accessible from surface?------------- Cl ® ❑
d Alarm or Control Panel Installed? -- ------ --_-`-
❑ ® ❑
7- Control Panel equipped with Timer I ETM/Counter--------- - -
❑ ❑
fl Pump installed in ❑ Bucket or e On Block or ❑ Other
a Pump MakelModel Liberty 290 ❑ Floats or Transducer
a Tank draw down
2 in/min
capacity 44 gain Squirt Height 10 ft
Pump on time 2.5 min Pump Off time 5 hrs 57.5 min Daily flow set at 270 gpd
uptlNWlw.
Mason County OSS Installation Report pg. 2 Parcel n . 1-
ABANDONMENT RECORD
rW- -...b.�geptic components abandoned as part of this project? -__ _ ___ _______. yes No
escribe:rame pumped out and Properly abandoned par WAC246T72A-0300'7 -______. YES 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 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 cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Heath and meet all
and Mason County Codes. State and Mason County Codes
l further certify that all information contained on this 1 further certify that eft information contained on this
.fomend attechetl Rewrd Drawl g/s rate. f°nn and attached RecordDrawing is accurate.
ignsami of/Installer �! Date
Printed a of ffigrree r d'�a4+�i
MASON COUNTY PUBLIC HEALTH ';rR
The undersigned approves this Installation Report and Sim
Record Drawing on behalf of Mason County Public O"_ _A_LE L. TA_HIA ,
UC D _ SIGNER
E-
Heath:
-
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UPE STIQote
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