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HomeMy WebLinkAboutSWG2024-00298 - SWG As-Built - 9/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00298 Parcel # 12019-75-00020 Applicant Name Maria&Andrew Dosl Subdivision (Name/Div/Block/Lot) Applicant Address 284 Crafts Prairie Rd City, State, Zip Bastrop TX 78602 Installer Name Kevin Smith Site Address 2281 E. Harstine Island Rd Sate! Designer Name Rod Left INSTALLATION CHECKLIST - Ii Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type Standard Gravity P reatment Type >5 ft.from foundation? ----------- - ❑INA AYES ❑ ao >50 ft.from wells? ----------- - `'�---- - ❑ 0 ❑ Y >50 ft.from surface wales? ----- -- D - r]2Q - - ❑ ❑� ❑ HCleanoutbetweenbuildingandtank? - _k-- -------- ❑ ❑� ❑ 0 Tank baffles present? ---------- ------------ ❑ ❑� ❑ f- 24"access risers over each compartment By- ------- ❑ ❑� ❑ W Effluent flier installed?--------------------------- ❑ ® ❑ to Septic tank size 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? --- ------------ ❑ QUA ®Yes NO 00 Manifold/D-box accessible from surface?----------------- ❑ ❑ mZ Check valves installed? ------ ------------ - ❑ ❑ oQ n Transport Line Size 4" Schedule/Class 3034 Bedrooms installed(check one) ®2 ❑3 ❑4 ❑5 [1 6 ❑Commercial/Other >10 ft.fromfoundation?-------------------------- El WA NYes NO >100ft.from wells?----------------------------- ❑ ® ❑ W >100 ft.from surface water?------------------------ E] © ❑ LL >10ft.from potable water lines?---------------------- ❑ Q >5 ft.from property lines and easements?---------------- ❑ ❑ X >30 ft.from downgredient curtain/foundation drains?---------- ❑ ❑ Drainfeltl level and observation ports present -------------- ❑ 0 ❑ ® Gravelial chambers or ❑ Clean gravel used? (check one) Proper cover installed Over drainfield?------------------- ❑ ® ❑ Pump tank setbacks consistant with septic tank?------------- ® WA ❑ YES ❑ NO Y Pump tank size gal Manufacturer _ z 24'access riser(s)antl accessible from surfaoa?------------- ® Li ❑ 9 a Alarm or Control Panel Installed? --------------------- ❑ ❑ E Control Panel equipped with Timer I ETM/Counter----------- e ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or E] Other o- Pump Make/Model ❑ Floats or ❑Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump oftlime Daily flow set at gpd uoaea sa',see i Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENTRECORD Were existing septic components abandoned as part of this project? -- ------------- ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-03007 •---"" ❑ YES ❑ NO RECORD DRAWING ma a.pennaa.m nwm ana mua es.aanro ana e..cnotNe enouan ro aao<n.i.me aem a m.rot«ra.n eowmn m,a maa.tlereloRme,a. Troaa seam o,aro�es oaum. oremmdaamaortoa anemaiansiayom,smarip�mp b�R�osaon.rvann a,�a,.a.arva aremnea.easwyane w.roam w�aNR:.iowcm mwaia,.amn�rea. waa.,oe.eraaon oona.aea.wa.am omm maimenarce acwss p.�na. in�mnim�w:wm oaw�aa.marwam aaaimiw aalap innnaluaanetlon eppmmWam aareep�iu Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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 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. blinaturs of Installer Date 1,�Ie-✓.IA &,f%A Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and R Record Drawing on behalf of Mason County Public M.S. aionRR Health: EXPIRES 12H51 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upamaaerztrmte § k C 0 17 � � « R Iw4RNkD �' 2 i oc \ _ G n : zm , m . .. . . .. . .�sx« sa,�.aw[ 17 ! § $ * \ mm \ \ \ \ \ \ \R „ f | me * c) m 2® ! w ` tam * m § / \ / 29 § g2 2 § 2 ; z ! q O - 2 ® } � k ƒ 2 O ` \ } C ZZ \� [ % 47 \ # rn z : �\ M \ \ } / 'n �\ cn ; « 9) mKCO \Fn \ \ /\ ! / \ ° f 0 O dm 0 2 ) \ $ ! 2@ ` G q\ § ` 2$ ; - § aee \ ( 0 � � r x m | > > " § \ � 0CN e C/) w z = Cl) m § \ ) \ > \ M � 0 § ) o \ m ( - � ( � R7 m f 3342 _ U)_ ! $ / co\ Al, \r a , /� ® � % \ j i O \ k 5 gym" f a 6\ 7io 2 D 2OD