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HomeMy WebLinkAboutSWG2024-00332 - SWG As-Built - 9/18/2024 Son County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number _SWG 2024-00332' Parcel# 22007-51-00052' Applicant Name TERRANCE ANTHONY Subdivision (Name/Div/BlocklLot) Applicant Address 2532 NE 32NO CT City, State, Zip PORTLAND OR 97212 Installer Name MASON COUNTY SEPTIC Site Address 1500 E TIMBERLAKES EAST DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s) Only ❑ Drainfeld Only 0 Repair ❑Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - -- - - - -- - -- - - - - - - - -- - - - - - - - ❑ NIA ®YES ❑ NO >50ft. from wells? - -- - - - - - - - - - - - -- - - - - --- - - - -- - El © El_ >50ft. from surface water? - - - - - - - -- - - - - - - - - - - - - -- ❑ ® ❑ HCleanout between building and tank? - - - -- - - - - - - -- - - - - - - ❑ ® ❑ t) Tank baffles present? - - - - -- - - - - - - - - - - - - - -- - - -- - - ❑ ® ❑ a 24"access risers over each compartment?- - - - -- - - -- - -- - -- ❑ ❑ WEffluent filter installed?-- - - - - - ��- - - - - - - - - -- - ❑ ❑ Septic tank capacity (working) EXISTING gal Manufacturer 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ® NIA ❑YES ❑ NO OJ LL ManifoldlD-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ 1:?Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ oa 2 Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) 92 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- - - -- - -- - - - - - - - - - - - - - - - -- ' ❑ NIA ® Yes ❑ No >100 ft.from wells? - -- - - - - - - - - - -- - - - - - - - - - - - - - - - ❑ ® ❑ W >100 ft. from surface water? - - -- -- - -- - - -- - -- -- - - - - -- El u- >10ft.from potable water lines?- - - - - - - - - - - - - -- - - - - - - - ❑ m ❑ Z > 5ft. from property lines and easements?- -- - - - - - - - - - - - - - ❑ B ❑ > 30 ft.from downgradient curtain/foundation drains? -- - - - - - - - - ® ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ 0 ❑ ❑ Graveless chambers or o Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - - -- - - - -- - - - - -- ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - -- ❑ MA ® YES ❑ No Z Pump tank capacity (flood) 1200 gal Manufacturer HAGERMAN a 24"access riser(s) and accessible from surface?-- - - - -- - - - - - - ❑ ® ❑ ~ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - -- - - ❑ 0 ❑ a ❑ � Control Panel equipped with Timer/ETM I - - - - - - - - - - - 0- - - ❑ a_ Pump installed in ❑ Bucket or M On Block or ❑ Other rl Pump Make/Model 15D SOL PUMP Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 54 gprn Squill Height 10 ft Pump on time .8 MIN Pump off time 8N HOURS Daily flow set at 180 gpd upaame erzvzme Mason County OSS Installation Report pg. 2 Parcel# 22007-51-00052' ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - -- - - - - - - _ _ _- ❑ YES O NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - -- - - -- - ❑ YES ❑ NO RECORD DRAWING Thia Is a pemmma mcond and must Ee*mutate and da.,imY.enough to re-Iocete In IM nasd or ima deoance sssvalse and rutum devslepmsnt Tymcsl Rev m Dram Is cxaam: Dmi nNn&mendald marmadn&arxA sepidpumpmnk bmllm,Norb snow,reserve dmmmini,exanng and pmp wd Wikings,bcnbn 0 wells,uvinlimm walls,abmvelian pods,cbmmb,entl abm msmmnmm er<ee6 pdMs. Inwmpble Remld Dmwinps meY«sore BdtlXunel dtlaY9ln float h618118M1an eppmVal Bnd mltletl perm113. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 1 further certify that all information contained on this form an attached Record Drawing is accurate form and attached Record Drawing is accurate. Signature of lnsnfa Date hQ (1 �a/ K vK ,w �r �tj'✓ I Printed Names a of Name �Be� MASON COUNTY PUBLIC HEALTH � 5iW41 .\ LINDY E WAI The undersigned approves this Installation Report and tICENSEDDESIONEa Record Drawing on behatl of Mason County Public e.n pts W,Iry Health: C, an Signature of Environmental Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updm.d Nztrzpla Y3Ozd � e ' e r -c7 V 01 Oi A W N -� 4 v e 0 f IWD a N N (n 7 0 O. @ 0 01 f0 O j • {ry ;°•O. .Z .C. C N 1 1.' ./ �..r �,• �'I .J �'! w k' i 1 0 G7 1 t l y --IMD O Ol C [ (D 9 N N a 3 _ O O N 7 x 7 N N U -tw,w i r APPROIV a SEP 1 $`20 Qw MASON COUNTY ENAR ENTAL HEALTH RE 1 r reIII v t 5 - . A P N , Q JV 10 tNpD W n � LICENSEO OE01 ,M• I 1