HomeMy WebLinkAboutSWG2024-00171 - SWG As-Built - 9/25/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00171 Parcel R 52006-50-00006
Applicant Name Dave Walker Subdivision (Name/Div/Block/Lot)
Applicant Address 12015 Marine Dr
City, State,Zip Tulakp We 98271-9306 Installer Name Bryan's Ezcavatinn
Site Address 110 W Marrows Ln Designer Name Eric Russell
INSTALLATION CHECKLIST
Fula System Inst3llaEon ❑Tarik(s)0nY ❑Dre ntwld only ❑Repair ❑Omar
System Type Standard Pressure Pretreatment Type
>S R.from foundation? --------------------------- ❑NIA EYES ❑ NO
>50ft.from wells? ------------------------------ ❑ ❑
2 >50ft.from surface wateR .----------------------- ❑ ❑
f Cleanout between Wilding and tank? ------------------- ❑ ❑ ❑
V Tank baffles present? --------------------------- ❑ ❑
24"access dsers over each compartment?---------------- ❑ ❑
W EMuem Otter installed?--------------------------- ❑ ® ❑
Nl
Septic tank capacity(worsing) 121J0 eel Mwad hser Sound Placement
O D-box water level and speed levaien Used? -------------- - ■NrA as NO
J
p>ZpO ManifddlPboz accessible from sudete?---------------- - ❑ e ❑
m= Check valves installed? -------------------------- ❑ ❑
O
Transport Line Size 2" SctwdulelClass Sch 40
Bedrooms installed(the&Oeat ❑ 2 ❑3 ®4 ❑5 FIB ❑CommerciallOmer
>tOft.from foundation?-------- ------------------ ❑WA Mas No
t] >100 ft.from wells?----------------------------- ❑ ■ ❑
J >100 R hen surface wateR------------------------ ❑ ® ❑
W ® ❑
E. >10R.from potable waterlines?----------------------
❑
_ >5A.from property lines and easements?---------------- ❑ ❑
>30ft.from dowrgradient curtaintroundation dreks?---------- ❑ I� ❑
Drein6eld level and observation ports present -------------- ❑ IF ❑
❑ Graveless chambers or ❑ Clean gravel used? (clwek oral
Proper cover installed over drainfield?------ ------------- ❑ ❑ ❑
Pump tarok setbacks consistent with septictank?------------ - ❑ WA ® YES ❑ NO
Nd Pump tank capacity(Rood) 1475 Oaf Manufacturer Sound Placement
Q 24-access riser(s)and accessible from surface?------------- ❑ ® ❑
H
y Alarm or Control Panel lnsalled? ------- ------------- - ❑ ❑
Control Panel equipped with Timer l ETM I Counter----------- ❑ ❑
7
a Pump installed In ❑ Bucket or M On Block or ❑ Omer
Pump MakelAlodel Liberty LE51 M Flnats or ❑Transducer
Tank draw down 3 inlmin Pump caP&* i4U opm Squirt Height 2.1 ft
Pump an time 1 Mt 35 Sec Pump o 'me 6 Hrs Oaiy Row set at 480 gpd
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SEP 2 5 2024 Lf
MASON COUNTY ENVIRONMENTAL HEALTH
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Mason County OSS Installation Report pg. 2 parcel a 52008-50-00006
ABANDONMENT RECORD
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sling Wfic mmponanls abandoned as pert of No project?
--------------- YES NO
IfPlease deecdbe: e
cornponenls pumMd W and properly abandoned per WAC2a 27
ylgygpq.______. 13M Qj No
RECORD DRAWING
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eeM<nra�lon OON.tlwnalk.wbaNpmaMerwwe¢meOlYe. �age(ptl WeM nrymM Wlpnw lmloitlwLL.wn aerof,
Ae.a4e TW asb eEeaerW Wepn en44efelek�,eynMe,q rMNa]Cvml¢.
Record Drawing Atlacned
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I cerbly that l installed the system in accordance with /certify that the system has been installed in aaror-
the septic design stamped-APPROVED-by Mason dance with the Who design stamped-APPROVED"by
County Public Health and thatany de dations shown Meson County Public Health and that any deviations
hen have been oleared/appmvad by both the designer shown hen have been c/eand/a
and Mason County Public HeaMr and meet ea State pproved by both
m County Pubiodes Hea/M and meet all
and Mason County Codes State e endnd Mason Mason County Codes
I further Certify that all intoonat/nn contained on this I further ceriffy that all infimr
lorm and attached Re a( n Contained on this
{I���� cord Drawing is accurate. firm and attached Record Drawing is accurale.
Sgnnsture of Installer 1 Date
I��aLI, SI*il-�
Footed Name of Sgnae deaRes.
9 L
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installabon Report and
Record Drewing on behalf of Mason County Public 001B3 .4.
lie ' ERIC R.RUSSELL
!l - e_xrrRES 00z ---
Sig MN Health Spedaeat Oe(e (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE umueewzvxie
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