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Home My WebLink AboutSWG2023-00121 - SWG As-Built - 10/2/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION WPA Permit Number SWG 2023 00121 Parcel # 22336-54-00062 71t I Applicant Name Antonio Marcus Subdivision (Name/Div/Block/ E) luSJ Applicant Address PO box 3131 Nnch cove Div 4 let 62 BK City, State, Zip Betfair We 98528 Installer Name Shumaker Ogoszu a `- Site Address 20 Ne Katherine Ct Designer Name Frank Marcinko INSTALLATION CHECKLIST [] Full System Installation ❑Tank(s)Only 0 Drsinfleld Ony ❑Repair ❑Other System Type Gravity Pretreatment Typa >5 ft.from foundation? ------------- -- ------------- ❑ NIA ■YES No >50ft. from welis? -- ---------------- ---------- - ❑ ■ ❑ _ >50ft.from surface wafer? ------- ----------------- ❑ ❑ Coarout between building and tank? ------------------ - ❑ ❑ tp Tank baffles present? -- - - - -- - --------------- ---- ❑ ❑ a24'access risers over each compartment?----- ----------- ❑ ❑ W Effluent fitter installed?- - - - - - - - - - - - - ------------- - ❑ ❑ 6) Septic tank capacity(working) 1150 gal Manufacturer Existinq 0 D-box water level and speed levelers used? -- - - - -- - --- - - - - ❑ WA YES ❑ No 00 Manifold/D-box accessible from surface?-------------- - - - ❑ e ❑ OGCheck valves Installed? - - - - - ----- ------ -- - - - - --- - ❑ ❑ 2 Transport Line Size 4 SchedulelClass 3034 Bedrooms installed(check one) ❑2 03 ❑4 ❑5 ❑6 ❑CommerciallOther >10ft.from foundation?---------- --------------- - ❑ wA YES ❑ NO >100 ft.from wells?- - ---------- ----------------- ❑ ❑ W >100 ft.from surface water7 ---- -------------------- ❑ ❑ LL 110ft. from potable water lines?-- ---- --------- --- - --- ❑ ❑ Za > Sft. from property lines and easements?- - - - - - --------- - ❑ W ❑ K >30ft,from downgradient curtain/foundation drains?---------- ❑ ❑ Drainfield level and observation ports present - - - -- ❑ e ❑ ❑ Graveless chambers or ® Clean gravel used? (Cheek one) Proper cover installed over drainfield?-- -- --- ---------- - - ❑ ❑ Pump tank setbacks consistent with septic tank?------ ------ - ❑ WA ❑ YES El NO Y Pump lank capacity(Rood) gal Manufacturer < 24"access riser(s)and accessible from surface?-- ---------- - ❑ ❑ ❑ aAlarm or Control Panel Installed? - - -- - - - - ------ --- ---- ❑ ❑ ❑ ? Control Panel equipped with Timer IETM/Counter- - -- ---- - -- ❑ ❑ ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Olher a Pump Make/Model ❑Floats or ❑ Transducer f d Tank draw down in/min Pump capacity gpin Squirt Height ft Pump on time Pump off fime Daily flow set at gpd VpYbE NIY�p�6 Mason County OSS installation Report pg. 2 Pareel n 22336-54-00062 ABANDONMENTRECORD Were esiselp septic components abandoned as pan of this prgect? ----- -_- _- _ YES No If Yes, please describe Were all components pumped oui and properly abandoned per WAC246-272A-030D? -- -- -- - - YES 13 NO RECORD DRAWING rtle Y.wTwm rave anti m.en a ecvxr.a awrnpuw eae.el r .apar M s.neea o1 fie.^.edNrwe na rwn an 0.Mye wadi. deerMb m�lkb aneraaawb►pAsp/Pa.pu^w Nrm�.No-n Ylw.ieeeM den4^M.mYp.N oiweeeE 4b^V,�awh.rnNw.,.,.e,aneemaoo pone,aamwa.ero rw p.Irwa m.•poFy a'wwl^Ie ILyY d•+Tw^'er tier WltlpMl arcs o er+resem eym.,I.^a�r ww^e. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certlty 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 devieo'Ons shown Meson County Public Health and that any deviations hem have been deared/appmved by both the designer shown here hem been de81001/apptoved by both and Mason County Public Health and meet oil State myself and Meson County Public Health and meet all and Mason County Codes. State and Mason County Codes 1 further certify met ail lnrommuon contained on this I further certify that all inhumation contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. S 24 2�z g Signature of 1 item Date PC fed Name of Sigmas � r MASON COUNTY PUBLIC HEALTH ,,, p S�c The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public 9 20100BOS Health: O frank A.Marcin a Caen LICENSED DESIGNER ;�i r •' I ��7��LC.� FX�1re,y o6l �2Si Signature of Envimlmekel Health Specielrst Dete (stamp, signature and date) THIS FORM MAY 9E SCANNED AND AVAILABLE FOR PDBLIC VIEW ON THE MASON COUNTY WEB SITE "p^•'•a^n'�'^ NE Katherine Ct 24 el 51' +25'el Record Of Construction N P pXp W� 2 ` 3 3m ao � ama a8 ' i c i I 1' 1� N ile� xpe 1 1 1 APPROVED Tank O OP's OCT 02 2024 MASON COUNTYENVIRONYENTALHEALT'' RET tJe�" E � mtooaoa FraM A.Meranka ; bq LICENSED DESIGNER Wpe ♦3'el N�Sta`e3 1,rlir�r i sty On-Site Septic ROC Name: Marcos Tax Parcel: 22336-54-00002 Scala = I" = 20' Address: 20 NE Katherine Ct,BeNair IFia mW a sure,,all pmpsrhlnn/houndariea here heen damonstrzted by theb xdsl and/or thnr Agem(s) Dn-Sae Septic Design I Allied Septic Design and Elevating