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HomeMy WebLinkAboutSWG2024-00210 - SWG As-Built - 10/8/2024 n SEP 3 0 - Mason County OSS Installation Report pg. 1 MASON COUM PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2024-00210 Parcel# 32235-75-00080 Applicant Name Stephen 8 Dona Riley Subdivision (Name/Div/Block/Lot) Applicant Address 995 SW Perth Shire Dr TR 8 OF SURVEY VOL 1 PGS 210-213 City, State, Zip Lees Summit,MO 64087 Installer Name Arrow Excavating Site Address 80 E Hawks View PI, Union Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ❑ Full System Installation ®Tank(s)Only ❑ Drainfieltl Only ❑ Repair ❑Other System Type Tank at House Pretreatment Type >5ft.from foundation? --------------------------- ❑NIA ®YES NO >50ft.from wells? ----------------------------- ❑ ® ❑ Z >50 R Elfrom surface water! ------------------------ ❑ ® FCleanout between building and tank? ------------------- ❑ ❑ V Tank baffles present? --------------------------- ❑ ® ❑ h- 24"access risers over each compartment?---------------- ❑ e El w Effluent filter installed?--------------------------- ❑ ❑ W Septic tank capacity,(working) 1000 gal Manufacturer Hagerman 2-compartment C1 0-box water level and speed levelers used? ------ --------- ❑NIA ❑YES NO 0O Man'rfold/D-box accessible from surface?----------------- ❑ ❑ ❑ mZ Check valves installed? --------------- ----------- ❑ ® ❑ 0Q :1-; Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 04 ❑ 5 ❑6 ❑Commercial/Other >10 ft.fromfoundation?------------------------ -- ❑ WA ❑ No >100 ft. from wells?-- --------� _-1_�_`_C_/_�_____- ❑ ❑ ❑ i����J.J AJ1.1V w >100 ft.from surface water?----- - ----- ❑ ❑ LL >10 ft.from potable water lines?--------- ----- ------ ❑ ❑ ❑ Z >5ft.from property lines and easements?-- ❑ ❑ ❑ of >30 ft.from downgradient curtai ation drains?---------- ❑ ❑ ❑ Drainfieltl level and o on ports present-------------- ❑ ❑ ❑ ❑ Gravel ambers or ❑ Clean gravel used? (check one) er cover installed over drainfleld?------------------- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ WA ❑ YES ❑ No Y Pump tank capacity(flood) at Manufacturer 7 Q 24°access riser(s)and accessible from surface?------------- ❑ ❑ ❑ aAlarm or Control Panel Installed? --------------------- ❑ ❑ ❑ g Control Panel equipped with Timer/ETM /Counter-- --------- ❑ ❑ ❑ C Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty LE51M ❑ Floats or ❑ Transducer j Tank draw down in/min Pump capacity gpm Squirt Height ft 1 a Pumpontime Pump of time Daily flow set at gpd 9 uoen.e az+rzo+e 3 1 I Mason County OSS Installation Report pg. 2 Parcel o M2 7u5-15 -00080 ABANDONMENTRECORD Were existing septic components abantlonetl as part of this project? --- - - - - -- ' -"- - " ❑ YES NO If yes, please describe. NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ---'- ElYES ❑ RECORD DRAWING no.at a P.^n ..nl..d and moa b.....hate ula de..PHve enough m rNocae in me n..a or m.intanenn.diwties°nd fusure DuiIC e u:,lawtion or weYqw� 'a harems n rt Dmin 4d 6 mmibld onmtation&iwcuL SIPtl pump tong location,NOM enaw,1—rn dnitRald,evsdng an, xo,:ea ,h p wul wm Pointy. ln pm.a.<oN ortl xin,an.,Phodeaddnional dtlryz in Snellnndiann approv.I W matedam Pns w M W m. tema . el6,obsedan Pons.aeanc .and Ph,, Inn .vY.i REF. ��THG�t � D 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 Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all into�at%on contained on this I further certify that all information contained on this form a�nd�ttached R rd Draw accurate. form and attached Record Drawing is accurate. o-t/.30 24 nature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH, 3 The undersigned approves this Installation Report and PgOLA JOY JONNaON', Record Drawing on behalf of Mason County Public lk _r+ICN Health: .ems t JQP2 mm Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAI-ABLE FOR PUBLIC VIEW ON THE MASON COUNTY V)EB SITE J'..d a...ots / ScAte : I'=too, < ae of w E LuM?k:'f5-i5'00082- 50, � J oa t;nusf �p�dKs VAE� Pl- e � Fa��� (5) 3x5g' petMgRy DF `o'm+d x �' Y T2ENLHES � S O.G. FaS^w'f i.�-� W ltH �2�0 SqR Dot? V11-- Wall PEsEKv5 AFEA' w : W too' oP N a SN Kew- c i O Au'u'o-V:sus:ltiz-r= N W LLa a i ^ © Cleazout 1200 C-zllon Septic Ta!Lk Q / 2-Com artraent w-th 1 Efficent Filter !!.DO Gallon Pump Chz ber V-1- Control Box r� L 399 f' tp' `c QMA� {— PAULA JOY JOMN$pN';�/� U E%Plpeg 1 R Z7 -7-q