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Home My WebLink AboutSWG2022-00278 - SWG As-Built - 10/14/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00278 Parcel# 22104-43-50400 Applicant Name David Beisley Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 897 City, State,Zip Vaughn Wa.98394 _ Installer Name David Blustery Site Address 181 Benson Ridge Road Designer Name Bob Paysse M e INSTALLATION CHECKLIST Full System Installation ❑Tonds)Only ❑Dreinflow Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5ft.from foundation? --------------------------.- ❑NIA Eras E] NO >50ft.from wells? ---------------------------- - ❑ E ❑ Z >50 ft.from surface water? ------ ------------------ ❑ E 1-1 FCleanout between building and tank? ------------------ - ❑ ® ❑ U Tank bafflespresent? ----- ---------------------- ❑ E ❑ 24'access risers over each compartment?---------------- ❑ E ❑ rW Effluent filter installed?-------------------------- - ❑ El Septic tank capacity(working) 2250 pal Manufacturer Sound Placement O D-box water level and speed levelers used? --------------- [I WA Eras E] No 00 Manifold/D-box accessible from surface?---------------- - ❑ ❑ rQZ Check valves installed? ---- -- ------ ------------- - ❑ ❑ OQ f Transport Line Size 4' Schadute/Class SDR 35 Bedrooms installed(check one) ❑ 2 ❑3 ❑4 ❑5 E 8 ❑Commercial/Other >10 ft,from foundation?------------------------- - El WA Eras E] NO >100 ft.from wells?----------------------------- ❑ ® ❑ W >100 ft.from surface water?------------------------ ❑ ® ❑ LL 110ft.from potable water lines?.--------------------- ❑ ® ❑ aZ >5ft.from property lines and easements?--------------- - ❑ ® ❑ d >30 ft.from downgradient curtaintfoundation drains?---------- E ❑ ❑ Drainfield level and observation ports present -------------- ❑ ® ❑ ❑ Graveless chambers or E Clean gravel used? (check one) Proper cover installed over drainfeld?------------------ - ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------ - ENIA ❑ yes El NO Zd Pump tank capacity(flood) gal Manufacturer Q 24"access dser(s)and accessible from surface?------------ - ❑ ❑ ❑ yAlarm or Control Panel Installed? --- ------------------ ❑ ❑ ❑ S' Control Panel equipped with Timer I ETM/Counter----------- ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model ❑ Floats or ❑Transducer y Tank draw down in/min Pump capadly gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd uoe•ma n�rzma Mason County OSS Installation Report pg. 2 Parcel 4 >Za 1011 - y3-So'/oa ABANDONMENTRECORD Were existing septic components abandoned as pan of this project? ------------ -- - YES NO If yes,please describe: Were all components pumped out and property abandoned per WAC246272A-0300? ------- - El Yes NO RECORD DRAWING mk Ia a ryrmamnt nwN.M marl e..rnam aM mwIPIM.nouen to mloua m uy nwa w nulnbnanw.eu.Isw.M hnun E.rNOPman1. Ty,[Remre oraw�ooeeob mnmnon tw oremnau d me.rcae mom no.s syom.saPnuwmP wm Iommn.wnn.00..aaaNa arm.naa,.nanny ens P�owa.a wnamya,Yam.nw.ua,wamnma:, xelb, paM,ayanoum.aM dMrmeMmnm a®pMN. amnPMe FamiE ormNrpa meYueek enCNonal mpn F And InalelYlkn eppmnl aM nWM parmns. El 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 clearadlapproved by both the designer shown here have been cleared/approved by froth and Mason County Public Health and meet all State myselland 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 /further certify that all information contained on this fomr end attached ecord Drawing is accurate. form and attached Record Drawing is accurate. ^ / Signature of Installer Date �L1✓ t� ��{+� Printed Name of Sign4, MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation ReportROBEp`o"�� 9!a ....... Record Drawing on behalf of Mason County Public OC FxwRes Healti. /y+4, — l� 1�� r's � FO Signature ofEnvironmentaY Health Spe Wtst at y (stamp, signature and date) THIS FORM MAY BE SCANNEDAND AVAILABLE FOR. IC VIEW ON THE MASON COUNTY WEB SITE umasee,u am 4CTj P� 50' DOWNSLOPE ATTENUATION ZONE DRAINFIELD (PER DESIGN) Z�s/ \ PRIMARY& RESERVE SEPTIC TANK I \ I I % � APPROXIMATE NEW HOME LOCATION _ JAPPROXIMATE IDRIVEWAY WATERLINE 1 � 1 � 1 �7 BENSON RI DGE ROAD 1V APpRQVgn. . _ - - - _OCT 141014 *4ASONCoUNrENVlRoNMENW 1PF ORD IIDIlRAWNG DJA HEALTH PIONEER DICC NQ INC- PRC �0+05M AERL TMWIE2 TESTHOLE3 SEPTIC DESIGNS ADDRESS: )OMBENEONKEDGE o-3z cis 132 cis 136C 32s TILL 32a TILL 36 TILI. 3113EMA N31Nh NRD. GRMEVIEW,WAwd DESIGNER: ROBEELTR PAM fFCE-3h &1803 Fn 3&142]- 3 DESIGN PAGE RECORD DM