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Home My WebLink AboutSWG2020-00345 - SWG As-Built - 10/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 20-00345 Parcel 9 12217-13-90103 Applicant Name John Hermon Subdivision (Name/Div/Block/Lot) Applicant Address 19680 East Hwy 3 Lot 3 of SP Y2789 PTN Gov Lot 2&SW NE City, State, Zip Allyn,WA 98524 Installer Name Tom Weaver Site Address 160 E OLD SH 3,Allyn 98524 Designer Name Tom Weaver INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(e)Only ❑ Grainfield Only ❑Repair ❑Other System Type Pressure Pretreatment Type Septic Tank >5ft. from foundation? -- -- --------------------- -- ❑ NrA 0 YES ❑ NO >50ft.from wells? --- ------- - - ------ ----------- ❑ e ❑ Z >50ft.from surface water? ---- -------------------- ❑ 0 ❑ r Cleanout between building antltank? - ------------------ ❑ ❑ Ly Tank baffles present? ------ ------------------- - - ❑ ❑ a24"access risers over each compartment?--------------- - ❑ ❑ W Effluent filter installed?---- -- --- -------- - --- --- - - - ❑ 0 ❑ N Septic tank capacity(working) 1,200 gal Manufacturer Infiltrator O D-box water level and speed levelers used? --------------- 0WA ❑YES ❑ No �J DO Manifold/D-0ox accessible from surface?--------------- - - ❑ ® ❑ u0= Check valves installed? ---------- ---------------- ❑ ❑ OQ 2 Transport Line Size 2" Schedule/CUss SCH 40 Bedrooms installed(check one) ❑ 2 i 3 ❑4 ❑5 ❑6 ❑CommerciallOther >70 ft.from foundation?------ ------------------ ❑ NIA . YES NO >100 ft from wells?-------- �J`Ho✓s8 is_&aT A q✓ kr ❑ 0 ❑ OJ >100 ft. from surface wales----Lfe T-ic�3L,zK------ ❑ ® ❑ Ll TAL a va a >10 ft. from potable water lines?----/-iy-S-________�L2X- ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - 3 1-��'�---- ❑ N ❑ > 30ft. from downgradient curtain/foundation drains?--------- - ❑ W ❑ Drainfield level and observation ports present - ---- ❑ IF ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?----- ---- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------- ❑ wA ® YES NO Y Pump tank capacity(flood) 1,200 cal Manufacturer Inahrator oX 24"access riser(s)and accessible from surface?--------- ---- ❑ ❑ ILAlarm or Control Panel Installed? ---- ----------------- ❑ ❑ Control Panel equipped with Timer/ETM/Counter---- ------- ❑ ® ❑ d Pump installed in ❑ Bucket or e On Block or ❑ Other IL Pump Make/Model Liberty 280 N Floats or ❑Transducer ILTank draw down 1 6 in/min Pump capacity 32 gpm Squirt Height 4 ft Pump on time 1 Min 50 Sec Pump off time 4 Hours Daily flow set at 380 gpd U~641rt61e Mason County OSS Installation Report pg. 2 Parcel# 12217-13-90103 ARANDONMENTRECORD Were existing septic components abandoned as pan of this project? -- - --- ❑ YES NO If yes. please describe: _ Were all components pumped out and properly abandoned per WAC246272A-03007 - — -- - -- ❑ YES ❑ NO RECORD DRAWING TN.a.pxmaym MeN.M mua M.Cwna.W CxsRoe...1ft m nA«.a In N.n...1 mum.—I..ptivle.. Ind ruwn d..I.pm.m. TWur R.,I P'.W.N..Yna.l onmrma a m.nnoa nn.Non S arwl s.N./NW Nnx bnl. Nmn umw.nnme dranlald,e.immp.m p-opo.ea wamy. nulrm m Mlls,...r— xM..oexrvNon pals tla.mw..ne 0.1 m.nanaic...wlln. I.—Mae R—nd.—rla mry ueae Ndnxn.1 aean n tine n.alalnn.wray.l and realm 1—U ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with /cemly that the system has been installed in Scour- Me 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 clearedrapproved 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 I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date Thomas Weaver Printed Name of Signee - t MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and iNOM5111 E.r,FAREn` Record Dewing on behalf of Mason County Public N" Health: �p/d/may Rt q n, qo IDIa127 Signature o(Envitonmenta/Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VIES SITE u.wnvuao�e - z � _ ,W . � 4 � . . \ ! � • � ' � � % « \ 5 � � ! on ; || !