HomeMy WebLinkAboutSWG2020-00068 - SWG As-Built - 10/30/2024 Mason County OSS Installation Report pg. 'I MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Permit Number SWG 2020-00068 Parcel# 22302-75-90123
Applicant Name Jacob Higgs Subdivision (Name/Div/Block/Lot)
Applicant Address 571 NE Twdeau Mt. rd.
city, Stale,zip Betlair,Wa 98528 Installer Name Jacob Higgs
Site Address Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other
System Type Gravity Pretreatment Type
>5ft.from foundation? --------------------------'- ❑NIA YES ❑ No
>50ft from wells? ---------------------------- -
❑ ® ❑
!id >50ft.from surface water? -______________________. ❑ ® ❑
Z ❑
FCleanout between building and tank? ----------------- - ❑
V Tank baffles present? -- - - - - --------------------- ❑ N ❑
24"access risers over each compartment?---------------- ❑ ❑
W Effluent fitter installed?--------------------------- ❑ ❑
N 1500 gal Ma ultacturer Haggennan
Septic tank capacity working)
C Dbox water level and speed levelers used? -------------- - ❑NIA YES NO
�
J O Manifold/D-box accessible from Surface?---------------- ❑ ■
O ❑ ❑
m— Check valves installed? - -- -- --------------'--'-"-
UTransport Line Size 4" Schedule/Claes 3034
Bedrooms installed(check one) ❑2 ❑3 E 4 ❑5 ❑6 ❑CommerdallOther
>10ft.from foundation?-------------------------'- ❑ ILA ■Yea ❑ NO
11
>t00ft.fromwells?-- ---------------------------
❑ : ❑
W >100ft.from surface water?-----------------------' ❑
u >loft.frompotablewaterlines?------------- -- ❑ ❑
aZ >5ft.from property lines and easements?--------------- - ❑ ❑
8 >30ft,from downgradient ourtainlfoundation drains?---------- 0 ❑ ❑
Drainfield level and observation ports present -------------- ❑ ❑ ❑
❑ Graveless chambers or a Clean gravel used? (check one)
Proper cover installed over drainfield?----------- - - ❑ ❑
Pump tank setbacks consistent with septic tank?------------- WA ❑ YES ❑ No
he Pump tank capacity(flood) gal Manufacturer
24"access riser(s)and accessible from surface?------------ - ❑ ❑
11
Q ❑ ❑
6 Alarm or Control Panel Installed? --------- ------ ❑ El
Control Panel equipped with Timer/ETM I Counter------ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block a ❑ other
IL Pump Make/Model ❑Floats or ❑Transducer
1 Tank drew down in/min Pump oapacfly aam Squirt Height ft
a
Pump on time Pump off time Daily Clow set at gpd
uPe.rea snvzo+e
Mason County OSS Installation Report pg. 2 Parcel a Eea3i; -7 o �q
ABANDONMENTRECORD
Were existing septic components abandoned as part of this proieclP ---------_____ . ❑ YES NO
If yes, please describe:
Vk
Were all components pumped out and property abandoned Per WAC246-272A-03007 - --- --- - ❑ YES ❑ NO
RECORD DRAWING
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[$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 cleared/approved by both the designer shown here have been Cleared/approved by both
and Mason County Public Health and meet at/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 /further certify that all mOrmabon contained on this
to pns
Record Drawing is accurate. form and attached Record Drawing is accurate.
l0 13�Sig a(" Dafe
� Ii K H1bb5
Printed Name of Sign" &ES
MASON COUNTY PUBLIC HEALTHThe undersigned approves this Installation Report and
Record Drawing on behalf of Mason County PublicHeathR
lU 3 0
S/ a vbonmenRd H"M speataffst Date (stamp, signature and date)
THIS FORM MAYBE SCANNEDANDAVMlJke-E FOR PUBLIC VIEW ON THE MABON COUNTY WEB SITE UPEaYd MII
I
NEW I V L
BUILDING R7p0
I I Rp
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WELL SITE
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ISEPTIC TANK
1
I LOCATION
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40 3034 SEWER LINE
INSTALL CLEANOUT5 1
EVERYTOOFF 1
I APPROVE
I OCT 3 0 2024
4 BEDROOM I m
GRAVITYDRAINFIELD \ I MASON COUNTYENVIRONMENTALH
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