HomeMy WebLinkAboutSWG2024-00360 - SWG As-Built - 10/30/2024 MASON COUNTY PUBLIC HEALTH
Mason County OSS Installation Report pg. 1
APPLICANTI PERMIT INFORMATION
Permit Number SwG �M"
OC 360 Parcel # /Z/O J` '3y 'ceebo
Applicant Name (�;bbc —16A -W
Subdivision (Name/Div/Block/Lot)
Applicant Address /924 2`2101" 3a
/ 6 alo 936* Installer Name '�,�-`city, State, Zip avab�
Site Address
Y4�2•t,Gaek✓ic«7 1"•� RA Designer Name Mrwr- �4+
INSTALLATION CHECKLIST T 9
Full system Installation ❑Tank(s)Only ❑ Dramfield Only ❑Repair ❑Other R < 0 i
System Type 2 bn Pr-'59""� �'""�� Pretreatment Type --,�,/ F
>5 ft.from foundation. - - - - - - - - - - - - - - " -q-�-- - -- ❑ NIA Y YEs
>50 ft, from wells? - - - - - - - - - - - 2�Ib� 1Y-� ❑ ef ❑
Y >50 ft. from surface water? - - - - - - - - '11 l�yr !/- -�
Z ? . _ _ p ❑ tsZ ❑
F Cleanout between building and tank. l u 5 �o24- �- ❑
L) Tank baffles present? - - - - - - - - - - - - - - " - - ❑
t— 24" access risers over each compartment?- - - - - - - - - - - - - - - - ❑ O
WEffluent filter installed?- - - - - - - - - - - -Y - - - - ❑ LJ
to f2'7g al Manufacturer 1dT4*Ml;rt IK-YLSo
Septic tank capacity (working) 9 �,{
r
x water level and speed levelers used? - - - - - - - - - - - - - - - E NIA YEs ❑ No
ifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ ❑
In
ck valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑rSchedulelClass 40
sport Line Size Zrooms installed (check one) 02 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/rrO.�tther
If from foundation?- - - - - - - - - - - - - - - - ' - - " - - " "- El �p YES ❑ NO
O >100 ft.from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - --
❑ �i ❑
W >100 ft. from surface water? - - - - - - - - - - - - - -- -- El ❑
LL >10ft. from potable water lines?- - - - -- - - - - - - - — - -- - - - ❑ ��-,�// El?Q > 5ft. from property lines and easements?- - - - - - - - - - - - - - --
❑ a-I ❑
C' > 30 ft.from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑
G
Drainfield level and observation ports present - - - - - - - - - - - - - ❑ ❑
I& Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ ..}�rt,, ❑
Pump tank setbacks consistent with septic tank?- - - - - - - - - - - - - ❑ N/A YES ❑ NO
Y Pump tank capacity(flood) 12IBI 9at Manufacturer W)fi'Gh r Ir-I'10100
Q 24"access riser(s)and accessible from surface?- - - - - - - - - - - -- ❑ El
F Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - " - ❑ ❑
IL ❑ ❑
2 Control Panel equipped with Timer/ETM/Counter- - - - - - -
Pump installed in ❑�`Bu-c�ket or ❑ On Block or ❑ Other �3Y �4
0' Pump Make/Model Or&= Jro tliA JKw1i1k W Floats or ❑ Transducer
2 .+
n Tank draw down .2 r/ in/min Pump capacity .�a gpm Squirt Height � 7 ft
IL
Pump on time Pump off time Daily flow set at Zya 9pd
uoea�w erzvm+a
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- - - - - - - - -- - - -- YES NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC246L272A-03007 ----- - -- IYYES NO
RECORD DRAWING
This IS a pamureas rased,and muse he axuna and GecrlWra enowh to n-mmum In the need or mtlnrenaae shnynMa and future eeeabpmers. twical Record
Drawings nand. Dimmed&marnldd memeallon a IayouL Sapt/Were Was/oaten.Navin same reserve ahmarsk,Seeing and prapoad Nildirgs,bcaeon olwellc,vnterlines,
yreM&observation ham,devwls,and dher meinlenam,e a-ass Ides. Incomplete RemN Osem,,S may u nse,add,nam[users In Final nalallafnn appmval and related parmiu.
E.Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with 1 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 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.
Q --P- 9htr)4 -
Signatu staller Date
Printed Name o/Signee \i1
G
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Repo
Record Drawing on behalf of Mason County Public Stott. two"
Health: 0/0, OL�l l3�/�241L/�r
p
Signature of Environmental Health Specialist Date�✓aCO�, (stamp, signature and date)
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CASE INLET
Abbreviated Description:TRACT 6 OF GOVT LOT 4&TAX 167J
ownar/eppi aut 7453
Parcel# 12105-34-00060M.Halverson Design LLC Barbara Green / Debbie Bennett PO Box 1519 Shelton Wa 98584 1920208th PI SW,Lynnvrood,WA980362 E GRAPEVIEW LOOP RD
Halversondesi nllc outlook.com "�°°"«