HomeMy WebLinkAboutSWG2024-00424 - SWG As-Built - 11/5/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00424 Parcel # 422165100178
Applicant Name Lawless Leonard B Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 484
City, State, Zip Hoodsport We 98W Installer Name Schoening Excavating LLC
Site Address 411 N Kokanee Ridge Dr Designer Name Not applicable
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑Drainfield Only N Repair ❑Other
System Type_ Gravity Pretreatment Type
>5 ft.from foundation? -- - ---------------- --------
❑NIA ®YES ❑ NO
>50fl.from wells? ------------------------------ ❑ ® ❑
2 >50 ft from surface water? ------------------------ ❑ ❑
A Cleanout between building and tank? ------------------- ❑ ❑
V Tank baffles present? --- ---- -------------------- ❑ ❑
LL24"access risers over each compartment?--------------- - ❑IIIIJ ❑
h Effluent filter Installed?---------------------------- ❑ El
Septic tank capacity(working) 1260 oel Manufacturer Haperman Pre-Cast
�0 D-box water level and speed levelers wed? -------------- - 0NIA vas; NO
00 Manifold/D-box accessible from surface?---------------- - e ❑ ElGQ Check valves installed? -------------------------- ❑ El
2 Transport Line Size Schedule/Class
Bedrooms installed(check one) ❑2 ❑3 ❑4 ❑5 06 ❑CommerciallOther
>10 ft.from foundation?-------------------------- El NIA Nves NO
>100 ft.from wells?----------------------------- ❑ ❑
W >100 ft.from surface water? ------------------------ ❑ . ❑
SQ >10ft.from potable water lines?--------------------- - ❑ E
K >5 ft.from property lines and easements?--- --- ---------- ❑ e ❑
>30ft.from downgradient curtain/foundation drains?---------- ❑ ® ❑
Drainfield level and observation ❑ ❑ports present --- ---- ---- ---
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?---- --------------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - NIA ❑ YES ❑ No
2 Pump tank capacity(flood) gal Manufacturer
Q 24"access riser(s)and accessible from Surface?- ------------ El ❑
ILAlarm or Control Panel Installed? ------ - - - ------- ❑ ❑
Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
fPump Make/Model ❑ Floats or ❑Transducer
RTank draw down inlmin Pump capadly gpm Squirt Height ft
Pump on time Pump oft time Daily flow set at gpd
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Mason County OSS Installation Report pg. 2 Parcel a 422165100178
ABANDONMENT RECORD
Were existing septic components abandoned as pan of this project? -- - - - - - - - -- -- -. YES NO
0 yes, please describe:Pumped and filled old tank with Des gravel
Were all components pumped out and properly abandoned per WAC246272A.0300? -------- YES NO
RECORD DRAWING
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® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI 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 Geared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself end 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 BY information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
-736 11/412024
Signature oflnstaller Date
Brayden Schoeino
Printed Nam ofSgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
Signature of Environmental hashift Sperm& Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uPml.c erzrzme
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