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Home My WebLink AboutSWG2024-00059 - SWG As-Built - 11/27/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number 5WG 2024-00059 Parcel# 320273300020 Applicant Name Melvin Hohn Subdivision (Name/Div/Block/Lot) Applicant Address 9121 Cherie DR SE City, State,Zip Lacey,WA 98513 Installer Name Richard Haulet Site Address 691 SE Binns Swger Loop Designer Name Tom Purdum INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑Drainfleld Only ❑Repair ❑Other System Type Pressure Pretreatment Type Nuwater >5 ft.from foundation? ----- ------ ❑ NIA YES NO >50 fL from wells? - - ------- - ---------------- - - - ❑ e ❑ Z >50 ft.from surface water? - - - -- - ------- - -- - - - - -- - - ❑ ® El FCleanout between building and tank? - --- ------ --- ------ ❑ ® ❑ U Tank baffles present? -- -- - - --- -- - -- -- - ---- -- -- - - ❑ ❑ a24"access risers over each compartment? ❑ ® ❑ W Effluent filter installed?- ---- --- --- - - --- - --- ❑ IN ❑ U) Sepfic tank capacity(working) 500 gal Manufacturer Hagerman precast o D-box water level and speed levelers used? - --- - -- ❑ WA ❑YES ❑ NO O0 ManifoldlD-box accessible from surface? ----- - - ❑ e ❑ U. t?Z Check valves installed? - - ❑ ❑ ❑ CQ f Transport Line Size 2" Schedule/Class sch40 Bedrooms installed(check one) ❑2 JM 3 ❑4 ❑ 5 ❑6 ❑CommercW/ORrer >10ft.from foundation?--- --- ----- ----- - ------- - - ❑ N/A ®YES NO >100 ft.from will--- -- -- - --- - -- ---------- -- --- ❑ IN ❑ W >100 ft.from surface water? - ------------ - ---------- ❑ e El u. >10ft.from potable water lines?------ - - -- --------- --- ❑ ❑ aZ >5ft.from property lines and easemenis?- - -- -- ---- ------ ❑ ® ❑ C' >30 ft.from downgmi lent curtain/foundation drains? ❑ ® ❑ Drainfield level and observation ports present --- -- -- ----- -- ❑ ® ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------- - --- - ------- ❑ ® ❑ Pump tank setbacks consistent with septictank?------------- ❑ WA ■ YES ❑ No Y Pump tank capacity(flood) 1250 at Manufacturer Hagerman precast Q24"access risers)and accessible from surface?- --- ------ --- ❑ E ❑ CAlarm or Control Panel Installed? ---- ----------------- ❑ F ❑ Control Panel equipped with Timer/ETM I Counter-- - - --- - -- - ❑ 0 ❑ a Pump Installed in a Bucket or ❑ On Block or ❑ Other rl Pump MakelModel Liberty 290 ®Floats or ❑Transducer a Tank draw down 2 Infiniti Pump capacity 44 gpm Squirt Height 5 ft Pumpontlme 1minl5se Pumpofifime 6 Daily flow set at 240 gpd upmeeamnors Mason County OSS Installation Report pg. 2 Parcel k 320273300020 ABANDONMENTRECORD Were edsting septic components abandoned as part of this pmlecl7 --------------- QYEa ❑ No It yes,please describe:1000gal septic tank pumped and demo _ Were all components pumped out and properly abandoned per WAC240-272A-03007'------ fYEA El No RECORD DRAWING mi.1..p<,m...m—rd w,pxa..e.m..rda. rli-.—a'm-1-1.mm.—dor.,d—n....awN..rd 1. onam:—.11 e. . nI.n< ,annaa..wxins°m",— "Is oh—tm n...o-ar-8I,rpu" inwinm.N R—Demns m. ...at,rW rd ldebp1nnna m.muaro".ppn.a n1aw p..nm. ® 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 Sepik 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 deviation here have been cleared/eppmved by both the designer shown here have been cleared/appmved by both and Masan County Public Healh and meet all State myself and Mason County Pudic Health and meet all and Mason County Codes. State and Mason County Codes 1 further certify that all information contained on this I further certify that all information contained on this fid.a�chad Record Drawing w accurete. form and attached Record Drawing is accurate. /'Z�`Zy SignnneMeoflnstafler Data Pdnted Name of Slgnee MASON COUNTY PUBLIC HEALTH pB� The undersigned approves this Installation Report and ?p,T^>E.puBaem; Record Drawing on behalfofMason County Public ENSEb0E510NER" Hearth: EXPIRES 2/07/2e25 /1 FAQ 1 17j424Zy 11/27/24 Slgnatwe o paonmenml11'' --Head,Specialist Dee (stamp,signature and date) THIS FORM MAY BE SCANNEDAND AVNI.ABLE FOR PUBLIC VIEW M THE MASON COUNTYWES SITE upu.d.nvare n�aT s r°��ia-o � niny x $ 06 �-RuNC aa�. i N = mTTNO° D T°� ° mTT gN n C�_NN A CI1 1 S <°o6r-z&0 m8„ o D ny g :� pp3o °°�"" r $tea HZIMmpo .. m�a m O Z Q 50n 0° 3P >x ��m0 O I• T z o < m9 TjN -Ng HMO O A a s 1 ' 1 -0a §ozpnj#ox -mc— 01 O y O Ny O { ° �m003. r m p1z AO 0§mm m~Om D < .� N x 3 TIxnP Om2 NN�y N 2 3a � n" �JP 3 ° " nm mJ n� KrI BINNS-SW IGER LOOP RO N m oW ED 1IaT—/ v m�yaCm Z, ICI pmv. r mG nil mZ zo 2p ur p "r 3 rox B 0 = D 2 m m m ', m m z I z -i � O 2 n Mr v m I i c n AO N O 5 a s $ c) 5 N A Z m G) �OD� � Dzn-0 m vDr7� m N m cn N Z r cn 4-n rn w 0 0vD1 mo 000OWTOTT D-100�00000 O W� Z w 0 C-IA -40 0>mzmc cc OMM22H Dal fp 03 y -I $cul 3o_m�mim3�33 OmTTm--_�cn N W N m m VC-j 88cmzmm5�pCOO Z=mm-mmmm-u p Z CoED o m O m 00 m Z O 0 7Dz 5?`Oow-04N=�G Zm1 �cz11�N�000ym 3Acn 3 C� Z < mor D.� {jOynOAN? 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