HomeMy WebLinkAboutSWG2023-00510 - SWG As-Built - 11/20/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
Permit Number SWG 2023-00510 Parcel# 42122-76-90071
Applicant Name Vince Hartney Subdivision (Name/Div/Biock/Lot)
Applicant Address 15632.92nd Way SE 9F Alp,S2.3 TMS
City, State,Zip Yelm,WA 98597 Installer Name Active Underpround LLC
Site Address 601 E Eagle Point Dr Designer Name Chris Elafrott
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repalr ❑Other
System Type Pressure Pretreatment Type Sand Auq.Bed
>5 ft.from foundation? ---------- ----------------- ❑wA myes NO
>50 ft.from wells? ----------------------------.- ❑ M ❑
>50ft.from surface water? -------- ------ ------ - --- ❑ ■ ❑
F- Cleanout between building and tank? ------------------- ❑ ® ❑
U Tank baffles present? - - - - - - -- ------------ ------- ❑ ❑
24"access risers over each compartment?--------------- - ❑ ® ❑
a N Effluent filter installed?--- ------------- ---------- -
❑ ■ El
Septic tank capacity(working) 1200 gal Manufacturer SPS
O D-box water level and speed levelers used? ------- ------- - WA ❑yes ❑ No
�O Manifold/D-box accessible from surface?- --- --- --------- - ® ❑ ❑
m= Check valves installed? - - --- ----- - - - - - - - - -------- ❑ ❑
]Q
2 Transport Line Size 2 Schedule/Class 40
Bedrooms installed(check one) ❑ 2 03 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 tt from foundation?- ------------------------- ❑ WA ® yes El No
>100 ft.from wells?----- -- ---------------- ------ ❑ ® ❑
W >100 ft.from surface water? ----------------------- - ❑ ® ❑
LL >10ft.from potable water lines?--------------------- - ❑ M ❑
QZ >5ft.from property lines and easements?- - ----- --------- ❑ ® ❑
K >30 ft.from downgradient curtain/foundation drams?---------- ❑ M ❑
Drainfield level and observation ports present -- - -- --------- ❑ M ❑
❑ Greveless chambers or M Clean gravel used? (check one) -
Propercoverinstalledoverdrainfield?-- ----------------- ❑ M ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ wA IM yes ❑ no
2 Pump tank capacity(flood) 1200 gal Manufacturer SPS
F24"access dser(s)and accessible from surface?------------- ❑ ■ ❑
y Alarm or Control Panel installed? -------------------- - ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter---- - ------ ❑ ■ ❑
a Pump installed in ❑ Bucket or ❑ On Block or M Other Pump Sib
0' L Pump Make/Modeliberty 280 M Floats or
2 ❑ Transducer
a Tank draw down 2.5 in/min Pump capacity 56 gon Squirt Height 42" ft
Pump on time 1 min 10 sac Pump off time 6 hour Daily flow set at 270 gpd
U.s ..
Mason County OSS Installation Report pg. 2 Parcel s 42122-76-90071
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? -- -- ---- YES NO
If yes, please describe;
Were all componene,pumped out and property abandoned per WAC246-272A-0300? - ------- ❑ YES NO
RECORD DRAWING
This is a permanent rea ad!and must W accurate and descriptive snough Is neeote in aq wal of elairdens e az ifle4 and thine dewkpnenl. Tiytel Recall
Onrvma4 fg Wn. 014.00d 6 nnarfthi aM1 1.1o1 51Ayml 5.,IW rn0lent besllon .bIN and pfOppsM nuikdla IOWtgn of uB114,wiMMpne.
'�rells,epseMCg1 pS14.tleMoule,arM alnermakknanCp oCrEss poietti IncomlAele ReruM.nAwvgB msy tlndls addnenal MIeyS in f,yl in41811adan eppeoval and related emits.
ecord 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 cleamd/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
JI further ce ' at n alned on this I further c Ch ardly et all information contained on this
to d atta or awing is accurate. form and attached Record Drawing is accurate.
S netu of Installer Dale �
James Medcalf @
Ptlnred Name of Srgnee
V
MASON COUNTY PUBLIC HEALTH 9 255080 Zoe s
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public ��/0 I T��
Health: Al
Fine,"VC. ., ( f lu lzy
Signature Of Enwrontnental Health specialist Date
/stamp, signature and date)
THIS FORM MAYBE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SrrE Ihdel.e°d^rp^°
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