HomeMy WebLinkAboutSWG2022-00541 - SWG As-Built - 12/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00541 Parcel 52004-50-00037
Applicant Name CURTIS JANHUNEN Subdivision (Name/Div/Block/Lot)
Applicant Address 1704 BEL AIRE AVE
City, State, Zip ABERDEEN,WA. 98520 Installer Name CK EXCAVATING
Site Address 421 W NAWATZEL BEACH DR Designer Name CINDY WAITE
INSTALLATION CHECKLIST
❑ Full System Installation ■Tank(si Only ❑Dralnfield Only ❑Repair ❑Other
System Type PUMP TO GRAVITY(EXISTING) Pretreatment Type
>5 ft.from foundation? -------- ❑WA DYES ❑ NO
>50 ft. from wells? ___________ 1� /nt Qe ❑ ❑
Z >50 ft.from surface water? p-__(_t�_/gyp(/f/ ❑ ElFQ- Cleanout between building and tank? -- _ ❑ m El
V Tank baffles present? - -- ----- r_______�1�(_ __ ❑ ® ❑
24"access risers over each compa 40-----______ _- ❑ ® ❑
yEffluent filter installed?---- - -_____ --- ❑ ® ❑
Septic tank capacity(working) 1500 cal Manu rer SOUND PLACEMENT
�o D-box water level and speed levelers used? --------------- ❑WA ❑YES ❑ NO
O0 Manifold/D-box accessible from surface?-- - -------------- ❑ ❑ ❑
Me: Check valves installed? -- --- --- - --- ------ -------- ❑ ❑ ❑
Oa
S Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ■3 ❑4 ❑5 ❑B ❑CommerciallOthar
>10ft.from foundation?-- - ---- -- ---- ------------- ❑ WA OYES NO
C >100ft. from"Its?----------------------------- ❑ ❑
W >100 ft.from surface water? ------------------------ ❑ ® ❑
M >10ft.from potable water fines?---------------------. ❑ ❑
>5 ft.from property lines and easements?---- ------------ ❑ ® ❑
>30 ft.from downgredient curtain/foundation drains?--------- - ❑
O 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?------------- ❑ wA EYES NO
Z Pump tank capacity(flood) 1500 cal Manufacturer SOUND PLACEMENT
Q 24°access riser(s)and accessible from surface?------------- ❑ ® ❑
yAlarm or Control Panel Installed? --------------------- ❑ ❑
f Control Panel equipped with Timer/ETM/Counter-----------
❑ ❑ ❑a Pump installed in ❑ Bucket or ® On Block or ❑ Other i `1
IL
Pump Make/Model 4djey- illy-15'). i Floats or ❑ Transducer
a Tank draw down /.e;- in/min Pump capacity apm Squirt Height ft
Pump on time Pump off time Daily flow set of 7E0 apd
u anlmns
Mason County OSS Installation Report pg. 2 Parcel tt 520D4-50-00037
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ------ - ------ - . 141 YES NO
If yes, please describe: A
Were all components pumped out and property abandoned per WAC246+272A-0300? -- - ----- jX YES 0 NO
RECORD DRAWING
Teti u a gmumnl rewN end mu.the accupp aM 0ee,W ye npyyp b e,ogry In the red of malmenance atlWMn entl IWun Eedew.went Typical Record
Dremmgs mndin: cinched retread enenpier&xixe.symo,ump yen,exceed,Nem,erru name drenched.eenen,end pooax be,Inge.ba4cn 0 ylle wateninn
vnlla,oWervelbn pone.tleslwfa,eM dllermeiMmmca ocCeu pgpd, Imm�(Aelo Recgy pewype my peeler fiesho rel dekys in final InsmlleMn eprywal end related pe,mlb
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with 1 certily 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 hem have been clearealapproved 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 edac/ ecerdwing is accurate. form and attached Record Drawing is accurate.
are natel/er Dafe I
Primed Name of Signee N��
MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report andRecord Drawing on behalfofMason CountyPublic 'F
Health: 1,
:D 0EOWA
Signature ofEnvironme al Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE aedeted N31¢gle
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