HomeMy WebLinkAboutSWG2024-00204 - SWG As-Built - 12/12/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00204 Parcel# 22123-22-50050
Applicant Name MICHAEL&CHRISTINE HANDY Subdivision(Name/Div/Block/Lot)
Applicant Address 5601 N 9TH ST
City, State,Zip TACOMA,WA 98406 Installer Name JACK JOHNSON
Site Address XXX ADONAI WAY Designer Name ALEX L. PAYSSE
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type CONVENTIONAL GRAVITY Pretreatment Type
>5 ft.from foundation? --------------- ❑Nut ®YEs ❑ No
>50ft from wells? --_-_-----_.._________________ ❑ ® ❑
W 150ft.from surface wateR -- ---------------------- ❑ ® ❑
HCleanout between building and tank? ------------------- ❑ ® ❑
V Tank baffles present? - --------------_-_ ❑ ® ❑
24°access risers over each compartment?---------------- ❑ ® ❑
WEffluent filter installed? --------------- ❑ ® ❑
Septic tank capacity(working) 1500 pal Manufacturer HAGERMAN
J Dbox water level and speed levelers used? ------------ --- ❑ MIA ®YES NO
�0 Manifold/Db m ox accessible fro surface?----------------- ❑ IN ElQ$r Check valves installed? -------------------------- ❑ ❑
Transport Line Size 4 Schedule/Cless 3034
l
Bedrooms installed(check one) ❑2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?-------------------------- ❑ NIA ® YES El No
>100ft.fromwells?-____________________________ ❑ ❑
W >100 ft,from surface water?------------------------ ❑ ® ❑
>10ft.from potable water lines?---------------------- ❑ ❑
> 5ft.from property lines and easements?---------------- ❑ ® ❑
a >30ft.from downgradient curtain/foundation drains?---------- ❑ ❑
Drainfield level and observation ports present ----- ❑ ® ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
e Proper cover installed over dremfield?- --------- ❑ ® ❑
Pump tank setbacks consistent with septic tank?------------- 0rw El YES ❑ No
Y Pump tank capacity(Flood) pal Manufacturer
24°access riser(s)and accessible from surface?------------- ® ❑ ❑
C Alarm or Control Panel Installed? --------------------- K ❑ ❑
SSS = Control Panel equipped with Timer I ETM/Counter-------- -- 0 ❑ ❑
p a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
C a Pump Make/Model ❑ Floats or ❑Transducer
ate- Tank draw down in/min Pump capacity gpm Squirt Height ft
r
Pump on dme Pump off time Daily flow set at ppd
Mason County OSS Installation Report pg. 2 Parcel a 22123-22-50050
ABANDONMENTRECORD
were eaisung septic corµwneols abandoned as part of this project? -- --- -- ❑ M ' NO
It yes,Please describe: _
Were aA components pumped out and fimpany abandoned per WAC246-272A-0300? .__ -- - _ ❑ YES NO
RECORD DRAWING
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® 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 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 Heath and that any deviations
here have been clearacimpproved by both the designer shown hem have been cleared/approved by both
and Mason County Public Heath and greet all Stale myself and Mason County Public Heath and most 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
/p it led Record Drawing is accurate. form and attached Record Drawing Is accurate.
6-20-2024
S reor/ptaller Date
Jack Johnson
Panted Heme of Slgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and Au a' MTe9C
Record Drawing on behalf of Mason County Public ..
Heath: F�
\Z � �2
Sgna um al Environmenmt Health Spactabst Data (stamp,sgnatum and dale)
THISFORil MAY BE SOANNEDANOAVA6ASLE FORFUMIC VIEW ON THE MASON COUNTY YIEe SITE
1
1
1 ADONAI WAY DRIVEWAY
1
I
FUTURE SHOP
O 1
O 1
IFUTURE HOME
O 1
ry
I I +I �
� 1 I
1 �
FUTURE SHOP
CONNECTION
SEPTIC TANK /
N
Y� INSTALLED DRAINFIELD
1 J 9'+ ON CENTER WITH
1 �J RESERVE BETWEEN
I
B1=32' APPROVED
I Cl DEC 12 2024
7=(CENTER OF LID/]N'D COMP) MASON COUNTY ENVIRONMENTAL HEALTE,
1 REr RWORD DRAVAM
CLLROMER: MIC14AELHANDY ,18r1 t ��z
PIONEER DIGGING, INC PARCELgnus-226=
SEPTIC DESIGNS ADDRECFmIADOWWAY x: 3 Ic\11'1
3tkt3 E\M.�v pEV`JM1 KD. GRMENIM W'A W5W DESIGNER: ALIX L PAYS¢ W•^"M��"
��fFk.[-3Gt1-42(.IW13 FV( 3GtNIJ-2353 y{FET: AsKmT SCALE P=30'