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Home My WebLink AboutSWG2024-00446 - SWG As-Built - 12/13/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00446 Parcel# 42212-50-15006 Applicant Name Chong-LI revocable living trust Subdivision (Name/Div/Block/Lot) Applicant Address 6328 NE Little Otter Ln City, State, Zip Bainbridge island We 981 to Installer Name Schoening Excavatinq LLC Site Address 50 N Baskin Ln Designer Name INSTALLATION CHECKLIST ❑ Full System Installation i Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type 2bdrgravity Pretreatment Type >5 ft.from foundation? ._________________________. ❑WA Yl:s ❑ NO >50ft.from wells? ----________________________.- ❑ e ❑ _ >60ft.from surface water? -______________________- ❑ El FCleanout between building and tank? ----______________- ❑ ❑ 61 Tank baffles present? -_ _________________________ ❑ ■ ❑ IL 24"access risers over each compartment?---------------- ❑ ❑ NEffluent filter installed?-_ _______________ ____ _ ____ .- ❑ ■ ❑ Septic tank capacity(working) 1094 gal Manufacturer Infiltrator IM1060 �11 D-box water level and speed levelers used? -----------___ - ® N,A ❑yeg El No O0 MILLanffold/D-box accessible from surface?-_______________ . ! ❑ ❑ C_ Check valves installed? - - ---- ------------------ -- ■ ❑ ❑ Transport Line Size 4" Schedule/Class Sch40 Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?-____________ ___ _________- ❑ wA ® Yes NO G >100 ft.from wells?----------------------------- ❑ 0 ❑ W >100 ft.from surface water?----___________________ - ❑ ® ❑ ILL >10ft.from potable water lines?--------------------- - ❑ ® ❑ QZ >5ft.from property lines and easements?--- ------------- ❑ C >30 ft.from downgradientcurtain/foundation drains?--------- - ® ❑ ❑ Drainfield level and observation ports present --- ---- ❑ Graveless chambers or E Clean gravel used? (check one) ❑ ❑ O Proper cover installed over drainfield?-------- ---- - -----. ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?---- -------- . 0 NIA ❑ YES El NO ZPump tank capacity(food) gal Manufacturer Q 24"access riser(s)and accessible from surface?------------. ❑ ElF y Alarm or Control Panel Installed? ----- --------------- - N ❑ ❑ a Control Panel equipped with Timer I ETM/Counter- ---------- S ❑ ❑ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other IL Pump Make/Model ❑ Floats or ❑Transducer IL Tank draw down intmin Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd a vwecea emaa,e 1 Mason County OSS Installation Report pg. 2 Parcel# 42212-50-15006 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? ---- - - YES NO If yea, please describe:Old metal tank caved in on itself. Pumped&backfilled Were all components pumped out and properly abandoned per WAC246-272A-0300? ------ -- YES NO RECORD DRAWING Tale Ie a eenm-a l rKerd.M mu.t M KCunb.M tlewlVe.^...0 m M In IM rwaE a m.lydaunu.c Ia_...tWa-d"."IUVmant 1".aemN fid- Ia doasla: delnMN&r,gnHoq aMNeden a Wa Widpump/ant Iwlb,,IbM.nwve dnmfiele,e:iatingantl pmpnadd e.ild,aBn'^nafi f—f. wnerlln.e. wells,rCaenNYn p.la,ry.np,Ia,y,tl W,ermainbrence Kpea aklb. Ircvn{ ae¢N Draeipe may Caddo adddanal delayafinal I natallallon apptwal and related perm ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 cleared/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 I further certify that all information contained on this 1 further certify that all information Contained on this forth and attached Record Drawing is accurate. form and attached Record Drawing is accurate. ^/0 12/12/2024 c Signature of/nstaller Dale Bravden Schoemno Printed Nana,of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: wtw uwl (Z(i3/ZLj Signsfu/e of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 'tll la,dantrzme Sn N P�wskin Ln ; i'°1CIOG4 N - Exiskiny No�nsc �+ J a orin.wpy A,�, 3 APPROVED NOV 19 2024 MASON COUNTY ENVIRONMENTAL HEALTH DP Mar RET I� urvw lucw4ime � 1 2.e%iSFln co\\gQecJ rw�.4a1 otQAdc iunk � Qom? .ri �laa�oval txv Wac 3. Eristi—�rv, A•o�Fia\a im un'r+ww�n \ecmL{ah APPROVED DEC 13 2024 MASON COUNTY ENVIRONMENTAL HEALTH Y RET 6 2