HomeMy WebLinkAboutSWG2024-00192 - SWG As-Built - 12/10/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00192 Parcel# 520241350060
Applicant Name Calvin Dahl Subdivision (Name/Div/Block/Lot)
Applicant Address 261 Hamilton Rd N HIGHLAND ACRES-LOT 6
City, State, Zip Chehalis,WA 98532 - Installer Name Andrew Lehman
Site Address 1503 W Highland RD Designer Name Adam Hunter
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑Drainfiekl Only ❑Repair ❑Other
System Type Standard Pressure Trenches Pretreatment Type
>5 ft.from foundation? ----------mli�
7'f�11 NIA EYES ❑ NO
>50 ft.from wells? ------------- _ 13 0 ❑Z >50 ft.from surface water? -------- { ❑Cleanout between building and tank? -- I Ivl l ❑ IN ❑U Tank baffles present? -------- --- -- ❑ ❑24"access risers over each compartment -- ❑ 0 ❑
WEffluent filter installed?-------------------------- - ❑ 0 ❑
fA
Septic tank capacity(working) 1250 gal Manufacturer HB Precast
o D-box water level and speed levelers used? -------------- - QN/A ❑vas NO
0OManifold/D-box accessible from surface?---------------- - ❑ ❑
mg Check valves installed? ------------- ----------- - - ❑ ❑
❑4
2 Transport Line Size 21nch Schedule/Class sch 40
Bedrooms installed(check one) ❑ 2 E 3 ❑4 ❑5 ❑6 ❑Commerciat/Other
>10ft.from foundation?--------------------------- ❑ NIA ■YES ❑ NO
im >100 ft.from wells?----------------------------- ❑ ❑
W >100 ft.from surface wai------------------------ ❑ ❑
LL >10 ft. from potable water lines?---------------------- ❑ ❑
> 5ft.from property lines and easements?--------------- - ❑ ❑
W > 30 ft.from downgradient curtain/foundation drains?--------- - ❑ ❑
Drainfield level and observation ports present ------ ❑ 0 ❑
e Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?------------------- ❑ ® ❑
Pump lank setbacks consistent with septic tank?------------- ❑ WA E YES NO
`L Pump tank capacity(flood) 1250 gal Manufacturer HB Precast
Q24"access riser(s)and accessible from surface?------------- ❑ 0 ❑
F_
a. Alarm or Control Panel Installed? -------------------- - ❑ ■ ❑
Control Panel equipped with Timer/ETM/Counter---------- - ❑ 0 ❑
7
0. Pump installed in ❑ Bucket or E On Black or ❑ Other
a Pump Make/Model LIBERTY LP280� 0 Floats or [I Transducer
=a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 5.5 ft
Pump on time 1 min 12 sec Pump oft time 4 him Daily flow set at 360 opd
Mason County OSS Installation Report pg. 2 Parcel# 520241350060
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ----- -- ❑ YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - --- - - -- ❑ YES ❑ NO
RECORD DRAWING
This Is a permanent record and must be accurate and 0es¢,i des enough m moccato in the need of maintenance activities and NWre development, Tuvbal Recoro
Drawings comaN It, d on of enow walcrince,
wolfs,coscrvation pods,cicanou6,aM og or maintenance access points. Inumgete Rewrtl OowlnW meY¢teat¢eddtlbr;al tlgays in final Installatian approval antl relahN pemnis.
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with /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 flat any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been clearedfapproved 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
12-4-24
Signature of Instanter Date "
Andrew L. Lehman
Printed Name of Signed C; '""•^ `;c`
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and souits ':n;
9 PP Q: HDAR9 J.HUNTER '.
Record Drawing on behalfofMason County Public CIE`K,vsFhiSKS'i.VKR'b
Health: L„.'„ ",
Iz ��blay 2`
Signature of Environmental Aalth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated antrzgte
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