Loading...
HomeMy WebLinkAboutSWG2024-00434 - SWG As-Built - 1/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00434 Parcel # 320222100010 Applicant Name Julie VanCleave Subdivision (Name/Div/Block/Lot) Applicant Address 110 E Cedarshade Lane City, State, Zip Shefton,WA 98584 Installer Name Brandon Thompson Site Address 110 E Cedarshade Lane Designer Name Adam Hunter INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑Drainfeld Only ❑Repair ❑Other System Type Glendon Pretreatment Type Biofiher >5 ft.from foundation? - --- - --- B L�l"7 L`>1J NIA �vss ❑ NO >50 ft.from wells? - - - - --- -- -- IC5S�-\1V71 ❑ ® ❑ Y >50 ft.from surface water? - ----- - -- - -- ---- - - ❑ ® ❑ rCleanout between building and tank? - -,}Q{� -�� - - ❑ ® ❑ V Tank baffles present? - - --- --- -- ---- -- - - - -- - ❑ ❑ a24"access risers over each compartm --- ❑ ❑ W Effluent filter installed7-- - -- - -- -- --_=- --- - - ❑ ❑ N Septic tank capacity(working) jA Q gal Manufacturer I N I I.T 70 0 D-box water level and speed levelers used? -- - -- - - -- - ---- - ❑ NIA YES ❑ NO 00 Manifold/D-box accessible from surface?- -- ------------- - ❑ ❑ mZ Check valves installed? - - - --- -- - -- --------------- ❑ ❑ 04 2 Transport Line Size 1' Schedule/Class 40 Bedrooms installed(check one) 02 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10ft.from foundation?--------------------------- ❑ NIA YES ❑ No >100 ft.from wells?--- -------------------------- ❑ ® ❑ W >100 ft.from surface wateR----------------------- - ❑ ® ❑ M >10 ft.from potable water tines?--------------------- - ❑ ® ❑ QZ >6ft.from property lines and easements?-- ------------- - ❑ ❑ C: >30 fL from downgradient curtainlfoundation drains?- ----- ---- ❑ ❑ Drainfield level and observation ports present - ---- ----- --- - ❑ 0 ❑ ■ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ---- - - --- -- - ----- ❑ ❑ Pump tank setbacks consistent with septic lank?- - --- -- - -- --- ❑ NIA 0 Yes ❑ No 2 Pump tank capacity(flood) 1060 at Manufacturer Infiltrator 4 24"access riser(s)and accessible from surface?- -------- ---- ❑ ❑ r a Alann or Control Panel Installed? - - -- - -- - ------------ - ❑ ® ❑ f Control Panel equipped with Timer I ETM/Counter-- --------- ❑ ® ❑ 7 b• Pump installed in ❑ Bucket or X On Block or ❑ Other a Pump Make/Model Aquaworx 112HP 115V ❑Floats or Transducer Tank draw down NA irVmin Pump capacity NA gpm Squirt Height NA ft a Pump on time to sec Pump oft time 10 min Daily flow set at 240 gpd Waew axirm�e Mason County OSS Installation Report pg. 2 Parcel a 320222100010 ABANDONMENTRECORD Were existing septic components abandoned as pan of this project? - - - - - - - - - - - - - -- YES NO If yes. please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? - - - - - - -- 0 YES No RECORD DRAWING Tnl.1.a pomanenl rt<eN and mua G accurale and E..'nP.h..nduen In,..lain. In.e.na.a or m.lnl.nane..envin..and roNla d.v.lopm.n.. "d-1.—n Ga ". —w 4' 1rsn1e11- -x,oren1a4n&lapin eaFt pampla'.Mawr Nalp a+an rmel.e d—We .-s'nga-d yopoxJ WO;mg..luo:vn V.41a we'e0nn :wls,a°s.lualgn Mns u-1.111 .mn.,mamn.-.ani a—pdnla. ax—rial.R—d U.,.r9.na1e1—Ina-11-Ida.,. Ana nayalmnaa,......M la.b[yrcJ c. 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 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 certity that all Information contained on this I further certify that all information contained on this form and attache R cord Drawing is accurate. form and attached Record i is accurate. 1/27/2025 {' t Signature BT Installer Date ' �:. Brandon Thompson Printed Name of Signee MASON COUNTY PUBLIC HEALTH ?+ �- >• The undersigned approves this Installation Report and +'pt x souls q Record Drawing on behalf of Mason County Public p: ADAMJ.HUNTER Health i'iCKieSeti @KS:l54F'A'r' Signature of Envlro�(Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE -- ` - \ \ � ■ § . , ! ~ © \ ® ) � m ( ! § ! g ! ; Ki §\ 2 : \ _ j � ` ) ( § \ ® 7 \ ! \ 00 ! \ \ § ) ) § \