HomeMy WebLinkAboutSWG2024-00129 - SWG As-Built - 1/8/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00129 Parcel# 320103150170
Applicant Name Tim Labelle Subdivision(Name/Div/Block/Lot)
Applicant Address 123112th Ave Swindlers Cove Estates
City, State, Zip Portland, OR 97209 Installer Name Brandon Thompson
Site Address -Ll E Swindlers Cove Rd Designer Name Adam Hunter
INSTALLATION CHECKLIST
Full System Installation ❑Tani only ❑ Dramneld only ❑Repair ❑Omer
System Type Gravity Pretreatment Type
>5 ft.from foundation? -- ----_ _to
�It-[1fy!nI ❑NIA EYES ❑ NO
>50 ff.from wells? -- - - - - -- --- 0-1:1-�Z >50 h.1rom surface water? - ___ _ _ _ _ w_ ❑ 0 ❑FCleanout between building and tank? rl- ❑ ❑
U Tank baffles present? - - - - - --- - - - -- - . ❑f- 24-access risers over each compartm - - --- -- ❑ ® ❑NEfnuent filter installed?- - - - - -- - - _ _ _ _ _ _ ❑ ® ❑
Septic tank capacity(working) 1530 gal Manufacturer Infiltrator
D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑NIA ■YES ❑ NO
00 Manifold/D-box accessible from surface?- - - - - - --- - - - - - - - - ❑ ® ❑
oaCheck valves installed? - - - - - - - - - - - - - - - - - - - - - -- - - -- ❑ ❑
f 7ranspon Line Size 4 inch Schedule'Cless 40
Bedrooms installed (check one) ❑2 ❑3 N 4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?- --- -- - -- - - - -- - -- -- - - ------ ❑ NIA . YES NO
>100#.from wells'- - - - - -- - -- - --- - - - - - - -- - - --- -- ❑ ❑
W1100 ft.from surface water? - - ----- --- - - - - - -- - -- -- - - ❑ ❑
M >10ft.from potable water lines?-- -- -- --- --- -- - -- -- - - - ❑ ® ❑
Z > 5ft.from property lines and easements?-- -- - -- - - - - - -- - -
❑ 0 ❑
> 301t. from downgratlienl curtain/foundation drains?- - -- - - - - -- ❑ ❑
Drainfield level and observation ports present - - - - - - - - - - - - - ❑ ❑
■ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - - - -- - - - - -- - -. ❑ Cl
Pump tank setbacks consistent with septic tanko - - - - - - - - - - --- ■ WA ❑ YES ❑ NO
Z Pump tank capacity (flood) NA at Manufacturer NA
Q 24"access nseds)and accessible from surface?- - - - - - - - - - - -- ❑ ❑
O. Alarm or Control Panel Installed? - - -- - - - -- - - - - - - -- - - - - ❑ ❑
Control Panel equipped with Timer I ETM I Counter- - - - - - - - __. ❑ ❑
7
C Pump installed in ❑ Bucket or ❑ On Block or ❑ Other NA
G Pump Make/Model NA ❑ Floats or ❑ Transducer
f
y Tank draw down NA in/min Pump capacity NA gpm Squin Height NA ry
Pump on lime NA Pump off time NA Daily now set at NA gpd
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Mason County OSS Installation Report pg. 2 Pa-ce:tt 320103150170
ABANDONMENT RECORD
Were existing septic Components abandoned as pan of th!s projectIt - - - - - - - - - - - - - - - ❑ YES Q NO
If yes please descnbe
Were all components pumped out and property abandoned per WAC246-272A.03000 - - - - - - - - ❑ 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 vnth 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 clearedrapproved 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 info ton contained on this I further certify that all information contained on this
form and atte a cor DraNnfigsexerl form and attached Record Drawing is accurate.
Signature of ms Date
BP-AN60N THOMP500
printed Name of Slgnee
MASON COUNTY PUBLIC HEALTH
N
The undersigned a q approves this Installation Report and
Record Drawing on behalf of Mason County Public O`.! ADnbl J.NuereR '
Health'
il�gvw�
Signature of Environmental Health Specialist Date
(stamp Signature,and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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