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HomeMy WebLinkAboutSWG2024-00191 - SWG As-Built - 2/14/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2024-00191 Parcel# 520241350030 Applicant Name Calvin Dahl Subdivision (Name/Div/Block/Lot) Applicant Address 261 Hamilton Rd N HIGHLAND ACRES-LOT 3 City, State, Zip Chehalis,WA 99532 Installer Name Andrew Lehman Site Address W Highland RD Designer Name Adam Hunter INSTALLATION CHECKLIST FLI Full System Installation ❑Tamils)Only [I Drainfield Only ❑Repair ❑Other System Type Standard Pressure Trenches Pretreatment Type >5 ft.from foundation? - - []WAFt]YES ❑ No 150 ft.from wells? -- - - - - - -- -p-P- -y F11 ❑ _ 150 ft.from surface water? - - - - - - -- --- - - - - - - - - - 0 ❑ F Cleanout between building and tank? ft---F€B-�4-28 - - El U Tank baffles present? - - - - - - - - --*5pN-0001QrT tTIDIRQNTW€NTAL HEAL ® ❑ S24'access nsers over each compartment?- - - - - JBW- -- -- - ® ❑ IN Effluent filter installed?- - - - -- --- - ❑ W ❑ N Septic tank capacity(working) 1250 aal Manufacturer HB Precast O D-box water level and speed levelers used? - - -- - - -- - -- - - - Q WA ❑YES ❑ NO OJ u ManifoldlD-box accessible from surface?- - - - - - - - -- - --- - - - ❑ El El 19= Check valves installed? - - - - ------ - - - - - -- - - - - - - - - - FRI ❑ ❑ G Transport Line Size 2 inch Schedule/Class sch 40 Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - - - - - - - - - - - - - - - - ❑ NIA FRI YES ❑ No G >100 ft.from wells?- - - - -- - - - - -- - - - - -- -- ------ - - - ❑ ® ❑ >lD0 ft.from surface water? - --- -- -- --- --- -- - -- ----- ❑ ❑ ti >10ft.from potable water lines?---- --- -- --- - - - ----- -- ❑ ® ❑ Q= > 5ft.from property lines and easements?- ---- - - - - - - -- - - - ❑ Q ❑ K > 30 ft. from downgradient curtain/foundation drains?---- --- - -- ❑ ® ❑ Drainfield level and observation ports present -- - - - - - - ------ ❑ ❑ Q Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - -- ---- - -- -- -- ❑ 5i] ❑ Pump tank setbacks consistent with septic tank?- ---- --- - --- - ❑ NIA ® YES ❑ No Y Pump tank capacity(flood) 1250 aal Manufacturer He Precast Q24"access nser(s)and accessible from surface?--- -- -- --- -- - ❑ 0 El~ Alarm or Control Panel Installed? ❑ Q ❑ f Control Panel equipped with Timer/ETM/Counter- - - - - - - --- ❑ 0 ❑ 7 0' Pump installed in ❑ Bucket or J] On Block or ❑ Other a Pump Make/Model LIBERTY LP290 ❑ Floats or ❑ Transducer f :3 Tank draw down 1 in/min Pump capacity 25 epm Squirt Height 5.5 ft a Pump on time 2 min 20 sec Pump oft lime 4 him Daily flaw set at 360 apd �peaee eoiau�s Mason County OSS Installation Report pg. 2 Parcel# 520241350030 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - -- -- - ❑ YES ® NO If yes, please describe. Were all components pumped out and properly abandoned per WA0246-272A-03007 - - - -- --- ❑ YES ❑ NO RECORD DRAWING Thn Is a pmnanenl rtcwtl aria...be accuraR mU cexnp4ve eri b rtiacW m an n a malnbnmw wMlava and hNue enMWrent Tvlx'al RxuO rawln,,[ Wln piain1reW6manlrogticnIwm&1gwt. iniICwnglanMKKa!m.M arrow.FPx IXareiW walerkcs. Iri cG'elvt!i r pat, I.. aM otM manleriaxe a'[ess rya-n!s In[u:yXle Rtta0 p3mlgs N[iPa1P d'JOiUTdI aPW51a AAa ms!aWlbn.ypWN dM R9feU pPrm16. I pV 3 J� GO 50� ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with l 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 hate 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. Stale 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. prime `Z Y/ 12-4-24 Signature of Installer Date Andrew L. Lehman Printed Name of Signee 2/7/25 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public H h, 26 Si nat of Environmental Health Specialist Date (stamp, signature and date) THIS FORA1 WAY BE SCANNEDANDAVNLABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE VOaaOCWiot!9 —- , � » ) \ � @ ` j /) � � | \ � PPROVE � e � � Jaw AA> / / \ z � | � f � � ©\