HomeMy WebLinkAboutSWG2024-00195 - SWG As-Built - 2/14/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00195 Parcel# 520241350050
Applicant Name Calvin Dahl Subdivision (Name/Div/Block/Lot)
Applicant Address 261 Hamilton Rd N HIGHLAND ACRES-LOT 5
City, Stale, Zip Chehalis.WA 98532 Installer Name Andrew Lehman
Site Address W Highland RD Designer Name Adam Hunter
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Standard Pressure Trenches Pretreatment Type
>5ft.from foundation? -- ----------- --- ------- --- - ❑NVA ®YES NO
>50 ft.from wells? -- ---- ---- ---- ----------- ---- ❑ ® ❑
Y >50ft from surface water? -- - -- --------------- - --- ❑ Q ❑
Z
FCleanout between building and tank? ------------------- ❑ 0 ❑
U Tank baffles present? -- ---- - - ------------------- ❑ 0 ❑
d24"access risers over each compartment?- --------- ------ ❑ 0 ❑
W Effluent fitter installed?------- --- - ---------------- ❑ ® ❑
to
Septic tank capacity(working) 1250 sal Manufacturer HB Precast
0 D-box water level and speed levelers used? - --- ---- --- ---- @ wA ❑YEs ❑ No
QO Manifold/D-box accessible from surface?- - --------------- ❑ FRI ❑
mZ Check valves installed? - - - - - ---- - - - ------- -- ----- ❑ ❑
OQ
f Transport Line Size 2 inch Schedule/Class sch 40
Bedrooms installed(check one) ❑ 2 M 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?------------------ - - -----. El WA AYES El NO
>100 ft.from wells?----------------------------- ❑ W ❑
W >100 R.from surface water?--------------- --------- ❑ ® ❑
W >10 ft,from potable water lines?-- -- - ------- - ❑ Q ❑
QZ >5 R.from property lines and ea ntp /a{ ❑ 0 ❑
C >30 fL from downgradient curta' dation draillsY-V�sa- ❑ � ❑
Drainfield level and observatio'An
-'-y- '' -�-� ❑ Q ❑
® Graveless chambers or S9fbli uysed. ack
Proper cover installed over drainfiekf?--- -�- --�aM[-IJT�-- -- - ❑ ❑
Pump tank setbacks consistent with septic tank?---------- --- ❑ rut AYES ❑ NO
Y Pump tank capacity(flood) 1250 at Manufacturer HB Precast
Z
H 24"access nser(s)and accessible from surface?---- ------- -- ❑ ® ❑
IL Alarm or Control Panel Installed? - --- ------ - ---- - ----- ❑ ❑
2 Control Panel equipped with Timer I ETM/Counter---- -- - ---- ❑ 0 ❑
7
d Pump installed in ❑ Bucket or R] On Block or ❑ Other
1 Pump Make/Model LIBERTY LP290 il Floats or ❑ Transducer
f
a
Tank draw down 2 intmin Pump capacity 50 apm Squirt Height 6 ft
Pump on time 1 min 10 sec Pump off time 4 fire Daily flow set at 360 opd
tpas.a amoora
Mason County OSS Installation Report pg. 2 Panel a 520241350050
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - - - ❑ YES ❑/ NO
If yes, please describe.
Were all components pumped out and property abandoned per WAC246-272A-0300? - - - - - - - - ❑ YES ❑ NO
RECORD DRAWING
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irdMrgstaAaIII. DramM1eMamanJpq memalmalaywr 5eW"'I Asovf mma"ir, I¢s dramfRa.'xs"ap',xnidE"xsm vra—mxel5.wsenm6
v.Hama,hat.pxrS.ckaMNS.am"rinaillMNRv Mci,s mars, m[drplaY ii Drax✓gs nv aRre smixinal ft, n 1i aSralldWn ii,,h laM,o,c Ftrtrns
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MPSONGi
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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 clearedlapproved by both the designer shown here have been clea ompproved 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.
,i 12-4-24
Signature of Installer Date
Andrew L. Lehman
Printed Name of Signee F:yw 2/7/25
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health: r .
Signi of tk4ormental Health Specialist Date
(stamp, signature and date)
THIS FORM vi BE SGWNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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