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HomeMy WebLinkAboutswg2024-00400 - SWG As-Built - 2/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2024-00400 Parcel# 32025-50-00921 Applicant Name Tiffany Ingersoll Subdivision (Name/Div/Block/Lot) Applicant Address 44942 Pine Shadows Rd Mill Creek Park Unrecorded City, State, Zip McArthur CA 96056 Installer Name Maples Excavating Site Address 180 BE Channel Point Rd Shelton Designer Name Arrow Septic Desi s Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Orainfeld Only ®Repair ❑Other �� OI System Type OSCAR X02 Pretreatment Type X02 O 15ft.from foundation? -- --- - - - - - - - - - -- -- - -- -- -- - ❑ NIA ®YES ❑ N >50 ft.from wells? --- - - - - - - -- -- - - ❑ ® ❑ Y >50ft.from surface water? -- - - -- - - - - - - - -- - -- - - - - -- ❑ ❑ f Cleanout between building and tank? - -- - - - - - -- -- -- --- -- ❑ ❑ U Tank baffles present? - - - - - - - - - - - -- - - - -- --- - --- -- ❑ ® ❑ R24"access risers over each compartment?- -- - - -- -- - -- -- -- ElEl® W Effluent filter installed?- --- - ---- -- - - - - - -- --- - - -- - - ❑ ❑ s Septic tank capacity(working) 1.250 gal Manufacturer Existing 2-Compartment ❑ D-box water level and speed levelers used? - ---- -- ❑ WA ❑ YES ® NO 0O Manffold/D-box accessible from surface?-- - - - - -- - - - --- - --UL El ® ❑ roZ Check valves installed? -- - - - - - - --- - ----- - -- - --- -- ❑ ❑ ❑4 M Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 s 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft,from foundation? - --- - -- - -- ❑ NIA ® YES El NO G >100 ft.from wells?- ---- - - -- --- ❑ s ❑ W >100 ft.from surface water?- --- - -- - -- -- - -- -- - - - -- - . ❑ ® ❑ M >10ft.from potable water lines?- - -- -- - - - - ---- --- - ---- ❑ s ❑ QZ > 5ft.from property lines and easements?-- - --- - - -- - - - - - - ❑ s ❑ C > 30 ft.from downgradient curtain/foundation drains? - - ❑ s ❑ ❑ Drainfield level and observation ports present --- ❑ 0 ❑ Proper cover installed over drainfleld?- -- -- -- --- - - -- - -- -- ❑ s ❑ Pump lank setbacks consistent with septic tank? - ❑ NIA s YES ❑ No ZPump tank capacity(flood) 1,250 at Manufacturer Ruth 2-Compartment F 24"access risene)and accessible from surface?- - --- - - - - - - -- Alarm or Control Panel Installed? - - --- - - - - - - - - - - - - - - -- ❑ s ❑ Control Panel equipped with Timer/ETM/Counter- - - - - --- - - - ❑ s ❑ 1 Pump installed in ❑ Bucket or ® On Block or ❑ Other (L Pump Make/Model AYMCDonald E-30 ® Floats or ❑ Transducer a Tank draw down — in/min Pump capacity 30 gpm Squirt Height — ft Pump on time 30 sec Pump off time 3 min Daily flow set at 360 gpd urcaaaea+rm�e Mason County OSS Installation Repoli pg. 2 Parcel Y 32o2� ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- YES ❑ No If yes,please desaibe. n(,&— Amk, {'�—' Were all components pumped out and property abandoned per WAC246-272A-0300?"-----'" EYES NO RECORD DRAWING T1Ja b a prnlnlnr nwp lM muII!!auunY!nit dlxriptive enau9fi m Mecav in Me need M menm�unp acYvttw and NW m dlvsbpnlnc TYp Rec Omvip!ivn0in: pmMiYd8mY'ICYE otieMNm84ryN.Se0'wPump urA IauOw,NaN artow.nxM dnlriAdd.Wral deY I"" WiW�es.I —xalxNlq xmlW�ms, yepl.dWrvaOon PwO.WSSINb.brit ONll mmlenma exlx poin6. Ir2amgYa RlmN pnranfib maJms¢sdMbiW deLySinfiwl'mstYYlm ippmW and/tliWp aR ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system I......dance with I cartify that the system has been installed in axor- the septic design stamped'APPROVED'by Mason dance with the sepdc 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 010aredfapproved by both and Mason County Public Health and meet alf state myseM and Mason County Public Hearth and meet all and Mason County Codes. State and Mason County Codes 1 further certity that all information contained on this I further certify that all information contained on this form antl attached Record Drawing is accurate. form and attached Record Drawing is accurate. 3Gip^n1afure of lns(h/Nr ` Date PnmedName of Sign. e' MASON COUNTY PUBLIC HEALTH A The undersigned approves thus tnaratletMie' port FbU � VzC- Reronf Dra g win on behaUof Mason Counry t� 1 Hee ,l 012 PAULAJOY JOHON' Z .i NS Ea" FNyi p�q N}f Th -L1 .f Environmental Health Spedali yst Dare t! Z (stamp,signetufe and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBUC VIEW ON THE MASON COUMY wBa BITE Uwbelamadn v � Lea- Cv Ga.n.9z/ s5oea5� 10lot �hv tp W5 I — --✓SCp� � � !"_ / V. 1 . — ^^ i i aVED FEB2 71015 MASONCOUNTYEN IRONMENTAUHE4LM A 21ec P _ t `eS�' '4 Scala: 7 � —y0 D 10 4P 60 80 $�� 4i J O-I Zti Sal} IOG (�, Conttol P» with Ar;A'o-Vic'+i Ala,c in rY 04. As- gu� OO AeA-1k KeedA.Q. 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