HomeMy WebLinkAboutSWG2020-00012 SYSTEM A - SWG As-Built - 4/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00012 Parcel# 12031-12-90030
Subd�\'n�n v�BlpcWLot)
Applicant Name Dave Peterson (
Applicant Address 6405 Dawson Dr.
City, State, Zip Plano,TX 75025 Installer Name Villines Excavation LLC
Site Address 621 E.Camden Way Designer Name Dale L.Tahia
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other.
System Type Gravity Bad Pretreatment Type NIA
>5 ft.from foundation? -------------- �— []NIA ®YES NO
>50 ft.from wells? ---------- (\1�� - 2m,
--
Z >50 ft.from Surfacewatel? - ----- 8 -`----Q�- ❑ ® ❑
F Cleanout between building and tank? WW% ----- - ❑ ® El
U Tank baffles present? - - ----- -- ❑ ® ❑
d24"access risers over each compartme t?---- - - ❑ El
W . Effluentfitterinstalled?---------- 61 --------- --
Septic tank capacity(working) ❑ ® ❑
N 1,250 -rat Manufacturer Infiltrator lM-1250
9- D-box water level and speed levelers used? -------------- - ❑ NIA Eves ❑ No
00 Manifold/D-box accessible from surface?---------------- - ❑ � ❑
Tz Check valves installed? ---- ----------- ---- ❑ ❑
04 4inch Schedule/Class 3034
2 Transport Line Size
Bedrooms installed(check one) ❑ 2 ®3 ❑ 45 ❑6 ❑Commerdal/Other
>10ft.from foundation?-------- _______ I1�� w'ter❑-1NIA 0Yes NO
>100 ft.from wells?----- ---------�-- '--��s7ty7� ❑
OJ >100 fL from surface water? -------
---- 4 ❑
o ft.from potable
Z >15 ft.from properlywnes atnd easemems? -- SDy��a b � 1 114 • ❑
Q ❑
X > 30 ft.from downgredient curtain/foundation drains?----�/�p+,�yy�F/V ® ❑
0 Drainfield level and observation ports present -- -- --- ----*-- O ❑
❑ Graveless chambers or M Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - ------ ------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - ® NIA ❑ YES ❑ No
Y. Pump tank capacity(flood) gal Manufacturer
Q24"access riser(s)and accessible from surface?------- - --- -- ❑ ❑ ❑
aAlarm or Control Panel Installed? -- - --------- ❑ ❑ El
7 Control Panel equipped with Timer I ETM I Counter--------- - - ❑ ❑ ❑
iL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a- Pump MakelModel ❑ Floats or ❑Transducer
0. Tank draw down in/min Pump capacity__—gpm Squirt Height ft
Pump on time Pump oft time Daily flow set at_gpd
"oa WIM1e
Mason County 068 Installation Report pg. 2 Partel t 12031-12-90030
,ABANDONMENTRECORD.
Were 044"sapec conhporwnta e),ndered ae Pan Of to pueiac? ----+------ Om ■ se. .
d yes.Isaasa describe:
were sowincreng pumped out and popery abandoned per WAC246-272A-0300?•------- ❑ Q �
:'RECORD DRAWING
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APPROVE
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ENVIRONMENTAL hEA,Ti,
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■ Record Drawing Attached
CER'TMICATIOM OF I WMA ATI0N
INSTALLER DESIGNER/ENGINEER
I candy that 1 installed the system in accordance With I certify that the system has been installed in accon
me septic design stamped'APPROVED'by Meson dance with the septic design stamped'APPROVED"by
County Public Health and that any deviations Mown Mason County Public Health and that any deviators
here he"been dearad/appro"d by both the designer Mown here have been deared/approved by both
and Mason County Public Heath and meat all State myself and Meson County Public Health and meet aft
and Mason County Codes. State and Mason County Codas
f further cerffy that ad irdonnabon contained on this /further certify that aft information contained on this
!vm and attached Record Drawing is accurate tone and attached Record Drawing is accurate.
Somose of instaaer Data
I '77 .ts, U/11', v-c4 �
Printed Name of S9aaa
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and ti4r J o
Record Drawing on behatof Mason County Public 5100214
� Dale L Tahja
�. Lli'(D ZS ESIGNER
Si V° I Heatth Specialist DON ( Vie)
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