HomeMy WebLinkAboutSWG2020-00013 - SWG As-Built - 4/16/2025 rAddress
ty OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
ber SWG 2020-00013 Parcel# 12031-12-90030
ame Dave Peterson Subdivision (Name/Div/Block/Lot)
ddress 8405 Dawson Dr. SYSTEM"B'
ZipPlano,TX 75025 Installer Name Vllines Excavation LLC
ss 821 E.Camden Way Designer Name Dale L.Tahja
INSTALLATION CHECKLIST
❑Other
Full System Installation ElTank(s)Only ❑Drainfeld Only ❑Repair NIA
System Type Gravity Bed Pretreatment Type
>5 ft from foundation? ---------- 0-
LLI ❑WA �� ❑ NO
>501L from wells? ----------- ❑ ® O
Z >50 ft.from surface water? --- --- 2 ❑
Q Cleanout between building and tank? - -A ❑ ® 0
F ❑
V Tank baffles present? --- -- ---- -
H- 24`access risers over each comparbne CL --Effluent filter installed?- --------- y ❑ ® ❑
N Septic tank capacity(working) 1,250 net Manufacturer Infiltrator IM-1250
0 D-box water level and speed levelers used? -- ------------ ' ❑ NIA ®YEa ❑ NO
J ❑
0O Manifold/0-box accessible from surface?---- -------- -- ❑ ® El
Check valves installed? - --- --- -- -- - "" - ❑
022 Transport Line Size 4 inch SchedulelClass 3034
Bedrooms installed(check one) 2 �1- 6 O Commercial//Oher
>tO ft.from foundation. - --- -- N/A Yes ❑ No
F ®
>100 R ❑ Elfrom wells?--------- --APB_1_&��__ ® El>100 fl.from surface wateA--- -- ❑
U: >10 ft.from potable water lines?-VA"tO Ty-ENViRONMENTAt HEAEiH ❑ ❑
a
>5ft.from property lines and Easements?- ---JIM-------- ❑ ❑
W > 30 ft.ft=downgradient curtainifoundation drains?------"--• ❑ ❑
Drainfleld level and observation parts present ---- -------_-.
❑
❑ Graveless chambers or W Clean gravel used? (check one) ® ❑
. ---------
Proper ccvennstalled overdremfleld?- ---------
Pump tank setbacks consistent with septic tank?------------ - TWA ❑ YES ❑ No
Z Pump tank capacity (flood) gal Manufacturer ❑
Q 24-access dser(s)and accessible from surface?-------- -- ❑ El ❑
SAlarm or Control Panel Installed? - - -- - - - - ""-"" - ❑ ❑
Control Panel equipped with Timer/ETM/Counter---------- - ❑ ❑
1 Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
n' Pump Make/Model ❑ Floats or ❑Transducer
g
a Tank draw down inlmm Pump capacity gpm Squid Height ft
Pump on time Pump off time Daily flow set at gPd
Moon Cou fty OSS Installation Report pg. 2 Parcel u 12031-12-90030
ABAND0liMENT RECORD: "
Were M*fi g $eptic componars i abandonad as pan or mis Pmlect? . -------------- 0 ns ® MO
a yes,please desonice:
Were all WmponaMa pumped out and properly abandoned par WAC246272A-03W? •__--__. 0 YES Q No
`-:.`RECORD ORAWMG
n*Fe daaauar never wwn.aaaassaa less, a
pm.Finaa : eusaw FesmdrM.rw
• .�dW.rYoa,vJ aFa mwtlwuan W✓d NsaasatieedgrnMa.
PpRO V �
MASON COUAPRNVIRONM25
J13W TALHEALTH
E Record D,a ing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
t cattily that I installed the system in accordance with I cerb'y that the system has been installed in accor-
the septic design stamped'APPRO VED'by Mason dance,with the septic design stamped'APPROVEW by
County Public Health and that any deviations shown Mason County Public Health and that my deviations
here have been chaued/appmved by bode that designer shown here he"been ctearedkpproved by both
and Mason County Public Health and meet a#Stele mysatl and Meson County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all intonation contained on this I further certify that all information contained on this
form and adached Record Drawing is a icutele. form and attached Recent is accurate.
-:3rg _� tlldis
Slynatunoflnslaller Dale G �?
77 L6 1/ tiit mc4 e
Rinfed Norms oI Signers so
a y
MASON COUNTY PUBLIC HEALTH :f �Lg Ad'N�
The undersigned approves this installation Report and F,
O On bBhaflofMas S
on County Public `� Dais
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he at Ia
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col � E
LICENSED DESIGNER
1 HMO Dam (stamp,signature and date)
nor
TNIaFtt.BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE NhSON COUNTY WEB&TE
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MAS GOUNTV ENVIRONMENTALHEAITH
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