HomeMy WebLinkAboutSWG2024-00420 - SWG As-Built - 4/15/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00420 Parcel # 42205-51-01063
Applicant Name EVANS EARTHWORKS Subdivision (Name/Div/Block/Lot)
Applicant Address 282 MILLER RD
City, State, Zip PORT ANGELES, WA 98363 Installer Name B-LINE CONSTRUCTION
Site Address 81 N DUCKABUSH DR N Designer Name CINDY WAITE
INSTALLATION CHECKLIST
■ Full System Irmitallatlon ❑Tank(s)Onty ❑ Drainfield Only ❑Repair ❑Other
System Type GRAVITY treatment Type
>5 ft.from foundation? -__-_---- __ _ - ❑ NIA ®YES NO
>50 ft.from wells? - ---------- o"--- - ® ❑ ❑
Z >50 ft.from surface water? . _____ _ _ �'�ty_ ❑ ■ ❑
H Cleanout between building and tank? - e -MpQ�- ------- ❑ ® ❑
V Tank baffles present? - - - - -- - -
--- ❑
IL 24" access risers over each compa - -- __ _ __ ___- ❑ ® ❑
W Effluent filter installed?- - - ------ __ t- ---- --- -- -- ❑ l ® 1 ❑
f� Septic tank capacity(working) 2 C7 Manufacturer Soy n G Q`1 •-e r� &N 4
�9 D-box water level and speed levelers ---------- -- - - - ❑ N/A ■ YES NO
QQLL Manifold/D-box accessible from surface -------- ---- -- - - ❑ ■ ❑
Check valves installed? - - - - - - - ------------ -- -- - - - ❑ ❑
LSS.. Transport Line Size 4 Schedule/Class 3034
Bedrooms installed (check one) ® ❑3 ❑4 ❑ 5 ❑8 ❑Commercialf0ther
>10ft.from foundation?-- - - --- ------------------- NIA ® YES NO
W >100 ft. from surface water? ----rL -
- -- n
� ■ ❑
>10 ft. from potable water lines?---- - _�- ---
��� ❑ ® ❑
> 5 ft. from property lines and easements?--
C > 30 ft. from downgradient curtain/foundation Eyll - ■ ❑ ❑
Drainfield level and observation ports prasent 4i'Z1----JOW- ❑ ® ❑
❑ Graveless chambers or ■ Clee 'gravel t e se (all"one)
Proper cover installed over drainfield?- ----------------- ❑ ■ ❑
Pump tank setbacks consistent with sepletW------------- ❑ Selk ❑ YES NO
ZPump tank capacity(flood) jai Manufacturer
Q 24"access nser(s)and accessible from rface?-------- ----- ❑ ❑
SAlarm or Control Panel Installed? ------------- --- ----- ❑ ❑ ❑ ��. 1
Control Panel equipped with Timer/E /Counter-- - --- - ---- Q ❑ ❑ "(
IL Pump installed in ❑ Bucket or ❑ Dn Block or ❑ Other
= Pump Make/Model _ ❑ Floats or ❑ Transducer
IL Tank draw down in/min Pump rapacity dpm Squirt Height ft
Pump on time Pump off time Daily Bow set at gpd
Up .21=18
Mason County OSS Installation Report pg. 2 Parcel n 42205-51-01063
A ANDONMEN ' RECORD
Were exieang septic components abandoned as pert of this project? - - _ _ _ YES , No
If yea, planes describe:
Were,all components pumped out and property ab ndoned per WAC249-272A.0300? - - ---- - - YES No
RECORD DRAWING
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APPROVE
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APR 15 ?!ti
MASON COUNT'EM°RONMENTAL HEALTH
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2(Recon)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 m 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 here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meat all
and Mason County Codes. State and Mason County Codes
I further certify that alb information contained on this I further certify that all information contained on this
th m and shed Record Drawing is accurato i. form and attached Record Drawing is accurate.
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Siguilliture of Installer to
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Pnnhtl Name of signee 8
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and s
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7eeidRe co Draw Iing on behalf of Mason County Public aNSSED I
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kh ^`IERWIES pare I \q
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Sig nvimnmlimal Health Specialist D to
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE �Wae asvmfe
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