HomeMy WebLinkAboutSWG2024-00470 - SWG As-Built - 4/16/2025 Mason County OSS Installation Report pg. 7 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG 2024-00470 Parcel 4 32018-53-03005
Applicant Name KENNETH HIRSHHORN Subdivision (Name/Div/Block/Lot)
Applicant Address PO BOX 18792
City, State, Zip SEATTLE,WA. 98118 Installer Name SCHOENING EXCAVATION
Site Address 212 W POPLAR Designer Name CINDY WAITE
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ® Repair ❑Other
System Type PRESSURE DIST Pretreatment Type
>5 ft.from foundation? - -- ------- - --------------- - ❑ NIA YES ❑ NO
>50ff.from wells? - - - - - - - - - - -- --------------- - -
❑ ® ❑
>60 ft.from Surface water? - -- - ---.,--------- ------ - El � ❑
H Cleanout between building and tank? -___________ ______ . ❑ ® ❑
U Tank baffles present? - _ ___ _ _ _ _ _ ___ _ __ _ ___ __ _ - ❑ ® ❑
1= 24"access risers over each compartment?. ______ __ __ _ ___ . ❑ ® ❑
4
W Effluent filter installed?- - -- -- -- - - --- -- -- --- - - --- --
� f w❑ ❑
�Y flop ❑ £X 1
Septic tank capacity(working) I - rreu gal Manufacturer
D-box water level and speed levelers used? ___ __________- ❑ NIA ❑ YES ❑ NO
�O Manifold/0-box accessible from surface?- _____ _________ . ❑
9< Check valves installed? - - - - - -- -- -- - ------- ------ - ❑ ❑
Transport Line Size 2 Schedule/Class SCHEDULE 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ON 6 ❑Commercial/Other W ••
>10ft.from foundation?--- - - --- - - - --- - - ------ -- - - ❑ NIA YES NO
>100 ft.from ft wells?-- -- --- --_ _ 1p w V ____ v
>100 .,from surface water? ---- T--�I -- ❑ ® o
ly >10 ft, from potable water lines?- - - Y ` ❑
C >5 ft.from property lines and easem ._QPR -^� „- ❑ ® o_ I�I
>30 ft. from dmirgradient curtain/foutlyftllXrglna?^, NTtE�7AL ® El
O Drainfield level and observation ports present NEgL7;,
- --, .__ ❑
❑ Graveless chambers or ❑ Clean gravel used? (lock one)
Proper cover installed over drainfield?--- -- --- ---- ------- ❑ ❑
Pump tank setbacks consistent with septic tank?-- --_--_-_._- ❑ NIA Yes ❑ No
ZPump tank capacity(flood)- !r1`7,f gal Menufacalrer
24"access riser(s)and accessible from surface?--- -------__- ❑
y Alarm or Control Panel Installed? - -- - ----------------- 13 ❑
Control Panel equipped with Timer/ETM/Counter- - - - -_-___- ❑ ❑
a Pump installed in ❑ Bucket or rr On Block or ❑ Other ,
Pump Make/Model I+L 152, m 2
K ❑ Floats or Transducer
p, Tank draw down _in/min Pump capacity !6( opm Squirt Height r ft
Pump on time Pump off time Daily flow set at - pd
up.d nnv201e
Mason County OSS Installation Report pg. 2 Parcel# 32018-53-03005
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - ❑ YES K NO
If yes, please describe.
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - --- -- � ❑ YES ❑ NO
RECORD DRAWING
Thb la is parmanant radon and must da accuse and de¢dpdvs enough to reluoala In this nand or ma pia,nnu amlvldac and tutus development Typical Remm,
DrawirpemnWin: DarinfiNrlamenibldonenlatian8layout,Semldpump,enhI S.NMhero fftnve@¢Infield,sofYngend prompted buildings, marm Olwells.wen, mans.
vollo.obaervetldn yen,deanours and other mouribraloce amass points. inundations Re[md cravings may maw
`imp imel delays in final irradiation approval and relate rmlor d pe
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I 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 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 meet all
and Mason County Codes. State and Mason County Codes
1 further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Sigirfis a of Installer Date P r
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Printed ame ofSignrse "r k'
MASON COUNTY PUBLIC HEALTH pA st is
p MIND V E wAITE
The undersigned approves this Installation Report and LICENSED DESIGNER
Record Drawing on behalf of Mason County Public
JSignn
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r vironmente He Ifh Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upmua enlnpte
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North 2nd Street
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h , $ `- 41 �, MASON COUNT EN RO MENIAL HEALTh
Cindy Waite
80 E Pickering Lane
Shelton,We. 98584
cindyewade@Rm,com
Cel1:360-701-0205
Home:360-426-2113
RE:212 W Poplar St
Parcel#32018-53-030005
Kenneth and Marlie Hirschhorn
PO Box 18792
Seattle,We. 98178
1 am turning in the record drawing for this repair.As per the approved design,operation and
maintenance is required at three months of installation and then every six months.
Maintenance provider should inspect each lateral to determine that there is no ponding.
The pump controls reading should be taken so we have history.One minute pump down
should be done also.
It is extremely important to keep the useage at 540 gallons per day.If alarms are going off,
should be addressed immediately.
Water use should be spread out through the day.Clothes washing should not be done all in
one day. The county has maintenance manuals that they should send you and they may
have some written in Spanish. No grease should be introduced to the system.All cleaning
products should be used per directions. Do not use dish soap that is a grease emulsifier.
Respectfully submitted
Cindy Waite /
3 ,x+ ,
IN fi^'
� C610E l
LICENSED DESIGNER 6I cc.uus uma