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Home My WebLink AboutSWG2023-00038 - SWG As-Built - 4/16/2025 Mason County OSS Installation Report p9. 1 MASON COUNTY PUBLIC HEALTH APPLICANTI PERMIT INFORMATION Permit Number SWG 2023-00038 Parcel# 32124-52-00031 Applicant Name Mark Tansev Subdivision (Name/DivlBlock/Lot) Applicant Address 410 NE 103rd St Apt 6B City, State,Zip Kansas City Installer Name Abel Excavation Site Address 251 E.Emerald Lake Dr.W Designer Name Bob P yesa INSTALLATION CHECKLIST Full System Installation ❑ nk(s)Only ❑Drainfeld Only ❑Repair ❑Other System Type Pretreatment Type >5 fL from foundation? -------------------------- ONA ❑vas NO >50 ft.from wells? ------- ---------------------- ❑ ® ❑ Y >50ft.from surface-alert .______________________- ❑ ® ❑ Z ❑ Q Cleanout between building and tank? ------------------ - ❑ ❑ r ❑ 1p Tank fretfles Present? ----- ---------'-'-"'-"-` ❑ H 24-access risers over each compartment?---------- ❑ Lu Effluent Lifter installed?--------------------------- ❑ ® ❑ N Septic tank capacity(working) 1500 pet MenWetlurtx Haggernan Precast rC?-2Chec:k water level and speed levelers used7 -------------- - ❑wA NO ____-__-ldlD-box accessible firm surface?---------valves installed? ------------- --"---..q^ SchedulelClass3034 ort Line Sizerooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑CommerciallOther ❑ NO ft.fromfaundatIon?--------- -------"--- - awn vea0 ft.from wells?----------- -----"-------- ❑ ❑ ❑ W >100 ft.from surface wataPl-_______________________ EL >10ft.from potable water lines?-_____________________ ❑ ❑ >5ft.from property lines and easements?-------- ❑ ® El d >30ft.from downgraoient curtain/foundation drains?---------- ❑ O 0 Drainfleld level and observation ports present -------------• ❑ ❑ Greveless chambers or E Clean gravel used? (check one) ❑ Proper cover installed over dralnfleld?------------------ - Pump tank4iMsconsistentwithseptictank?------------- NA ❑ ves ❑ No ZPump tan (flood) gai Manufacturer-. —2qr acces and accessible from surface?---------Alarm or anel Installed? -------------------"- S Control Ppped with Timer/ETM ICounter----------- ® ❑ ❑Pump inst ❑ Bucket or ❑ On Block or ❑ OtherPump Mal ❑Floats or ❑Transducer i Pump cepaary Dorn Squirt HeightPump oft Ome Daily Flow set at opd 16 2025 MASON COUNTY ENVIRONMEN iAL HEALTH JBW Mason County OSS Installation Report log, 2 Parcel# 32124-52-00031 ABANDONMENTRECORD Were wdsng septic components abandoned as part of the project? --- __ ____ If Yea, Please describe _____ . YES Q NO Were all components pumped out and property abandoned per WAC24&272A-0300? •------ . ❑ YES ❑ NO RECORD DRAWING TM1b b.wrm.aem nwre.na roan en.cw..r.w monNl...uuen m ruloap In w a•w w ina .bna eWN..nq rwa.a prmncOn vmptil; OniMlwadmvWoq orlaMtlmdaYaK E.PI1CNv'D W. e-.Abamm,r.mrve EnFflNO. •••�•M. TFk'.I Rama w115 caaamCmiPve.cb.nwN..M OViv m.lnlvmrs va» dnN. Fmn •v`an9eM CnW+.a WIa4N.,balbnNw.ra.vaMlnw. P pee Rvcy ereMn9a maY>6aR aa4ltlorial aary.nllmllmWlhlM aPPnralva yatl wmYly. 1� a s� OJ 2 0 ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I earthy that I installed the system In accordance with I c*Y*that the system has been installed in accor- the septic design stamped APPROVED-by Masan dance with the septic design Stamped'APPROVED'by County public Health and Mat any deNations shown Mason Col public deignalth end that any PROV EC here have been GearerlFapproved by both the designer shown here have been c/eamd/appmved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet ell and Mason County Codes. State and Mason County Codes 1 further Parlay that all information contained on this I further cer tify that all information D win contained on this tom+fomn and�oN Drawing is accurate. form and attached Record Drawing is accurate. `AI;-H SO e ISaflnatellerf1 Date 11 r✓l fir rlc Pnnled Name ofSignee I I MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and AS147 . ng on behatt of Mason County Public E{P1Rae " ronmerdel Health Specialist Data (stamp,signature and date) THIS FORM MAY BE SCANNEDANDAVAIL LE FORPUSLICVIEW ONTHE MASON COUNTYWEa SITE Wawaerzvsmn EMERALD LAKE DRIVE WEST I � I I PROPOSED WATERLINE olI ppR � 0 E N I PROPOSED I R MgSON APR 61Q7 BUIDLING COUNTY AREAEAIVIRONMEN NEAL7h D L_---- Dc` I 10' FOUNDATION PROPOSED SETBACK TO DF SEPTICTANK PROPOSED DRAINFIELD I m m >� I � I I P IAPPROX. OHWM I — ter b � �7 EMERALD LAKE- E t iV AN ASBUILTI CHARGED WINSSIGNOFPEE WILL BE CHARGED AT TIME a INSTALLATION CLISTO�MEA: MARK U 1 TE l HOLE I: TEST HJLE 2. L NEER. DIGGING, INC <'L` °.° _ P.4RCFL x3112452-00031 li,,,T:4ow r.� a rJw SEPTIC DESIGNS ADDRESS: 251 EMERALD LK DR W ��L�w,V RT�'�,'�Rn. cRArF�1M'"'A 115-K DEICNER: ROBERT H.PAYSSEfTICFxnt2G 130.1 F:,� k+�-42]2353 SHEET. SITEPWN SCALE P=30' - �•v.w eux.d..�o,o