HomeMy WebLinkAboutSWG2024-00414 - SWG As-Built - 5/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00414 Parcel# 22116-75-00010
Applicant Name Arthur Sommer Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 437
City, State, Zip Allyn, WA 98524 Installer Name owner install
Site Address 230 E Rivendell Rd, Grapeview Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
• Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type pressure trench Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO
>50 ft. from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - ❑ 0 ❑
F Cleanout between building and tank? - - ❑ 0 ❑
U Tank baffles present? - - ❑ ❑■ ❑
a24" access risers over each compartment?- - ❑ • ❑
W Effluent filter installed?- - ❑ 0 ❑
N
Septic tank capacity(working) 1,250 gal Manufacturer Hagernan
0 D-box water level and speed levelers used? - - ❑ NIA ❑ YES ❑■ NO
J
DO Manifold/D-box accessible from surface?- - ❑ 0 ❑
002 Check valves installed? - - ❑ it ❑
6Q
2 Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed(check one) 0 2 ❑■ 3 ❑4 0 5 0 6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A is YES ❑ NO
0 >100 ft. from wells?- - ❑ In ❑
w >100 ft. from surface water? - - ❑ ® ❑
LT. >10 ft. from potable water lines?- - ❑ ❑■ ❑
Z > 5 ft. from property lines and easements?- - ❑ I 0
Q
re > 30 ft. from downgradient curtain/foundation drains?- - ❑ II ❑
CI
Drainfield level and observation ports present - - ❑ II ❑
❑ Graveless chambers or NE Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ■❑ ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A is YES ❑ NO
`-L Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
< 24" access riser(s) and accessible from surface?- - ❑ El ❑
F—
a Alarm or Control Panel Installed? - - ❑ 0 ❑
E Control Panel equipped with Timer/ ETM /Counter- - ❑ II ❑
D
n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a• Pump Make/Model Liberty 280 • Floats or ❑ Transducer
d Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 3 ft
Pump on time 2.3 minutes Pump off time 6 hours Daily flow set at 360 gpd
uDdatec 8J1201P,
Mason County OSS Installation Report pg• 2
Parcel 22 t I "— ��5 + C�
ABANDONMENT RECORD
_ 10 YES tp NO
Were existing septic components abandoned as part of this project?
If yes, please describe: YES ❑ NO
Were all components pumped out and properly abandoned per WAC246-272A-0300?
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record
tion.North arrow,reserve
ed
Drawings s contain:
rvati n: ohs el 8.a outsnand other ifold maintenance access points.tank
Incomplete Re d Drawings may create additOfl l delays iof final installation l approv location
al and relatedie'rmits.
wells.observation ports.Ge
Sf. P -4a(--\ D
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 installed the system in accordance with 1 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
nd Mason
aso Countyouty Public
ubi Health and meet all
and Mason County Codes.
odes
1 further certify that ail information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
ZZ Z
gnature of Installer Datet9 .
• J Sr M oil2 d C t�whe J ' . r.
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Printed Name of Signee W� :-A;:':-A;:' i, `h
\-,
MASON COUNTY PUBLIC HEALTH � t��
astor!3aa
' PAULA JOY JOh{NSON
The undersigned approves this Installation Report and s CiCUISE 'bJSIGNEft•'
Record Drawing on behalf of Mason County Public EXPRES r1 t
Health: C^w ^ c[ 7J23
4 �-ut.-LS
�S l " ` (stamp, signature and date)
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated sntno,a
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