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HomeMy WebLinkAboutSWG2024-00159 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SING 2024-00159 Parcel # 22005-51-00005 Applicant Name Mike Randich Subdivision (Name/DivlBlo• Lot) Applicant Address 1222 Friedlander Dr. IkA9'N-, City. State, Zip Abeerdeen WA 98520 Installer Name B-LINE CON^ 1 Gi N Site Address 750 E PHILLIPS LAKE LP RD Designer Name 1Q �NJ, . INSTALLATION CHECKLIST ❑ Full System Installation III Tank(s)Only ❑ [lrainfieid Only ❑Repair ❑Other System Type PRESSURE Pretreatment Type �5 ft from foundation? - - - 0 NIA It YES ❑ No e >50 ft. from wells? - - ❑ ® ❑ .ir >50 ft. from surface vrater? • - - - - 0 IN 0 V Cleanout between buildino and tank? • ❑ Ill 0 Tank baffles present? . • ® ❑ ❑ ell 24-access risers over each compartment? - - - - [] © ❑ i. Qs Effluent filter installed?- - ® ❑ ❑ Septic tank capacity (working) qal Manufacturer 0 D-box water level and speed levelers used? - - 0 NIA ElYES ❑ NO DO ManifotdlD•box accessible from surface?• . Li ❑ mz Check valves installed? . ❑ 0 0 0< 2 Transport Line Size Schedule/Class Bedrooms Installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ NIA ❑ YES 0 NO CI >100 ft from wells? - - - - - • ❑ ❑ ❑ W >100 ft from surface water? • - -- - - - ❑ 0 0 LL >10 ft. from potable water lines?. - 0 ❑ ❑ Z > 5 ft from property lines and easements? - - - - - • ❑ 0 0 Q D > 30 ft from downgradient curtainifoundation drains? - - El ❑ Dratnfield level and observation ports present - - • ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ® NIA El YES ❑ NO b Pump tank capacity (flood) qal Manufacturer < 24" access riser(s)and accessible from surface? • • - - - - - - - - - - ® ❑ 0 1— a. Alarm or Control Panel Installed? - - 0 Fil 0 Control Panel equipped with Timer/ ETM I Counter- - ❑ lid 0 a Pump installed in ❑ Bucket or ❑ On Block or ig Other C,k...k \)Q.��� ` 2 1 Pump Make/Model 4�•1oec+/ t - .115Q rogi Floats or ❑ Transducer R. Tank draw down 2- in/min Pump capacity Sv gpm Squirt Height 3.3 ft Pump on lime 41 S,e - Pump off time 3‘•-T Daily flow set at qpd . Mason County OSS Installation Report pg. 2 Parcel # 22005-51-00005 ABANDONMENT RECORD Were existing septic components abandoned as part of this protect'' - • ❑ YES (A NO It yes. please describe T'' __ Were all components pumped out and properly abandoned per WAC246-272A-0300? - • 0 YES ❑ NU • RECORD DRAWING Trim la a permanent record and mual be accurd o and deaulpti+ar',laugh to re-totals In In.Head of matnt.nanu actnaW and IULU'Wretapment. Iyn.ar NhZ3l i Drafer46=Main Ownheie$rnenAOU coe,Nteliorr d tatout ftelewmv tan,location N:rer aro v reserve dralr4erd maim and pr7po.0 twrdmpa el.'1l4r respells tvreren'a mane * iar.atcn posta tteanod" ano om*'mvi.wr.anx ar.ASs Four* r:.-vrtele Re=s Orates rrar:Taate eddaione'defer In fele,costa:at.r aulrrc4ai aim relayed Gsr*is 14Iatw. 0:k Z C,o„Sree.1 Q.,he\ Mete. '.,,sL.\)e Ne �'ta►�lib r L� w 1r .F I\oqr Fx.ai• Y b 0 Record Drawing Attactteil CERTIFICATION OF INSTALLAtION INSTALLER DESIGNER/ENGINEER /certify that!installed the system in accordance with I certify that th system has been installed in accor- the septic design stamped "APPROVED"'by Masan dance with the ptiC design stamped APPROVED"by County Public Health arid that any deviations shown Mason County Public Health and that any deviations here have been cleared/opproved by both the designer shown here hake 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 Mosari County Codes 1 further certify that all information contained on this I further certify that all information contained on this form and attached Reco rawrng is accurate form and attached Record Drawing is accurate Sr ture of Instaltnr! Date ` r PnntotNamn of Srgnno MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health Rib/1W\ c(W) c161C--- Signature of Envfronmontai Health Specialrst Date (stamp signature and date) THIS FORM MAY BE SCANNED ANU AVAILABLE FOR PUBLIC VIEW ON T' E MASON COUNTY WEB SITE L';"6.1`'''`'. _ _ sr* _...„.. i r a....w , -415.--.., ✓.—.- -....r..••.— vet.•. F Ii ►y t• II • •. bep• 'O• •lit -, • • -4 Mitiat4D 4S ( ilt,, b.q, •.4l a ♦It', l'� •'� v / •'9 ••, O` • O, ,•O , ` L ''' li 71... °II • ''.. ..'". .‘...... ..... .. ............_ :.� R et I yell t%141. 1:R.. 1/4'11 \.3 (Is VW con j -20__. war*mum a g g Aatil j ' i • •• OW• • •0. • • ..• — 4 / 5 ti r) i stiri O Gw O 3 P ell , " ED Cis E i fcc __ APPROVE ® COUNTY JUN 0 5 2025 MASON E,yy�RO Y �T, HEALTH RET Printed From Mason Co Puttiircf how Maaan Comity UM;: ii