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Home My WebLink AboutSWG2025-00060 - SWG As-Built - 8/25/2025 • OKLI*JE e Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00060 Parcel# 520241350040 Applicant Name Calvin Dahl Subdivision (Name/Div/Block/Lot) Applicant Address 261 North Hamilton RD City, State, Zip Chehalis WA 98532 Installer Name Andrew Lehman Site Address 1507 Highland rd Designer Name Adam Hunter INSTALLATION CHECKLIST ❑ Full System Installation E Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Standard Pressure Trenches Pretreatment Type >5 ft. from foundation? . ❑ N/A El YES ❑ NO >SD ft.from wells? - �['- }S❑-`i - - Q ❑ Q ❑ Z• >50 ft.from surface water? - JUL 3 0-10n IUI ❑ RI F Cleanout between building and tank? - - ❑ ❑ ❑ V Tank baffles present? - ! - - ❑ ❑ ❑ 4 24"access risers over each compartment'By- - - ❑ ® II W Effluent filter installed? ❑ ❑ ❑ N Septic tank capacity (working) 1250 gal Manufacturer HB Precast — CID-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ OPEoQ Check valves installed? - - ❑ ❑ ❑ f Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 E3 Q, it ❑Commercial/Other >10 ft. from foundation?- -tJ ❑ N/A ❑ YES ❑ NO • >100 ft. from wells?- � >100 ft.from surface water? - - - - - - A...- 2025 ❑ ❑ ❑ iu it >10 ft. from potable water lines?- - - - rma " .,c.. r. Z '7v 1�. . ❑ ❑ ❑ K > 5 ft. from property lines and easeni tiIS? maw _ ❑ ❑ ❑ > 30 ft. from downgradient curtain/foundation drains? - ❑ Q ❑ Drainfield level and observation ports present - - ❑ I] 0 ❑ Graveless chamb as or E Clean gravel used? (check one) Proper cover installed over drainfield? ❑ ❑ ❑ Pump tank setbacks co+sistent with septic tank? ❑ N/A ❑ YES ❑ NO • Pump tank capacity(flooc) 1250 gal Manufacturer HB PRECAST Z < 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ 0~. Alarm or Control Panel Irish Wed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/ Counter - ❑ Q 0 m a Pump installed in ❑ Bucket or On Block or ❑ Other O.0 Pump Make/Model LIBERTY 280 ❑ Floats or ❑ Transducer 0.• Tank draw down 3 in/min Pump capacity 60 qpm Squirt Height 2.66 ft Pump on time 1MIN 2SEC Pump off time 4HRS Daily flow set at 360 gpd updaled B1121Q018 Mason County OSS Installation Report pg. 2 Parcel n 520241350040 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ❑ YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES Q NO RECORD DRAWING This is a permanent record and must be accurate and dscr pIive enough to re-locate in the need of maintenance activities and future development Typical Record Drawings contain Drainnela&manifold onentatlon&layout Sects/pump lank location.Honn arm reserve dralntlea,existing and proposed buildings.location of wellp waterlines wells observation ports cleanouts and otner maintenance access points Incomplete Read Drawings may create additional delays in final installation approval and related permitsIT PPPOIit ill p AUG 2 5 2025 ap $CId CC F C.JEW4 E] Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 I further certify that all 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. 7.7%./ ... 7-14-2E Signature of Installer Date Andrew L. Lehman 7/30/25 Printed Name of Signee jot.MASON COUNTY PUBLIC HEALTH - /`@ij v The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public I He giSIN t1 q � l , . C ` Si aEnvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated erztrzuta f RECORD DRAWING (continued) `r. s S_ „ u :O I o F e i c - z ° y ' 3g. o IY a g IN N to 4. s I N A.A134 N I a a 3' - �1 // o