HomeMy WebLinkAboutSWG2020-00322 - SWG As-Built - 10/13/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
• APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00322 Parcel # 421137590100
Applicant Name IA(4 rat-) tind-e,VV1/0001 Subdivision (Name/Div/Block/Lot)
Applicant Address 3(o I E SN n b-e4- /2.7d(,e rid
City, State, Zip VA-Ur 1 01- 19 Z Installer Name Logan Spear
Site Address $a Vo- Designer Name Jim Hunter
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pressure trench Pretreatment Type n/a
>5 ft.from foundation? ❑ N/A ® YES ❑ NO
>50 ft. from wells? - ll ❑
>50 ft. from surface water? - - ❑❑
Z II ❑
t
Q Cleanout between building and tank? - Wr
- -3 .%��2-- - ElIR ❑
`
(� Tank baffles present? - ❑ ® ❑
a24"access risers over each compartment?- - - -_- � - El I ❑
W Effluent filter installed?- Au z� �`-- ❑ ® ❑
N
Septic tank capacity (working) 1200 gal Manufacturer Hagerman
❑ D-box water level and speed levelers used? - - mg N/A ❑ YES ❑ NO
QJ
O Manifold/D-box accessible from surface?- - ❑ ® ❑
OOZ Check valves installed? - - ❑ II ❑
❑Q sch40
2 Transport Line Size 2" Schedule/Class
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 LI 6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
0 >100 ft. from wells?- - ❑ LU ❑
W >100 ft. from surface water? - - ❑ 0 ❑
ti >10 ft.from potable water lines?- - ❑ MI ❑
Z > 5 ft. from property lines and easements?- - ❑ U ❑
> 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑
Drainfield level and observation ports present - - ❑ • ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
ZPump tank capacity(flood) 1200 gal Manufacturer Hagerman
Q 24"access riser(s)and accessible from surface?- - ❑ MI ❑
H- Alarm or Control Panel Installed? - - ❑ UI ❑
°'2 Control Panel equipped with Timer/ ETM/Counter- -
❑ II ❑
m
n- Pump installed in • Bucket or ❑ On Block or ❑ Other
a'• Pump Make/Model Liberty 280 ® Floats or ❑ Transducer
ci
a Tank draw down 2.25 in/min Pump capacity 54 gpm Squirt Height 2 ft
Pump on time 1 .1 min Pump off time 4hrs Daily flow set at 360 gpd
Updated 8/21i2018
Mason County OSS Installation Report pg. 2 Parcel# 421137590100
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES El NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ NO
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
Drawings contain Orainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed build,ngs,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
SLR
1Record Drawing Attached
CERTIFICATION OF INSTALLATION f
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.
M6Y/23
S gn re of 1 staller Date r 24' 1-3^1.
•
Logan Spear
Printed Name of Signee
if ai • z
MASON COUNTY PUBLIC HEALTH sA-
The undersigned approves this Installation Report and •
O.' M�' }'t:f4?ER
Record Drawing on behalf of Mason County Public "+ -fc"'5p lXSI�.ivl R '
Health: EXPMES: 03/22/Z11-
i&t\QA.1131(11 [6 I )517-
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018
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