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HomeMy WebLinkAboutSWG2024-00328 - SWG Application / Design - 12/10/2025 A r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2024-00328 Parcel # 221167590072 Applicant Name Thomas Waller Subdivision (Name/Div/Block/Lot) Applicant Address 4 PNCNVi-(ilk City, State, Zip 41(A/es/few, wA—qesrtc Installer Name Josh Peterson Site Address 427 E Rivendell Rd Designer Name Rod Left INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Gravity /Pretre ent Type >5 ft. from foundation? - ��__-./ S N/A Q YES ❑ NO >50 ft. from wells? - ,yr - - 0 ❑ Z >50 ft. from surface water? �i,- El .4 Cleanout between building and tank? - - -- 1� - �,-Q��UU-44-" - ❑ CI ❑ 0. V Tank baffles present? - \� - ❑■ ❑ E-a 24" access risers over each compartment?- - - 0 ❑ ,eg� W Effluent filter installed?- ' .. - ❑ © ❑ u) . Septic tank size 1000 gal Manufacturer Hagerman C1 D-box water level and speed levelers used? - - ❑ N/A • YES ❑ NO I DO Manifold/D-box accessible from surface?- - El PI m2; Check valves installed? - - ❑■ ❑ ❑ ❑ai E' Transport Line Size 4" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - © N/A ❑ YES ❑ NO 0 >100 ft. from wells?- - ❑ ■❑ ❑ --1 i >100 ft. from surface water? - - ❑ 0 ❑ W u. >10 ft. from potable water lines?- - ❑ ■❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ X ❑ a > 30 ft. from downgradient curtain/foundation drains? - - ❑ IN ❑ Drainfield level and observation ports present - - ❑ \sky/ ❑ © Graveless chambers or ❑ Clean gravel used? (check one) -F� b,‘ Proper cover installed over drainfield?- - ❑ �t �0,k, ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO 'l Pump tank size gal Manufacturer Q24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ F- a Alarm or Control Panel Installed? - - ❑ El E Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑ a --.Pump installed in ❑ Bucket or ❑ On Block or ❑ Other fZ Pump Make/Model ❑ Floats or El Transducer a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 7-7-/i 7 '9v 2- _ ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ID YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? • - D YES 0 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: Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow,reserve drainfieid,existing and proposed buildings,location of wells,waterlines, wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final Installation approval and related permits. RI Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify that I 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 certifyr.t all information contained on this I further certify that all information contained on this form and a r ed Record Drawing is accurate. form and attached Record Drawing is accurate. / li9ht /-z`r ,,„.. :t. azure of Installer Date w lea ��s S8-''✓ s Printed Name of Signee w �w :Crc 1i MASON COUNTY PUBLIC HEALTH +"' !,,Z The undersigned approves this Installation Report and 1,4 mh Record Drawing on behalf of Mason County Public R' / f';� +joirIrCEN9E tcg,3NErt Health: / WIRES 12/15/ 1.4 Signature of EnvironmentaliHealth 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 • 330.00' • . ).. . . \ • • rn � 8 24 : 03 o) 1- D rn mnm 01 �m� o © m?_+ o KL C Z o mG) o = b -,_o x -•N •\,_..., ,/-- ---- ./ m "%, Mo ►m o -4m � o rm• 330.00' • o 4 N -1 0 ( \*4 I v o 01 � o r \r Z p o n 0 D 0 Z D D co o n ,,'� ! f 55 r C O r r o r m r r ° D d r r r m _{ D Om m T CO r -I r o 2 0 1 0 D O Z D m m e m < ytoF i.. ,r- D Z D c c mil m Z 1 mT'f n 1., V cn T O G O O m X O 2 K C) I I I a Y ry m z m m cD D "; N ; p z m co Z z �► n o 13 D N m Op O Z O o . 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