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HomeMy WebLinkAboutSWG2024-00312 - SWG As-Built - 12/19/2024 4 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00312 Parcel # 419033390074 Applicant Name Mike Donahue Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 281 City, State, Zip Milton, WA 98354 Installer Name Andrew Lehman Site Address 36 W Wivell RD Designer Name Adam Hunter INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ® Drainfield Only ❑Repair ❑Other System Type 3 bedroom Pressure System Pretreatment Type >5 ft.from foundation? - - ) 4 4. - - •- ❑ N/A YES ❑ NO >50 ft. from wells? - t. \ - - - ❑ 0 ❑ Z >50 ft. from surface water? - - - - ' -- Y - -- 0 IN ❑ Cleanout between building and tan --(jr.:... - El 0 0 U Tank baffles present? - \ --(jr.:...- - - - - - �-.----' -- ❑ ® ❑ a 24" access risers over each compart ent?- - .- El--- - 0 El W Effluent filter installed?- 8� " - 0 111 0 co Septic tank capacity (working) 1200 gal Manufacturer existing 0 D-box water level and speed levelers used? - - © N/A 0 YES ❑ NO OO Manifold/D-box accessible from surface?- - El El El C0Z Check valves installed? - - © ❑ 0 OQ 2 Transport Line Size 2 inch Schedule/Class schedule 40 Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- •- 0 N/A ® YES 0 NO 0 >100 ft.from wells?- - 0 ® ❑ WEl>100 ft. from surface water? - - 0 IN il >10 ft. from potable water lines?- - 0 ® ❑ Z > 5 ft.from property lines and easements?- - 0 II --cf., > 30 ft.from downgradient curtain/foundation drains? - - 0 I ❑ Drainfield level and observation ports present - - ❑ NI ❑ igj Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 II ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A li YES 0 NO • Pump tank capacity(flood) 1200 gal Manufacturer existing < 24" access riser(s)and accessible from surface?- - ❑ MI ❑ ~ a Alarm or Control Panel Installed? - - 0 0 El 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ I ❑ m d Pump installed in 0 Bucket or IN On Block or ❑ Other n'• Pump Make/Model Liberty LP280 I Floats or 0 Transducer a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 2 ft Pump on time 1 min 12 sec Pump off time 4 hrs Daily flow set at 360 gpd Updated 8/2 112 0 1 8 Mason County OSS Installation Report pg. 2 Parcel # 419033390074 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES ■Q 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 drainfield,existing and proposed buildings.location of wells,waterlines. wets,observation ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 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. 8-22-24 Signature of Installer Date Andrew L. Lehman Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 02,\_ Record Drawing on behalf of Mason County Public Health: \fiCA 1\eAlt (Ofil p.io f( s \f, i nature of Environmental Health Specialist Date (stamp, signature and date) Signature THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 165't D r • m u w 0 0 D r m w O x o o 0 o T _ D O 2 m 1- _ _ m DO Z m N m D N NJ Z FF Q1 V: I , ?N H ,-liSIS O ,m x O g 2 r Sib W�Qe 9N\y5\X3 N 1 ~ 8 8 \* NJ z D r M C \ 3 v m co -1 n v H D n ) z D7C co DZ z O C -1 C m r r 70 0 115'1 3 CD m n 0 m O 13 z n0 m A A 70 4 c 7.1 cg C3 OW (�Wm D O p (n M '; L 0 O � N _ z z m rii 7J * yi = C1 N 0 0 o -I vNO -•m a, /b y R° -� m 'P Dy � j2 Z N M o co CA r 2 (n j S —+ K oc 0 - O r vs i o• fi • 1m _ice_ ✓•'\%\ m _#z:v 11/- ti\ m \ S O 0 0 D Z ` ZN ,`i y`'� m m D —I / m 7Vy1 ii GN * m 0 A0 D NP ;c==��. 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