HomeMy WebLinkAboutSWG2024-00178 - SWG As-Built - 1/30/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00178 Parcel# 42211-31-90000
Applicant Name Patricia Lewallen Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 1353
City, State, Zip Hoodsport, WA 98548 Installer Name Craig Shockman
Site Address 711 N. Finch Creek Rd. Designer Name Dale L. Tahja
INSTALLATION CHECKLIST
O Full System Installation O Tank(s)Only O Drainfield Only O Repair O Other == _ - -m=:.-', - =*
System Type Pressure Trenches Pretreatment Type
>5 ft.from foundation? -
-- ❑ NIA ❑YES ❑ NO
>50 ft.from wells? - 0-rir.1, .- ❑ ❑
Z >50 ft. from surface water? - \ ' =',4, ?-j ''` - ❑ ❑ CI
Q Cleanout between building and tank? I -}
CJ Tank baffles present? - ���8� - O ❑ ❑
''" '°� -SAN
O O O
a4'r?�
24"access risers over each compartme - -- - - - ❑ O El
rW Effluent filter installed?- - .- O O O
Septic tank capacity(working) gal Manufacturer
0, D-box water level and speed levelers used? - O NIA ❑YES El NO
OO Manifold/D-box accessible from surface?- . O O O
(OE Check valves installed? - O O O
GQ
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) 0 2 O 3 O 4 O 5 O 6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A ❑ YES ❑ NO
fa >100 ft. from wells?- - O O O
W >100 ft.from surface water? - - O O O
u, >10 ft.from potable water lines?- - O O O
Q >5 ft.from property lines and easements?- - O O O
G >30 ft. from downgradient curtain/foundation drains?- - O O O
Drainfield level and observation ports present - - O O O
O Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - O O O
Pump tank setbacks consistent with septic tank?- - O N/A IN YES ❑ NO
• Pump tank capacity(flood) 1,200 gal Manufacturer Graystone(existing)
Z
< 24"access riser(s)and accessible from surface?- - O IN O
H
a Alarm or Control Panel Installed? - - O II O
2 Control Panel equipped with Timer/ETM/Counter- - O O al
- Pump installed in ❑ Bucket or ® On Block or ❑ Other
d Pump Make/Model Liberty 251
� ® Floats or O Transducer
a Tank draw down 1 in/min Pump capacity 25 gpm Squirt Height NA ft
Pump on time floats Pump off time floats Daily flow set at on demandgpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 42211-31-90000
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ® YES O NO
If yes, please describe: existing drainfields were disconnected from existing septic tanks
Were all components pumped out and property abandoned per WAC246-272A-0300? - - i] YES O NO
'
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to reaocate in the need of maintenance activities and future development Typical Record
Drawings contain: Drainfleld&manifold orientation e.layout Septicipump tank location.North arrow reserve drainfield,existing and Proposed buildings.locat,on of wells,wateriines.
wells,observation ports.cleanouls.and other maintenance access points Incomplete Record Drawings may create additional delays xi final installation approval and related permits.
® Record Drawing Attach
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 certify that all information contained on this I further certify that all information contained on this
to rid attached Record Drawing is accurate. form and attached Record Dr. ing is accurate.
CAdeleitos) J -2L -�b Ai
art,
Sig & (4S1'Ieic ,,fAJ
f lnstallor Date i�Q. A 1
0
Printed Name ofignee �� o'w�syy���,
40/MASON COUNTY PUBLIC HEALTH r° J'2•i
The undersigned approves this Installation Report and 5100214 'PA
The
Record Drawing on behalf of Mason County Public O Dale L.Tahja
,r,
Health: 1, 0 LICENSED DESIGN ' #
' ('): , ' C- ).,,,r)
Signature of Envi on r t Health Specialist Date „..._ ,,,_
(stamp; signature an• date)
`
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 9,21/2C1a
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