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Home My WebLink AboutSWG2023-00392 ASBUILT - SWG As-Built - 5/22/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2023-00392 Parcel# 12108-50-01023 Applicant Name Ronald Coval Subdivision (Name/Div/Block/Lot) Applicant Address 312 Cleaveland Street City, State, Zip Hoquaim, Wa 98550 Installer Name TC Septic Inc Site Address. 90 E. Bahama Drive Designer Name Bob Paysse INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Oscar XO2 Pretreatment Type >5ft. fromfoundation? - ______________- ❑ NIA 1kYES NO >50ft.fromwells? ----------- --------- - ❑ ❑ >50ft.fromsurfacewater? --- --- --_ o �� _ ❑ ❑ Z - UI- Q Cleanout between building and tank? _ , Tank baffles present? ------ -- _ ____ � �,- a24"access risers over each compart _ r _Q 3Z _-fir f _ 0 ❑ NEffluent filter installed?----__-__ ❑ ❑ ❑ Septic tank capacity(working) 1 anufa6ttit Haggerman D-box water level and speed levelers used? --------------- fJ NIA ❑YES ❑ NO 9O Manifold/D-box accessible from surface?--------- -- ------ ❑ 0 ❑ GZ Check valves installed? -__ ________ ______________- ❑ UI ❑ Transport Line Size 1" Schedule/Class 40 Bedrooms installed(check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?-- ------ ------------------ ❑ NIA DYES ❑ NO j3 >100ftfromwells?----------------------------- ❑ Iii ❑ W >100ft.fromsurfacewater? ------------------------ ❑ 0 ❑ Z >10ft. frompotablewaterlines?---------------------- ❑ UI ❑ Z >5ft.frompropertylinesandeasements?---------------- ❑ 0 ❑ >30 ft.from downgradient curtain/foundation drains?---------- ❑ © ❑ Drainfield level and observation ports present ---- ---------- ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ III ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NIA UI YES ❑ NO zPump tank capacity(flood) 1250 gal Manufacturer Haggerman 24"access riser(s)and accessible from surface?------------- ❑ ® ❑ Alarm or Control Panel Installed? --------------------- ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter----------- El 0 ❑ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Turbin IlL Pump Make/Model 30gpm turbine 2 0 Floats or ❑ Transducer a Tank draw down 1.2 in/min Pump capacity 30 gpm Squirt Height n/a ft Pump on time per mfr Pump off time per mfr Daily flow set at 240 gpd Updated 8/212018 Mason County OSS Installation Report pg. 2 Parcel# 12108-50-01023 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --------------- JJ NO YES If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- YES O 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, wells,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 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. 5B G Signature of installer Date Tony Dumford Printed Name of Signee w ; MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report"andRecord g.' ROBEAr A"AY55E Drawing on behalf of Masor�s�nfy Pub.j�� EXPIRES Hea 6FNS, .6 Sig ature of Environmental Health Specialist Da ✓z ' 4 (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PURL C%IEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 \ r \ rr r� \ i r \\\ 1 \ \�. CASE INLET DOUBLE SLEEVED WATERLINE i 0I NEW HOME ° % " APPROXIMATE °\\ \\ SHORELINE O XO2 TANKS W/ CLEANOUT A. 4 b 5 - 2 BEDROOM OSCAR X02 W/ RESERVE 3 � } r ' '�yrt��k",,'• 3,.tip �� O } FGE'cI5tT M37Y7AYESE p• 4 A4ENt 4L HEq<I�r RECOJD 1D1AWJIITG PIONEER DIGGING INC. CUSTOM RON COVAL TEST HOLE I: TEST HOLE 2 PARCEL#:12108-50-01023 0-14 SI LOAM 0.15 S1 LOAM SEPTIC DESIGNS ADDRESS: 90 E BAI-IAMA DR 14+MOTE.CLAY 15+MOT. LAY 3083 E MASON BENSON RD. GRAPEv1EW,WA 98546 DESIGNER: ROBERT H.PAYSSE {pis OR FIEDT MSR�REFERENCES NTYwI o SI6 INTENDED FOR R SEPTIC OFFICE-360-426-1803 FAX-360 427 2353 SHEET: ASBUILT SCALE 1.,=30' PURPOSES r rr a REVIEW.PROPOSED DEVELOPMENT NOT N98 E FOR SETBACKS U T°EuO o o SEPTIC COMPONENTS.