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HomeMy WebLinkAboutSWG2023-00012 - SWG As-Built - 3/21/2023 C- C Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH . APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00012 Parcel # 32006-50-02001 Applicant Name RICK KEMMAN Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 750 City, State, Zip BUCKLEY, WA. 98584 Installer Name BAMFORD SEPTIC Site Address 1130 E ISLAND LAKE DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only Repair ❑ Other System Type GRAVITY Pretreatment Type >5 ft. from foundation? - ❑ N/A ■❑ YES ❑ NO >50 ft. from wells? - - 1_M_1_[t. WI _ ❑ © ❑ Y >50 ft. from surface water? - H Cleanout between building and tank? - - - , MAR 17 2023 - ❑ • ❑ V Tank baffles present? - - - ❑ ® 0 a24" access risers over each compartment?By • ❑ MI Cl)W Effluent filter installed?- - ❑ 0 El Septic tank size 1530 gal Manufacturer INFILTRATOR 0 D-box water level and speed levelers used? - ❑ N/A 0 YES ❑ NO OO Manifold/D-box accessible from surface?- _ _ _ - ❑ it ❑ m— Check valves installed? - ❑ ❑ 6Q 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- - ❑ ® ❑ J >100 ft. from surface water? - ❑ W ❑ LL >10 ft. from potable water lines?- - ❑ a El Z > 5 ft. from property lines and easements?- 0• > 30 ft. from downgradient curtain/foundation drains?- - ❑ ❑ Drainfield level and observation ports present - _ ❑ IN ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES I NO Pump tank size gal Manufacturer Z < 24"access riser(s) and accessible from surface?- - ❑ 0 ❑ a.~ Alarm or Control Panel Installed? - Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model � ❑ Floats or ❑ Transducer Tank draw down EL Tank Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 51/leisoya r.;oun OSS ti� linstanation Repot toy)„ I — _ Parcel# �2GGC- Were existing septic components abandon®d asONEId�Vir 602(.„ ;R� If yes, please describe: part of this project? .. Were all components pumped ....—...w_.-.__- .._�- �' YES 0 NO ' out and -p�---�' -----•..� - �.__ componentsProperly abandoned per WAC246 ---_ _ iiThis s apermanentT - • °�E - i record and must be accurate and descriptive enough l- LING Drawings fs contain: record &and mu orientation&layout,SopUGpam to re-locate in the need of wails, scrveUon p tent<Iocation,North arrow,reserve draintiield existing and maintenance proposed hut/clings,ties and devote ��•desr,outs,and other maintenance access pment Typical Record points. Incomplete Record Drawings may create additional Betas in final installation approval— 2 g y location of wells,waterlines, y and refaced permits. 6 k4 real c/>co... 3/0 e co 41 ., I dr f'' v�:. are t �--;►` ��„tG/,�L � i, t: , t4.-, /i Z.,/ce A/4 , L,oc al,a}, G6 a t.4 ch./wt.-4 f I r i1 'I ll _11 -� -y== _� �' ecord Drawing Attached �' INSTALLER ._._�"-`RICAM,� All OF e `' �..1G'�il°EG.�6:4� -� / certify that I installed the system in accordance with I r..li`ii3IY aN s"l EN GENT.-:ER the septic icertify design stamped"APPROVED" li I certify that the system by Mason I. y has been installed In actor- ED County Public Health and that any deviations shown II dance with the septic design stamped" here have Health Mason County Public Health and that any deviationsll by jl he Mason beenun cleared/approved by both the designer shown here have County Public Health and meet ell State I� beenocleared/approved by } and Meson County Codes l) Statemyself and Mason County Public Health ani botht all /further certify that all information contained on this I State and Mason County ICIr and certify atta Coatis I farther certify that all information contained on this Irf 9 fched- Record Drawing is accurate. :., 11 form and attached Record Drawing is accurate. Signature of Installer I s r Date �f of 4 printed Name of Signee "��""'"""------ - N -AP i,P 41 �'�! ff - �� I i�� ° ),As"Z 9 �1 7 MASON41 COUNTY P —�_`�` i S'P • 5 N�' _ �,a_ 'I) PUBLIC HEALTH The undersigned a �` . .:i approves this Installation Report and �' o` CIN 54 N�,�� Record Drawingt f on behalf of Mason County Public i .� ED slcrr�r +Ij jl Health: wi�` gym_ 3h-1 (Z - e� ,kEso5 Signature of Environmental Health Specialist ist = Date iii� THIS FORM MAY lily SCANNED AND AVAIL ABLE FOR PUBLIC (stamp, signature and date) li VIEW MASON � �17iE COUNTY WEB SITE Updated 82112 to a ri j Lke Dom-. M u vE: MASO,,Co�N� 21 20?3 7RER°N4ENTALHEAr -40\' -1- 4J1 LTh \. \ „ O S314.Ay 11d4X g .2 -/vy20 &ems 0 I s 30 4-,‘14.1 ti-dok--1-04- Gzi•til re 1I^ie- wet i S , ,, d C1Pa"41 u :s . r 3,-(44-1- 0 P lisic 60 Rect.e v e a e &- / t -r-..b,., .z 1 Z Q 0- SZ LS c L -k- Qy ti: II 1 •v' p ng �9�1 0 isi s .a1A y` 10 18 , '1 NDY WAITE �'A`i -r LICENSED DESIGNEE \1�j EXPIRES 05'10/ f : 3i0 /