HomeMy WebLinkAboutSWG2024-00263 - SWG As-Built - 8/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00263 Parcel # 12207-75-90041
Applicant Name Frank 8 April Houslev Subdivision (Name/D'N/Block/Loo
Applicant Address 3530 NE Old Belfair Hwy#56
City. State.. Zip Belfair,WA 98528 Installer Name Maples Excavating
Site Address 622 E Alden000d Rd, Better Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
❑ Full System Irstelletion ❑rankle) Only ❑ Dratmeld Only ❑ Repair ®Other -eo�te e'o�nnam
System Type Gravity Trench Pretreatment Type
>5 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA ❑ YES rag
>50ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑
Y >50it from surface water? - - - - - - - - - - - - - - - ❑ ❑
Z
FCleanout between building and tank? - - - - - --y-f'�- - - - - ❑ ❑ ❑
U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
H 24" access risers over each c ment?- - - - - - - - - - - - - - - - ❑ ❑ ❑
W Effluent filter in - - - - - - - - - - - - - - - - - - - - - - - - - -
' ❑ ❑ ❑
0
Ic tank capacity (working) gal Manufacturer
❑ D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ Yes NO
3zJ El El ❑
O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - -
o?Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
❑¢
M Transport Line Size Schedule/Class
Bedrooms installed (check one) W 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑CommerciaVOther
>1Cft. from foundation?- - - - - - - - - - - - -MTU
- NIA VYES ❑ NO
❑ >10nft. fromwells?- - - - - - - - - - - - - - - - a-� 0 ❑>100ft. from surface water7------ - ---- - IN ❑
>10 ft.from potable water lines?- - - - - - - - - a{Z > 5 ft. from property lines and easements?- - - ❑� > 30 ft. from dcwngratllen[curtain/foundation drDrainfield levee and observation ports present - - � ❑
❑ Graveless chambers or Q Clean gravel used? (check one)
Proper cover instated over drainfield? - - - - - - - - - - - - - - - - - ❑ ❑
Pump tank setbacks consistent with septic tank?-- - ----- - - --- ❑ NIA ❑ YES No
Y. Pump tank capacity (flood) gal Manufacturer
Z - - ) ' s5ble from surface?- - - - - - - - - - - ❑ ❑
24 tlGCC55 fiSEf(5 dntl BGGE
dAlarm or Control Panel Installed? -- ---- ----- - - - ❑ ❑ ❑
2 Control Panel equipped with Timer; ETM /Counter- -- ------- ❑ ❑ ❑
d Pump ins±afed in ❑ Bucket or ock or ❑ Other
Pump Make/Model ❑ Floats or ❑ Transducer
❑ Tank draw In/min Pump capacity gpm Squirt Height ft
Cu
ump on time Pump off time Daily Flow set at gpd
irl-4 IT'.¢a-a
Mason County OSS Installation Report pg. 2
Parcel# 122-01 - 15'9 [)0q
ABANDONMENT RECORD
Were existing septic components Labandoned as part�o`this p�ro*e 4
" _ _ _ ___ _ _ _ ___ _ " ® YES NO
If e, please describe: TCz�• NO
Were all components pumped out and properly abantlonetl per WAC246-272A-0300? ' - -- -- ' " ®YES
RECORD DRAWING
N E f - 'v2 ENW O Ip W I0. .nd
T p aeni ncPNanE muSrE dra,a P 9fi ray pps Epp EbFIE'. S ,I pp ,Y 1 , titled,
2vnrgs dd.' Dta MelE8maR1lNE o ti .81 ,s,:' pUp p al M1NM
—1x oeda—a.n lsa.danwtg a',"",mamm�an®a—� Pon¢ Iw'na.Rend Drd—la meyo to aEd Ooral tleleys rfira nsti lotion apPTVY arE rtla�etl pemiAs.
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI 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 cleare lapproved 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 l further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
it. �� ,✓�— �$-
Slgreturecrinstaller Date
Printed Name of Signee
I
MASON COUNTY PUBLIC HEALTH �
The undersigned approves this installation Report and i,.
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Record Drawing on behalf of Mason County Public - a s
PAULA JOB OMns01+ `
Health: L' i ���+latOlSt �NEt! r
S e�yl (8A (Z� 29e 2 {z vD
Signature of Environmental eelth Specialist Date (stamp, signature and date)
THISFO.RM MAY BE SDANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTYVJEB SITE epe^'°r"rzme
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APPROVED
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