HomeMy WebLinkAboutSWG2022-00233 - SWG As-Built - 6/27/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00233 Parcel # 42318-51-00007
Applicant Name David & Laurie Sobocinski Subdivision (Name/Div/Block/Lot)
Applicant Address 4533 Tacoma Ave S Lake Cushman#4 TR 7
City, State, Zip Tacoma, WA 98418 installer Name Bamford Septic Repair
Site Address 1441 N Potlatch Dr, Hoodsport Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
® Full System installation ❑Tank(s) Only ❑ Drainfield Only 0 Repair ❑Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - - 0 ❑ ❑
°-� >50 ft. from surface water? - - 0 ❑ ❑
Z - ❑ ❑
HCleanout between building and tank?
O Tank baffles present? - ❑ 0 ❑
a24" access risers over each compartment?- - ❑ 0 ❑
W Effluent filter installed?- a ❑ 0 ❑
cn
Septic tank capacity (working) 1,000 gal Manufacturer existing 2-compartment
Cl D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO
oOJ Manifold/D-box accessible from surface?- - ❑
a?-2 Check valves installed? - 2* fry^ R - ❑ 0 ❑
C:)`t
2 Transpor
t Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A 0 YES ❑ NO
C] >100 ft. from wells?- - 0 ❑ ❑
W >100 ft. from surface water? - - 0 ❑ ❑
IL >10 ft. from potable water lines?- - ❑ 0 ❑
Z > 5 ft. from property lines and easements?- - ❑ 0 ❑
f > 30 ft. from downgradient curtain/foundation drains? - 0 El ❑
® Drainfield level and observation ports present - - ❑ 0 ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO
• Pump tank capacity (flood) 1287 gal Manufacturer Infiltrator
Z - ❑ 0 ❑
< 24" access riser(s) and accessible from surface?
Alarm or Control Panel Installed? - - ❑ 0 ❑
n. ❑ 0 ElE Control Panel equipped with Timer/ ETM /Counter-
n
Cl- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a' Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer
a
Tank draw down 2" in/min Pump capacity 50 gpm Squirt Height 6 ft
Pump on time 1.2 min Pump off time 6 hr Daily flow set at 240 gpd
Updated 8,21.12018
Mason County OSS Installation Report pg. 2
Parcel# q23I "S ( -OCIC)0
ABANDONMENT RECORD
- [?!f-YES 0 NO
Were existing septic components abandoned as part of this project?
1
If yes, please describe: U 1 0 6{a tV1fiN coodOl .a
_
Were all components pumped out and properly abandoned per WAC246-272A-0300? - ®'YES D 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.
—C e H-K1 1,- hA. 3
1g 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
1 further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Date
Signature of Install 1'
Printed Name of Signee • v4 -1 4
MASON COUNTY PUBLIC HEALTH
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The undersigned approves this Installation Report and r�� 51Gp319
Record Drawing on behalf of Mason County Public PAULA JOY JOHN30N'-31
L10E�+l$tti d1=SiGNrfi''��:xb
Health: �"'S� es yi si��
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Signature of Environmental Health Specialist Date (stamp, signature and date)
Updated 82t/2018
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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