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HomeMy WebLinkAboutSWG2021-00109 - SWG As-Built - 8/22/2022dm Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION • Permit Number SWG "22 \-' 0\O° arcel # 22221-53-001 [ g i Applicant Name Jannell Hicks Subdivision (Name/Div/ k/l,t)1 2 Applicant Address 7914 W. Dodge Rdf Twanoh Falls N 2022 11 City, State, Zip Omaha, NB. 68114 Installer Name Tim jf,QExcavating LLC Site Address E 241 Forest In belfair wa Designer Name Peninsula Septic Desiq INSTALLATION CHECKLIST Full System Installation El Tank(s)Only ❑ Drainfield Only ❑ Repair El Other System Type Pre treatment drip Pretreatment Type NU water >5 ft. from foundation? - - ❑ N/A ®YES ❑ NO >50 ft.from wells? - .- ❑ ® ❑ z >50 ft.from surface water? - - ❑ ® ❑ H Cleanout between building and tank? - - ❑ IN CI U Tank baffles present? - - ❑ ® ❑ a24"access risers over each compartment?- - El ® ❑ W Effluent filter installed?- •- ❑ ® ❑ Septic tank capacity (working) 1000 gal Manufacturer Hagerman D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO 0 O Manifold/D-box accessible from surface?- - CI II CI u. ODZ Check valves installed? - - ❑ ❑ CI 0 Q 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ® YES ❑ NO >100 ft. from wells? - - ❑ ® ❑ cm 111 >100 ft. from surface water? - - CI II CI u„ >10 ft. from potable water lines?- - ❑ ® El Z > 5 ft. from property lines and easements?- - ❑ ® ❑ 62 > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ o Drainfield level and observation ports present - - ® ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ® ❑ ❑ Pump tank setbacks consistent with septic tank? - - El N/A ® YES El NO • Pump tank capacity (flood) 1 000 gal Manufacturer Hagerman < 24" access riser(s)and accessible from surface?- - ❑ ® ❑ F- a Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ NI ❑ D a_ Pump installed in ElBucket or ❑ On Block or 0 Other Flow inducer a• Pump Make/Model Orenco/PF200511 II Floats or ❑ Transducer EL a Tank draw down in/min Pump capacity 20 gpm Squirt Height NA ft Pump on time 10 Pump off time 2 hours Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Pareef# 22221-53-00109 • ABANDONMENT RECORD • %N tc x, ri j ;it component,: abr nclnned ts: nail of to S prniec - g YFS d NO if yes.please doscrto: xiStitrq S1.►tiG tank _. ..._ ___. _. ___.. ___. __ Were at componerts pumped o rt and property abandoned per WAC24E'I-272J1-0300 - - Q YES 0 NO • RECORD DRAWING 'nos is a rormargtrl f c.Cd Jed must b• t,N *and dwntAptr.•enough In rw-ioi str in the nww8 ui'tnaitdrnaetw ni:lititits and Rare*O*vskop gein. Tyti:ul R,:tord DrniM,.cMssnr tYaMitall•nr o,otWttlRion$lentil.;:`Clsktr_rt Vint luc»lo.t4:t trncau,r.ctrrrn ciwi tBait,taaftiwt rtrd Mnt¢iOVtl rvpt keitii rt to rwlSs.w9)irtnecc, .. .ctrxrea$w parr..Ga:nyts.Vol JINX Ina nlcw-oe (Wks, rnio•=+F*,s•I:!vx-,rtt, inn.rcc+lrnt:i i4#1"jaatkW4rbOGlscrap:,rScxl4t(tntUttry041,:: .. • Record Drawing Attached 2 CERTIFICATION OF INSTALLATION • INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with I certiFj that the system has been installed in accor- the septic design tamped APPROVED"by Mason dance with the-septic design stamped"APPROVFD'by County Public Health and that any deviations shown Mason County Public Health and that any deviations hero have been clearedlepproved by bath the designer shown here have boon cicaretL opproved by both and Mason County Public Health and meet all Stare myself and Mason County Public Health and meet as and Mason County Codes Slate and Mason County Codes 1 further cattily that as information contained on this I further certify that at!inforrriatlon Contained On this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. r G t Ftr/G iz io Signature of JostaNar 17rrh' I/ jib Oat, Printed Manx MASON COUNTY PUBLIC HEALTH i : The undersigned approves this Installation Report and !j S / ';1� Roeurd Drawing on behalf of Mason County Public / r • lcillcrr. 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