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HomeMy WebLinkAboutSWG2022-00245 - SWG As-Built - 7/19/2022 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022 00245 Parcel# 22107-50-00066 Applicant Name John Visser Subdivision (Name/Div/Block/Lot) Applicant Address 1800 SE 202nd Ave City, State, Zip Camas Wa. 98607 Installer Name Shumaker Construction Site Address 1080 E Mason lake dr s Designer Name Jim Henry INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type pretreat drip Pretreatment Type Nu Water >5 ft.from foundation? - •- ❑ N/A ® YES ❑ NO >50 ft. from wells? - - 0 0 0 >50 ft. from surface water? - 0 0 0 Z HCleanout between building and tank? - - 0 0 ❑ o Tank baffles present? - - 0 0 0 d24"access risers over each compartment?- - El 0 ❑ d N Effluent filter installed?- - III El Septic tank capacity(working) BNR 500 gal Manufacturer Haqermen's O surface?D-box water level and speed levelers used? - - Ili N/A ❑ YES ❑ NO OO Manifold/D-box accessible fromface?- - 0 ❑ El • 002" Check valves installed? - . 0 ❑ ❑ CiQ * Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 0 5 0 6 ❑Commercial/Other >10 ft.from foundation?- - 0 N/A IN YES 0 NO >100 ft.from wells?- . ❑ IN ❑ o W >100 ft. from surface water? " " El 0 0 LL >10 ft. from potable water lines?- - 0 0 0 Z > 5 ft.from property lines and easements?- El0 Eld > 30 ft.from downgradient curtain/foundation drains?- - 0 0 ❑ Drainfield level and observation ports present - - 0 0 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 0 ❑ Pump tank setbacks consistent with septic tank? - - 0 N/A ® YES ❑ NO • Pump tank capacity(flood) 1250 gal Manufacturer Haqermen's Z Q 24"access riser(s)and accessible from surface?- - ❑ 0 0 aAlarm or Control Panel Installed? - - 0 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ m a. Pump installed in 0 Bucket or 0 On Block or 0 Other 2 Pump Make/Model ORP200511 ® Floats or ❑ Transducer d Tank draw down 1.5" 10 min in/min Pump capacity 50 gpm Squirt Height ft Pump on time Pump off time Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 22107-50-00066 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES © NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 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 8 manifold orientation 8 layout,Septidpump 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. gRecord 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 R d Drawing is accu te. form and attached Record Drawing is accurate. Crg l ature o nstaller Date 1441 ��l�{ 4"-C Printed Name of Signee MASON COUNTY PUBLIC HEALTH re‘- The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: QPrer1V611n 1 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/212018 L / A • / . r- / m 0 • ..-•''v�MNO 0 � •; r.,) O, • b V P_ / / O o _I O + / U =A / • r Q` O • 0 \ CJ1 is yN c/• zo 7 / coo .= (1 c v o 0) . rm rn O (-c) O Z fV C/ O \ ( rn) , — DI77 N rn 1 1 rn /Q, , r • c a xi y4 .........„..--- P� Q p /a --IS_ Q g 0 , i :7617......„---- 46 \ m •IIIC.r �y \ z" j Co) O D C) w P• . 0 (:----": c p° N � ° 00®O®O 3 — (n 3 m 3 D (n J Z 00 U O. 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