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HomeMy WebLinkAboutSWG2022-00104 - SWG As-Built - 1/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00104 Parcel # 12317-14-90061 Applicant Name Bonie& Grant Butler Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 2101 City, State, Zip Belfair, WA 98528 Installer Name Eric Site Address 2207 NE Old Belfair Hwy Designer Name Frank Marcinko INSTALLATION CHECKLIST III] Full System Installation El Tank(s)Only El Drainfield Only ❑Repair ❑Other System Type Pressure Distribution Pretreatment Type >5 ft.from foundation? - - ❑ N/A El YES ❑ NO >50 ft from wells? - - ❑ NU ❑ Z >50 ft.from surface water? - - El II HCleanout between building and tank? - - El U ❑ V Tank baffles present? - - ❑ M ❑ I- 24"access risers over each compartment?- - ❑ II ❑ a W Effluent filter installed?- - ❑ MI 0 N Septic tank size 1250 gal Manufacturer Hagerman Precast 0 D-box water level and speed levelers used? - - IllN/A ❑ YES 0 NO DO Manifold/D-box accessible from surface?- - ElIN El o0Z Check valves installed? - El II El 0Q 2 Transport Line Size 2" Schedule/Class Sch 40 Bedrooms installed (check one) 0 2 I:1 3 ❑4 0 5 El 6 ❑Commercial/Other >10 ft.from foundation? - ❑ N/A . YES ❑ NO C >100 ft.from wells?- - ❑ ® ❑ Li, >100 ft.from surface water? - - ❑ MI ❑ u. >10 ft.from potable water lines?- - El ® ❑ 2• > 5 ft.from property lines and easements?- - ❑ II d > 30 ft.from downgradient curtain/foundation drains? - - ❑ IN ❑ CI Drainfield level and observation ports present - - ❑ ® ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? - ❑ Nil ❑ Pump tank setbacks consistant with septic tank? - - El N/A j YES ❑ NO • Pump tank size 1250 gal Manufacturer Hagerman Precast < 24" access riser(s)and accessible from surface?- - ❑ a ❑ ~ d Alarm or Control Panel Installed? - - CI0 ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ 0 ❑ D d Pump installed in ❑ Bucket or • On Block or ❑ Other d• Pump Make/Model Liberty 290 ® Floats or El Transducer d Tank draw down 2.6 in/min Pump capacity 66 gpm Squirt Height 4 ft Pump on time 54 sec Pump off time 4 hrs Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 12317-14-90061 Were existing septic components abandoned as part of this project? - - 0 YES ® NO It yes,please describe: _ Were al components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES [] NO j tr_Y_.( t . _ s •L•y;{.1 f:- 7iI 114,iriFFU f.itTl.•. . y.'y'c•. .µ,'*v J b'.S0t j'• _ .. .. • This la a parmenent record and must be accurate and descriptive enough to re-locate In the need of maintenance acUvltlss and future development Typal!Record Drawings contain: Drairfteld&manrfold orientation&layout,Septic/pump tank location.North arrow.reserve drelnfiold.existing and proposed buildings.location of welts,waterlines. wells.observation ports.cieanouta.and other maintenanoe access points. Incomplete Record Drawings may create additional detaye in final hetatladon approval and related permits. APp Rov JAN E MAs ',uUNrYEN2 0 ?0?3 fRONMFNr Jaw AL HEALTH ® Record Drawing Attached 7,.+ RJ� w 7 R " _Tt ♦.....t'" tY:+si_y a.—.4 v.x�'�.,.!A. e t J,-.. a..+.: .+_ ..>t .�T! : } Lll ...f:�igir INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of lnstalie Date :. , ,, /� i 64.L br�e5ar7 t it Printed Name of Signer) ,ir le ,\ it MASON COUNTY PUBLIC HEALTH .:- , ` 'i.11 The undersigned approves this Installation Report end ,:i 11 Record Drawing on behalf of Mason County Public Fri 1 He % LICENSED DESIGNER • • /Sign u vironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/2112018 7 +17'el 226' +- +2'el I Well X-0 A , Record Of - 1 rli 1 k0T. ►, Construction sPd� ; 100% o�°�cleanouts/ % 11 Reserve Observation 1 X Ports(4) e 1 I SL#3 X , 4 1 d7�q 1 /� 1 C Alarm 1 e mer \\\\ 1 �f, co •• 1 1 EF-4 Effluent a '� 1 Q ? I Filter Installed / ., \ a: + Clean Annually + o ss'+- vaj� rLin _-�- • Power Line Parking sot •Q- >;11 o i ki 1 4 ,f4r . lio ,-) / i 1 00144-7 AA•IAA 4 ' \ co `0- 20100609 F,1+ Frank A. hlarcinko P P R O' V .. A,- LICENSED DESIGNER • -.4, �1AN 2 0 2U23 ;,'f_!s © . //may MASON COUNTY ENVIRONMENTAL HEALTH +7'el 226' +- JBW +0'el Septic ROC Scale = 1" = 40' Address: 2207 NE Old Belfair Hwy, Belfair Name: Butler Tam parcel # 1231744-90061 PL.. ilus is not a ,-on all or •ir:y I es I n r+�ncs n been der ons i the O+mer',i ; their;geodes} On-Site Septic Design Allied Septic Design and Excavating