HomeMy WebLinkAboutSWG2022-00597 - SWG As-Built - 1/20/2023rift, _
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Mason County OSS Installation Report pg., iAN 1 R 2n2 V ASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00597 BY: Parcel # 473717-50-00007
Applicant Name Tim Zoerhoff Subdivision (Name/Div/Block/Lot)
Applicant Address 360 N Potlach Dr N Lake Cushman Division: 2 Lot: 7&8
City, State, Zip Hoodsport, WA 98592 Installer Name Maples Excavating
Site Address Same Designer Name Arrow Septic Designs
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 ❑■ YES ❑ NO
>50 ft. from wells? - - 0 ❑ ❑
Z
>50 ft. from surface water? - - 0 ❑ ❑
< Cleanout between building and tank? - - ❑
U Tank baffles present? - - ❑ 0 ❑
H- 24" access risers over each compartment? ADPE-r) - ❑ 0 ❑
a_
? ❑ 0 ❑
W Effluent filter installed?. ADDED -
En
Septic tank capacity (working) 1,000 gal Manufacturer Existing
0 .D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO
'� ❑ 0 ❑
�O Manifold/D-box accessible from surface?- -
OOZ Check valves installed? - - ❑ 0 ❑
tnQ 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
CI >100 ft. from wells? - - 0 ❑ ❑
W >100 ft. from surface water? - - 0 ❑ ❑
ti >10 ft. from potable water lines?- - ❑ 0 ❑
Z > 5 ft. from property lines and easements?- - ❑ 0 ❑
Q
C4 > 30 ft. from downgradient curtain/foundation drains? 0 ❑
o
Drainfield level and observation ports present ❑ II 0
❑ Graveless chambers or 0 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) 1,060 gal Manufacturer Infilltrator
Z
< 24" access riser(s) and accessible from surface? ❑ 0 ❑
F-a. Alarm or Control Panel Installed? - - ❑ ® ❑
E Control Panel equipped with Timer/ ETM / Counter- - ❑ 0 El
D
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
a Pump Make/Model Zoeller N152 0 Floats or ID Transducer
E a
7 ft
Tank draw down 1 in/min Pump capacity 25 gpm Squirt Height
Pump on time 2.4 Minutes Pump off time 6 Hours Daily flow set at 240 gpd
Updated 82112018
i
Mason County OSS Installation Report pg. 2
Parcel# 12 ` 01- 50- dODO- •
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - II YES
El NO
If yes, please describe: _ a k d dro lkey -eA,4 W oS 030 aY\dO vled•
Were all components pumped out and properly abandoned per WAC246-272A-0300? - IR YES
El 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
lelopment of Typical
waterlines,
Drawings contain: Drainfield&manifold orentation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposedbuildings,
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
oily 6,
ROVE
JAN202023
MASON COUNTY. ! RONMENTAL HEALTH
I'i - -•rd 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 Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signature of Installer Date
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Printed Name of Signee " '` L k
MASON COUNTY PUBLIC HEALTH < rv.• w ,
The undersigned approves this Installation Report and i-ri.` PAULA JOY JOHNSON •''‘
Record Drawing on behalf of Mason County Public ,gcs'L�EJ4$6 iMil0;iEf;<.. i
Healt01)d ----el% L....2D---25 —.
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Sign ure o 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
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