HomeMy WebLinkAboutSWG202000384 - SWG As-Built - 1/31/2023 CLEAR FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00384 Parcel# 32127-51-00011
Applicant Name JDR CONSTRUCTION Subdivision (Name/Div/Block/Lot)
Applicant Address 7707 56TH AVE CT NW LAKE LIMERICK 2, TR 11
City, State, Zip GIG HARBOR 98335 Installer Name JASON SCHAUER/FINAL VISION
Site Address 550 E ROAD OF TRALEE Designer Name LAWRENCE PURDUM/APEX DEo
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type PRESSUR ST,RIBUTION Pretreatment Type
1 -. ti jay ii,
>5 ft. from foundation? - - - - - - - ❑ NIA ❑ YES ❑ NO
>50 ft. from wells? ` ' - -y - - - - � ❑ ❑
>50 ft. from surface water? - - - - -d am,- N - - -
- ❑ ❑
< Cleanout between building and tank? - ---coyyi • d - ❑ ❑ ❑
t? -
F- 24" ac0 Tank bcesssrpers over each compartment?- d�� �k`HFg174.i- - ❑ ❑ ❑
a
W Effluent filter installed?- - ❑ ❑ ❑
co
Septic tank size 1,250 gal Manufacturer HAGERMAN PRECAST
0 D-box water level and speed levelers used? - - II N/A ❑ YES ❑ NO
XO Manifold/D-box accessible from surface?- - El El El
OOZ Check valves installed? - - ❑ ❑ ❑
0<
2 Transport Line Size 2-IN Schedule/Class SCH 40
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO
0 >100 ft. from wells?- - ❑■ ❑ ❑
W >100 ft. from surface water? - - ❑ ❑ ❑
u. >10 ft. from potable water lines?- - ❑ ❑ ❑
z > 5 ft. from property lines and easements?- - ❑ ❑ ❑
Q
ce > 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 consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO
• Pump tank size 1,250 gal Manufacturer HAGERMAN PRECAST
< 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑
~ Alarm or Control Panel Installed? - - ❑ ❑ ❑
a
• Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑
n
- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a• Pump Make/Model LIBERTY 280 • Floats or ❑ Transducer
a_ Tank draw down 1.80 in/min Pump capacity 39.8 gpm Squirt Height 5 ft
Pump on time 90 SEC Pump off time 4 HRS Daily flow set at 358.02 gpd
Updated 8/21;2318
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 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 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.
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SEE ATTACHED BAN 3 t� ON��N1P�HEP\
�tiPS. UN�� 301
111 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
I further certify that all information contained on this I further certify that all information contained on this
fo and a ached Record Drawing is accurate. form and attached Record Drawing is accurate.
:._,L,_
1/30/23
Signature of Installer Date
•
JASON SCHAUER met.• ,,
Printed Name of Signee �vr•kr or WA,�-
MASON COUNTY PUBLIC HEALTH �QG'"I '�ZJ,
The undersigned approves this Installation Report and `" - ,i '?
; ?-
Record Drawing on behalf of Mason County Public '
Hea ' " 8
Lawrence M.Purdum
' LICENSED DESIGNER
�\' �U / �3 EXPIRES 2�5 0 5j
Sign ture f vironmental Health Specialist Date (stamp, signature and date)
Updated fi 2lfzota
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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