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HomeMy WebLinkAboutSWG2022-00558 - SWG As-Built - 1/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPL1 iT/ PERi IT INFORMATION Permit Number SWG 2022-00558 Parcel # 42204-50-00111 " 1 ,__ Applicant Name Brian Brown Subdivision (Name/Div/Block/Lot) 1 z E Applicant Address 10221 NE Kingston View Ct. Lake Cushman Div. 5 Lot 111 I ^' I - a City, State, Zip Kingston, WA 98346 Installer Name T.J. Goos 1 Site Address Designer Name Dale L. Tahja I 7i=zi ` i IMsTA ;,IF ATIoN cHEc I;aST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑ Other System Type Pressurized Trenchs Pretreatment Type NIA >5 ft. from foundation? - - ❑ N/A ® YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ Ili CI H Cleanout between building and tank? - - El ® ❑ u Tank baffles present? - - ❑ ® ❑ ti' ° 24" access risers over each compartment?- - ❑ ® ❑ wi- Effluent filter installed?- - ❑ ® ❑ Septic tank capacity (working) 1.250 gal Manufacturer Hagerman 13 D-box water level and speed levelers used? - - It N/A ❑ YES El NO oO Manifold/D-box accessible from surface?- - ElME ❑ u. oil-2 Check valves installed? - - 0 ® ❑ oQ 2 Transport Line Size 2 inches Schedule/Class Sch.40 Bedrooms installed (check one) Q 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? ❑ N/A In YES El NO �0 >100 ft. from wells? ` - -� � -- ❑ ❑ W >100 ft. from surface water? - - -,a.. - - CI NI CI 1%.. >10 ft.from potable water lines? .4.- ' - - 311_2 2 - - 'k - - El ® ❑ 3 > 5 ft. from property Ylines and e�@�� �i��Y-EhV�RO���TAL-i-i��Tki- 0 NI ❑ - > 30 ft. from downgradient curtain/foundation dam ❑ © ❑ 0 CI Drainfield level and observation ports present ❑ I ❑ El Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfleld?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A IN YES ❑ NO Y Pump tank capacity (flood) 1.000 gal Manufacturer Hagerman Q24"access riser(s) and accessible from surface?- - ❑ ® 0 f-- o. Alarm or Control Panel Installed? - - ❑ MI ❑ Control Panel equipped with Timer/ ETM /Counter- - El MI El d Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Model Liberty 150 El Floats or II Transducer a a Tank draw down 1.5 in/min Pump capacity 20 gpm Squirt Height 9 ft Pump on time 3 min Pump off time 7 hrs 57 min Daily flow set at 180 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel#1A O \ S — 1 t, ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - (] YES im NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES [l 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: Dralnfleld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve&ainfleld,existing and proposed buildings,location of wells,waterlines, welts,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval and related permits. APPROVE .': . JAN 3 0 2023 e MASON COUNTY ENVIRONMENTAL HEALTH JBW ® Record Drawing Attached CERTIFICATION OF INSTALLATION 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 hens 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 1 further certify that all information contained on this form n attached Record Drawing is a urete. form and attached Record Drawing is accurate. \\ q P iiir 0 ignature of Installer Date G�r 1 r Poitil)rovv Goc. s .....Ai* • •f a9,44? *74 - Printed flame of Signee �� o�/,'di'"""vti.A" 4 ?�,i., • MASON COUNTY PUBUC HEALTH ; vo. J�.'gli w =��The undersigned approves this Installation Report and , ' 5 • 2Ta ` +4, Record Drawing on behaff of Mason County Public if!�" DALE L. TAH jA ?r t Heaith� 4" L NE N U© SIGNER rt \ �, t, ..vik-,,,y-, Sign re f ronmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8n1a018 i 1 I O c 1 `c._:_,------ . 06)--n'T \—(' ‘6,.. lb k N *•.% 41 Ve 1 a I. )rnC)-- ''c . in 1...._p ...-V , I i i i cp I _ � --4 re . ` • .- (� xL 1 j K 1 \ _ s.q,,,.. .(\b?..,.. - • g / • /' \I 'C'e- r\It' 'rr� g 1 • 'r0 1 p O 40 i 1 V •' I 1 1 I* + ife �-, - 1 0 , r • R ■rrrar �ispq ♦ \ , missours imator1%� r.NrErr�,' 0 al._ 'f a Qh,, Q'(Y` -\.\`112 . I It e,kAPPROVE it , 0 01 . Is Ott JAN 3 0 2023 orf >4". 'yU , q 1� ►\ MASON-COUNTY ENVIRONMENTAL HEALTH 4 rI i n v, .'4 1 J B W {i ce'r , Q.4. • �t`