HomeMy WebLinkAboutSWG2019-00390 - SWG As-Built - 2/13/2023 Mason County OSS Installation Report pg. 9 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMItINFORMATION
Permit Number SWG 2019-00390 Parcel # 42213-22-70585
Applicant Name Joel Parsons Subdivision (Name/Div/Block/Lot)
Applicant Address 21509 186th Street East
City, State, Zip Ordinq, WA 98360 Installer Name T.J. Goos
Site Address 24050 N. US Highway 101 Designer Name Dale L. Tahja
IMITALLATION CHECKLIST'
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Pressurized Bed Pretreatment Type NuWater BNR 500
>5 ft. from foundation? - - ❑ N/A ®YES ❑ NO
>50 ft. from wells? - - ❑ II ❑
Z >50 ft. from surface water? - - El ® ❑
< Cleanout between building and tank? - - ❑ ® ❑
O Tank baffles present? - - ❑ ® ❑
a24" access risers over each compartment?- - 0 IN
N Effluent filter installed?- - ❑ 0 ❑
Septic tank capacity (working) 1.000 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO
000 Manifold/D-box accessible from surface? - ❑ 0 ID
m' Check valves installed? - ❑ Mil
OQ
2 Transport Line Size 2 inch Schedule/Class Sch. 40
Bedrooms installed (check one) ❑ 2 0 3 0 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES ® NO
0 >100 ft. from wells?- - ❑ 111 El
>100 ft. from surface water? - - ❑ C 1'
LU
LL >10 ft.from potable water lines?- - ❑ II Nul N 0
Z > 5 ft. from property lines and easements?- - ❑ C N in
Q > 30 ft. from downgradient curtain/foundation drains? - - Elc� ElNu]Drainfield level and observation ports present ❑ >. ❑
❑ Graveless chambers or • Clean gravel used? (check one)
Proper cover installed over drainfield?- - IDion Pul
® C.
Pump tank setbacks consistent with septic tank? - - ❑ N/A HE YES ❑ NO
ZPump tank capacity(flood) 1.000 gal Manufacturer Hagerman
< 24" access riser(s) and accessible from surface?- - ❑ IN ❑
F-a. Alarm or Control Panel Installed?
• Control Panel equipped with Timer/ ETM /Counter- - ❑ UI ❑
a. . Pump installed in ❑ Bucket or ® On Block or ❑ Other
a.
• Pump Make/Model Liberty 280 It Floats or ❑ Transducer
a Tank draw down 1.5 in/min Pump capacity 36 gpm Squirt Height 8.5 ft
Pump on time 3.4 min Pump off time 5 hrs 56.6 min Daily flow set at 270 gpd
Updated 8/2'12018
Mason County OSS installation Report pg.2 Parcel# I *V--- '1;�_ C<0 �J
ABANDONMENT RECORD
Were existing septic components abandoned as wt of�this prole 1l r: i----- YES 0 NO
If yes, please describe: ,\ n1S j€'1 \C ,\"�1 C '',�f-t( r \�I rl
Were all components pumped out and property abandoned per WAC248-272A-0300? - - ky Yr! 0 NO
RECORD DRAWING
This is a permanent record and must be acourant and dwcrlp@ve enough to re-iocat*In the need of maintenance activttes and future development. 'typical Record
Drawings contain &Wield&manifold orientation&layout,88pdc umP tank loin,North arrow,resents drahieaid,existing and proposed buadmgs,location of wells,waterlines,
webs,observation ports deanoute,and other maintenance access points. Incomplete Record Drawings may avate additional delays in fetal Instaikton approval and related permits.
•
U 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 end that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Meson 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 ,.. ,te. form and attached Record Drawing is accurate.
Signature oft ter �i, • +,+ .
�— 11^'►C�(a S ''' ie
s P 'vi•v
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH .�- �. ' "r<-+f
Age• �51W214 ;�'�:
The undersigned approves this Installation Report and F
Record Drawing on behalf of Mason County Public ""PO`"'ft DALE L. TAHAA �i
LIC SECS DESIGNER
Heal ".Itaura ...,.,, ����..���� .
''4 ------ 0 Fe 7w EXV i::;: - -:•.
re 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 Upddad tu2112318
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, AAPPROVE
FEB 13 2023
MASON COUNT!'�'��;-�•
NMENTAL HEALTH
0711