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HomeMy WebLinkAboutSWG2022-00410 - SWG As-Built - 2/6/2023, . j ir Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00410 Parcel# 22206-52-00016 Applicant Name WALTER/MARGIE BENSON Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 1465 City, State, Zip BELFAIR, WA. 98528 Installer Name ROYAL FLUSH SEPTIC Site Address 70 NE SNOWCAP PLACE Designer Name CINDY WAITE INSTALLATION CHECKLIST NJ Full System Installation ❑Tank(s)Only ❑ Drainfield Only $1 Repair ❑Other System Type PRESSURE DIST Pretreatment Type >5 ft. from foundation? - 0 N/A ®YES ❑ NO >50 ft. from wells? - _ ❑ ® ❑ Z >50 ft. from surface water? - 4_- -t- NI ❑ ❑ Cleanout between building and tank? - - ❑ ® ❑ tJ Tank baffles present? - 1 _FFR O 2_ V1.1_ _ ❑ ❑ a24"access risers over each compartmen . _ CI ® CI Effluent filter installed?- -- ' Br _ _ _* - 0 ® 0 Septic tank size 1250 gal Manufacturer HOUSE BROTHERS 1 I c3 D-box water level and speed levelers used? - - © N/A ❑ YES ❑ NO XOO Manifold/D-box accessible from surface?- - El II CI C1 Check valves installed? - - 0 ❑ ❑ E Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) Q 2 El 3 El 4 El 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A D YES El NO C) >100 ft. from wells?- - ❑ © ❑ W >100 ft. from surface water?- CI ® CI LL >10 ft. from potable water lines?- - El © CI 5> ft. from property lines and easements?- IX Ci > 30 ft. from downgradient curtain/foundation drains?- 0 CI GI level and observation ports present El Ill El fj Graveless chambers or ❑ Clean gravel used? (check one) Low Rt.o/t fe Proper cover installed over drainfield?- - CIb IN ❑ Pump tank setbacks consistant with septic tank?- - El N/A ❑ YES El NO Y Pump tank size 1250 gal Manufacturer HOUSE BROTHERS Z H24"access riser(s)and accessible from surface?- - CI I] ❑ a. Alarm or Control Panel Installed? - - ❑ UJ ❑ Control Panel equipped with Timer/ETM/Counter- - ❑ ® ❑ \�Q t d Pump installed in El Bucket or It On Block or ❑ Other d Pump Make/Model LIBERTY 290 ® Floats or ❑ Transduce / ii.0 ) fi Tank draw down �rt a 1> ZS in/min Pump capacity � gpm Squirt Height 18+ ft Pump on time j . Z. Pump off time `t h r Daily flow set at 180 gpd Updated act2m r Mason County OSS Installation Report pg. 2 Parcel# 22206-52-00016 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 0 NO If yes. please describe: i Were all components pumped out and properly abandoned per WAC246-272A-0300' - - 0 YES 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 wets.waterlines, wels.observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 1 /A Ire RIO VE D FEB - 6 202.3 �*p`�` JASON COMM atmRCE � MI 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 furt - certify at all information contained on this I further certify that all information contained on this fo atfa/�-d cord Drawing is accurate. form and attached Record Dral�ng is accurate. if / / 0/ 31 Z6z3 /-' r. Sign:t. : of s alter Date Z3 -Z?4/N P .S. . 0 Printed Name of Signee t � , L.41 . ..,- `� i a, MASON COUNTY PUBLIC HEALTH 004 -. �`.;- •°i• A YE ht• E The undersigned approves this Installation Report and r. LICENSED of S...vl R Record Drawing on behalf of Mason County Public 1.'e"...1. ' ' - -r':`.^r-„-;, Health: 1Y Feb 7nz3 Signature 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 Updated 8/21/2018 r .el°4131/2-1—:1-s /1/2....."" ......"'s—.-.... .."'"..--. PPROVE ki.o . 6)' ° 1,� . 1 FEB 0 6 2023 • f-,-;•- `�/� �,���i N; j� �r ,ENVIRONMENTAL HEALTH Avec ( ,..„.....1-, ,.-: ,.4., l BIN . terAV 461 alec,..,"ray tors Z 3 5L o�_ 3-7 `,,P \?1, °Q ,! �7 `�� W l/ .,I' fig\ �1 a= •'r V ft ,t, 7.. `4. r or ` t 1I V il ii, , / 2.24 it ...IP dc UCE4NSED 11 - '• R'•'' 41k44) 1 1 tli) / I.tt4%8 for "" • 0 _ �;:) '2 ,) s'4,i4c fay •0 . . . t� 1 .7,. 1:.[f'• �K,� ' 3o1 -tom / J ..4 b 3� ri - 0 t1 ( ` \\\