HomeMy WebLinkAboutSWG2022-00504 - SWG As-Built - 2/8/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERK' INMIWATION ,�'"
9
Permit Number SWG 2022-00504 Parcel # 32134-23-90030
JAN -31 ?uz3
Applicant Name Bob Abelson Subdivision (Name/Divv//Block/LLott)) -::.,
Applicant Address 141 E. Deer Creek Rd. )kli.3 � S \" 6y
City, State, Zip Shelton, WA 98584 Installer Name T.J. Goos
Site Address Mason Lake Rd. Designer Name Dale L. Tahia
INSTALLATION CHCKAJOT
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Sandlined Pressure Bed Pretreatment Type Sand Augmentation
>5 ft. from foundation? - - ❑ NIA ®YES ❑ NO
>50 ft. from wells? - .- ❑ MI 0
Z >50 ft. from surface water? - - 0 ® El
Cleanout between building and tank? - - 0 ® 0
V Tank baffles present? - - ❑ ® 0
f= 24" access risers over each compartment?- - ❑ ® 0
a
W Effluent filter installed?- - ❑ ® ❑
Cl)
Septic tank capacity (working) 1.250 gal Manufacturer Hagerman
t1. D-box water level and speed levelers used? - - Ill NIA ❑ YES ❑ NO
OO Manifold/D-box accessible from surface?- - ❑ ill
C92 Check valves installed? - - 0 IN ❑
caa
2 Transport Line Size
2 inch Schedule/Class Sch. 40
Bedrooms installed (check one) 0 2 ❑ 3 El 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ NIA II YES ❑ NO
>100 ft. from wells? ❑ ® ❑
W >100 ft. from surface water? - - ❑ 0 ❑
tj. >10 ft.from potable water lines?- - ❑ ® 0
1 > 5 ft.from property lines and easements?- - 0 0
> 30 ft.from downgradient curtain/foundation drains? - ❑ ® 0
CI
Drainfield level and observation ports present - - ❑ ® 0
0 Graveless chambers or a Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 ® 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
Pump tank capacity (flood) 1.250 gal Manufacturer Hagerman
Z - 0 0
Q 24" access riser(s) and accessible from surface?
I—
a. Alarm or Control Panel Installed? - - El MI 2 Control Panel equipped with Timer/ ETM /Counter- 0 a 0
-
m
°- Pump installed in ❑ Bucket or a On Block or ❑ Other
2 Pump Make/Model Liberty 280 ❑ Floats or 0 Transducer
a
Tank draw down 1.75 in/min Pump capacity 42 gpm Squirt Height 7 ft
Pump on time 2 min. Pump off time 5 hrs 58 min Daily flow set at 360 gpd
Updated 8121/2018
Installation Report pg.2 Parcel# \ �— ���Z�
Mason County OSS Insta a'Po
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES too
If yes, please describe: - 0 YES 0 NO
Were all components pumped out and properly abandoned per WAC24&-272A-0300? -
RECORD DRAWING .
This Is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future da T t Ty
pical Record
Drawn contain Drapltield 8 mardfadd orientation&layout,Septic/pump tank location,Nor arrow,reserve dnbraeld,existing and proposed buildings,location Owego.,waterlines,
wags,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create addttlonal delays in final Insteitatlon approval and related permits.
• Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
I certify that the system has been installed in accor-
t certify that!installed the system in accordance with dance with the septic design stamped"APPROVED"by
the septic design stamped"APPROVED"by Mason
County Public Health and that any deviations shown Meson County Public Health and that any deviations
here have been cleated/approved by both the designer ���andher have beenson Countye Public Health and by both all
and Mason County Public Health and meet all StateState and Mason County Codes
and Mason County Codes. on
I further certify that all information contai ed on this I further m �rtifythhadtPallll informationD Drawing contained
8� this
form and attached ecord Drawing 7s rate.
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Signature Installer Date �r s `ilk+
ry (` . S - k
1' ) � � f SE C
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Printed Name Signer
C:),‘' '1 t '' • v.
MASON COUNTY PUBLIC HEALTH �, ' •
S1CiU214 ` F =+
Q The undersigned approves this Installation Report and '��► DALE L.TAHJA _ ` ��
�
Record Drawing on behalf of Mason County Public - LI P nF S;GNER
Health: .r10. . r,..;, _. ��►��`r��ir.
EXIT?;s: .: '' �I.
gFeL 10,>
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 upde+ed 8121nofe
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