HomeMy WebLinkAboutSWG2022-00455 - SWG As-Built - 3/6/2023 cc
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00455 Parcel # 223024450020
Applicant Name Dwayne Hindman Subdivision (Name/Div/Block/Lot)
Applicant Address 7390 Mount Buckhorn Ln Apt-F305
City, State, Zip Bremerton WA 98311 Installer Name Sam Hyat
Site Address 7310 NE Elfendahl Pass,Belfair,WA 98528 Designer Name Franklin Clark
INSTALLATION CHECKLIST
■ Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair El Other
System Type Pressure Pretreatment Type
>5 ft. from foundation? - - ❑ N/A II YES ❑ NO
>50 ft. from wells? - - ❑ IN ❑
Z• >50 ft. from surface water? - - CI ❑
H Cleanout between building and tank? - - ❑ E ❑
U Tank baffles present? - - ❑ II ❑
a24" access risers over each compartment?- - ❑ I. ❑
W Effluent filter installed?- - ❑ IN ❑
cn
Septic tank size 1250 gal Concrete Manufacturer House Bros
0 D-box water level and speed levelers used? - - 111 N/A ❑ YES El NO
XO Manifold/D-box accessible from surface?- - CI II CI
002 Check valves installed? - - ❑ M ❑
0<
2 Transport Line Size 2" Schedule/Class Schd40
Bedrooms installed (check one) El 2 U 3 ❑4 El 5 El 6 El Commercial/Other
>10 ft. from foundation? - - ❑ N/A II YES ❑ NO
>100 ft. from wells?- - ❑ E ❑
o
W >100 ft. from surface water? - - ❑ II CI
Li >10 ft. from potable water lines?- - ❑ 111 ❑
Z > 5 ft. from property lines and easements?- - ❑ IN ❑
Q
a > 30 ft. from downgradient curtain/foundation drains? - - ❑ MI ❑
Drainfield level and observation ports present - - ❑ II ❑
ii Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ II ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A MI YES El NO
• Pump tank size 1250 gal Concrete Manufacturer House Bros
< 24" access riser(s) and accessible from surface?- - ❑ II ❑
I—
a Alarm or Control Panel Installed? - - CI II CI
2 Control Panel equipped with Timer/ ETM / Counter- - ❑ IM ❑
D
a Pump installed in ❑ Bucket or II On Block or El Other
a• Pump Make/Model ZoellerN152 El Floats or El Transducer
a
Tank draw down 2 in/min Pump capacity 50+ gpm Squirt Height 4 ft
Pump on time 35 secs Pump off time 2 hrs Daily flow set at 360 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel # 223024450020
ABANDONMENT RECORD
Were any existing septic components abadoned as part of this project? - - ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES In 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 bui dings,location of wells,waterlines.
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final insta lation approval and related permits.
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
at Pt;rviaau,f C.uufuy Fualic ryeairn ana meet ati 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 attached e ord Drawing Is accurate. form and attached Record Drawing is accurate.
Signature of Installer Date
C ` s,+
Printed Name of Slgnee
MASON COUNTY PUBLIC HEALTH rr" 510•
0413 +�+�t�
The undersigned approves this Installation Report and :. FRANIQJNJCUARX•
Record Drawing on behalf of Mason County Public Do4Reki0/28/2024
Health:
(6 (Z
a'
Signature of Environment Health Specialist Date (stamp, signature and date)
( p g
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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