HomeMy WebLinkAboutSWG2022-00562 - SWG As-Built - 3/16/2023 C •G
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APP SCAN:TI:PEf MItiNFORAilAf N .
Permit Number SWG 2022-00562 Parcel # 42201-43-00060
Applicant Name Austin Brereton Subdivision (Name/Div/Block/Lot)
Applicant Address oLS3.5 /}wyld
City, State, Zip Hoodsport, WA 98548 Installer Name T.J Goos
Site Address 25381 N. Hwy 101, Hoodsport Designer Name Dale L. Tahia
INSTALLATION:CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑Other
System Type Pressure Trench Pretreatment Type
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - •- ❑ ® ❑
Z >50 ft. from surface water? - (� (�5 �� ❑ 0 0
a Cleanout between building and tank? - - - - L1. +. X- -}j - ------_-
I— - ❑ ® ❑
✓ Tank baffles present? - ❑ II
O,~ 24" access risers over each compartment? —MAR 9 Zf123 _�U'ilt ❑❑ 0 ❑
W Effluent filter installed?- 0 ❑
co By -- -
Septic tank capacity (working) 1.250 g Hagerman
9 D-box water level and speed levelers used? - - Ill N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ 0 ❑
OQCheck valves installed? - - ❑ 0 0
2 Transport Line Size 2 inch Schedule/Class Sch. 40
Bedrooms installed (check one) ❑ 2 0 3 0 4 0 5 0 6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
>100 ft. from wells?- - 0 ® ❑
W >100 ft. from surface water? - - 0 IN
ti >10 ft.from potable water lines?- - ❑ 0 0
Qz > 5 ft. from property lines and easements?- - 0 MI 0
d > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® 0
Drainfield level and observation ports present - - 0 It 0
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A IN YES ❑ NO
• Pump tank capacity (flood) 1.000 gal Manufacturer Hagerman
a24" access riser(s) and accessible from surface?- - 0 It 0
I—
A. Alarm or Control Panel Installed? - - 0 0 0
• Control Panel equipped with Timer/ ETM /Counter- - 0 0 ❑
-• Pump installed in ❑ Bucket or 0 On Block or ❑ Other
Q• Pump Make/Model Liberty 280 ❑ Floats or 0 Transducer
la
• Tank draw down 1.75 in/min Pump capacity 36 gpm Squirt Height 7.5 ft
Pump on time 2.8 Pump off time 5 hrs 57.2 min Daily flow set at 270 gpd
Updated 8i21i2018
•
Mason County OSS Installation Report Pg. 2 Parcel# y \ �`)j-0C`0(-n
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - ----- ❑ YE
s
If yes, please describe:
Were all components pumped out and properly abandoned per WAC24S-272A-0300? - - ❑ S ❑ NO
RECORD DRAWING
This Is a permanent record and must be accurate end descriptive enough to re-locate In the need of maintenance activities and future development T pIul Record
Drawing&contain: DrainhiMd 6 manifold odenualon&layout,SspOdpump tank location,North arrow,reserve draktlsid,eXiating and proposed buildings,locution of wells,wateiinas,
wells,observation ports,deanouts,and other maintenance access points. krcomilee Record Drendngs may create addlaM delays in final Installation approval and related perm(ts.
• Mel
Mq�NCOUNT_Ntr o „%),
Ja isa i M1NTAC HEq '.
H
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 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 ail
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 ac re . form and attached Record Drawing is accurate.
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Signature t ler ate Jr f
dr,�„ , ��i
ise
Printed Name of Signee ;,..,A. of ski,,,* I*, `*i
MASON COUNTY PUBLIC HEALTH �� '`r`1'�.1
51Cm214 �`
The undersigned approves this installation Report and ,,r� 44
Record Drawing on behalf of Mason County Public i O'` DALE L. TANA 2' 4I
He-. LICE 0,£SIGNER th
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"" 3-4e-231
Sig r ; • . mental Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES SITE Updehd eV211°te
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