HomeMy WebLinkAboutSWG2016-00250 - SWG As-Built - 3/17/2023 c . C-
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION p
Permit Number SWG 16 - �m 2 S d Parcel # 2 Zm 3 if4 ! m� �3
Applicant Name Jerry Vorpha
Applicant Address 1738 Mcleod Circle
Subdivision (Name/Div/Block/Lot)
G3 OF c v • Li /qg
City, State, Zip Dupont, WA 98327 Installer Name Hanson Excaava�tiiorn—LL�C
Site Address 1( .6 Cot.1&' Z LIV. N. Designer Name 10AI sri-G i ,
INSTALLATION CHECKLIST
(Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type PkiTSSv(LE SY S 7 w•` Pretreatment Type N --
>5 ft. from foundation? - - tyi N/A ❑ YES ❑ NO
>50 ft. from wells? - - ❑ F ❑
Z >50 ft. from surface water? - - El ❑H
Clean out between building and tank? - - ❑ ❑
0 Tank baffles present? - - ® ❑ ❑
i-- 24" access risers over each compartment?- - ® ❑ ❑
a ❑
w Effluent filter installed?- - El
cn
Septic tank capacity (working) 1500 gal Manufacturer Sound Placement
0 D-box water level and speed levelers used? - - yr N/A ❑ YES ❑ NO
—Ip0 Manifold/D-box accessible from surface?- - ❑ ❑
co Z Check valves installed? - - ❑ ® ❑
0< Sch. 40
Transport Line Size 2 Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑ 3 '4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - NrN/A ❑ YES ❑ NO
>100 ft. from wells? - - ❑ ig ❑
o
W >100 ft. from surface water? • - - El ❑
>10 ft. from potable water lines?- - ❑ V ❑
z > 5 ft. from property lines and easements?- - ❑ Cid ❑
OE > 30 ft. from dowegradient curtain/foundation drains? - 14 ❑
0
Drainfield level and obssivation ports present - ❑ (' ❑
xGraveless chambers 4r ❑ Clean gravel used? (check one) �:6rfc� S' :?'r C NO n.�
y�2-S 3'. ?.S+-4q ' �'7,-
Proper cover installed over drainfield?- - ���
Pump tank setbacks consistent with septic tank? - - ❑ N/A EYES ❑ NO
Y Pump tank capacity (flood) 1500 gal Manufacturer sound placement
< 24" access riser(s) and accessible from surface?- - ® ❑ ❑
1--
Alarm or Control Panel Installed? - - ® ❑ ❑
°' 2) ❑ ❑
2 Control Panel equipped with Timer/ ETM/Counter- -
0
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
Pump Make/Model Orenco 1 hp turbine PF301012 ® Floats or ❑ Transducer
a,
a Tank draw down in/min Pump capacity 26.55 gpm Squirt Height 2 ft
Pump on time 2 min 16 Sec Pump off time 3 Hour 34 Sec Daily flow set at 360 gpd
U,dared 8/2112018
q Sri
Mason County OSS Installation Report pg. 2 Parcel It 2-Z 003 — I1005 3
ABANDONMENT RECORD I
Were existing septic components abandoned as art of this project'? - - ❑ YES % NO
If yes. please describe: N ''i;' _e
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 'r ' 1
RECORD DRAWING ,
This is a permanent rocord and must bo accurate and descriptive enough to to-locate In the need of malntonanco acttvltlos and future davelopmenL Typical Record
Drawings contain: Drainfiold&manifold orientation&layout.Septic/pump tank location,North arrow.reserve drauttioid,existing and proposed buildings,location of wells.waterlines,
wells,obsorvalon ports,deanouts,and other maintenance access points. Incomplete Record Drawings may croato additional delays in final installation approval and related pormto
f
[X.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 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
14 erL 3/17/2023
S nature of Installer Date fir.i
Jared Hanson t<,,.r� '
Printed Marne of Signee 0 a F��+
° � �-� A&�3
MASON COUNTY PUBLIC HEALTH a E•'•- j
,:The undersigned approves this Installation Report and ,,� . 99 `'�ti •
•
Record Drawing on behalf of Mason County Public . i o: TOBY j.TAH)A-SYREIT '�'Zvi
Health: dir
LICENSED DESIGNER 1
RIT\On°C201 �'t7 'L.:5 EXPIRES: 06/07/
•
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 updated8t21f2018 _..
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APPROVED
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�`��a aII MAR 17 2023 o =
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MASON CQUNn ENVNMENTAI NEAIS� `�
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