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HomeMy WebLinkAboutSWG2021-00694 - SWG As-Built - 3/20/2023 . C-C Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00694 Parcel# 223315100004 Applicant Name COLETTE HARN Subdivision (Name/Div/Block/Lot) Applicant Address 1161 NE COLLINS LAKE DR City, State, Zip tiELFAIR,WA 98528 Iiislallel Nartte ABBA EXGAVATINC LLG Site Address 1161 NE COLLINS LAKE DR Designer Name ADVANTAGE PERC&DESIGN INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type_ PRESSURE BED Pretreatment Type >5 ft. from foundation? - - - - - -- - - - ❑N/A ®YES ❑ NO >50 ft. from wells? - - - - - - -- - - - ❑ © ❑ Z >50 ft.from surface water? - - El El 1-- • Cleanout between building and tank? - ❑ Et ❑ o Tank baffles present? - - - 0 01 ❑ a24' access risers over each compartment?- - Li I I ❑ w Effluent filter installed?- - -- - - - - -- -- - ❑ [II ❑ in Septic tank size 1060 gal Manufacturer INFILTRATOR o D-box water level and speed levelers used? - © N/A ❑YES ❑ NO Q 0 Manifold/D-box accessible from surface?- - ❑ II ❑ m Z Check valves installed? ❑ 0 ❑ 0Q . 2 Transport Line Size___ ___T 2" Schedule/Class - 40 Bedrooms installed(check one) 11 2 ❑3 ❑4 r] 5 ❑6 ❑CommerciaVOther >10 ft.from foundation?- -- - -- - - ❑ N/A ® YES 0 NO a >100 ft.from wells?- - ❑ ® 0 W >100 ft.from surface water? - - ❑ ® CI cr. >10 ft.from potable water lines?- .- - --- - ❑ MI 0 Zd. > 5 ft. from property lines and easements?- -- - ❑ ® 0 lie >30 ft.from downgradient curtain/foundation drains?- - ® El ❑ • Drainfield level and observation ports present - - ❑ IN ❑ IN Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 Pump tank setbacks consistant with septic tank?- - ❑ N/A ® YES ❑ NO Y Pump tank size_- 1060 _gal Manufacturer INFILTRATOR Q24' access riser(s)and accessible from surface?- . . - - - -- ---- 0 ® ❑ N ❑ a. Alarm or Control Panel installed? ❑ E Control Panel equipped with Timer/ETM/Counter- - ❑ a 0 0 a- Pump installed in ❑ Bucket or ® On Block or ❑ Other Ell Pump Make/Model LIBERTY LP280 inFloats or 0 Transducer , rI'l,tt inlmi a Tank draw down ; n Pump capacity *.:50 f7pm Squirt Height :.) ft Pump on time I 1'1, Pump off time l/ tsrc-. Daily flow set at b() qpd Updates ealrzo1e Mason County OSS Installation Report pg. 2 Parcel# 223315100004 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Ei YES Q NO If yes. please describe Were at components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES E 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 erarneetd 5 nanMld oner.tatron S layout.Septic.'pomp lank bcaacn.North arrow.reserve dranhe.d,erostang and proposed baddngs.Location of wefts,w»tertirws, nwlls.observation ports.deanocts and other maintenance access points Incomplete Record Plowings may ue.Me additional delays in final instatiabcn approval and related permits -pc 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 mstailed 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 1 further certify that all information contained on this 1 further certify that all information contained on this cfn and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 't,L\`-'�' ��..,r) V 2-10-23 i nature of Installer Date g ..•I PAM M BUSEK i.•'e- !it / Punted Name of Signee I. ;1 .� MASON COUNTY PUBLIC HEALTH j 1p'. -ot The undersigned approves this installation l ROVED ? , t • • `��tf Record wing on ehalf of Mason Coun4l tic 111.•��. . LIC='�ar .SIGNER Heft O 2023 �:,... -. ',. .w�, 3/20/ ature of Environmental Health SpecialisMA GOUN E IRONMENTAL HEAamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FD IdI..IC VIEW ON THE MASON COUNTY WEB SITE Updated fQ1Qd e l s � z ro C' � 1� �s L„ 0 ago �P /Q,1 / .Ile :/L o- / . p, o or o / . 0- C. p+ rn T o ^ o' ��`/r" 4, * (3 a. // 4,3 ri) 0 m n " 0 v sLI rn N MAR 2 U 623 N MASON COUNTY ENVIRONMENTALDJA HEALTE n a) Nrn — `U .j -Ti v rD 0 co CD r r w r d x C7 u. _G '^ II 00 ro N � wzm n O � N� "y�� �s� to yr rn T. W ?� r> rr it, •G f ' �.. ny G. C �t ve �D U IVY�`'�� r O 00 �+ O 1 m'a 5r � , 1W G CC%' �'L N r