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HomeMy WebLinkAboutSWG2022-00513 - SWG As-Built - 3/27/2023 Mason County OSS Installation Report pg. 1 0., .0 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00513 Parcel# 32232-75-90034 Applicant Name Jim Walker&Gwen Anderson Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1292 TR 3-D OF SURVEY 5/59 LOT:4 OF SP#2429 City, State, Zip Belfair,WA 98528 Installer Name Joe Fassio Excavating Site Address 125 E Union Heights PI N, Union Designer Name Arrow Septic Designs INSTALLATION CHECKLIST 0 Fun System Installation D Tank(s)Only ❑ Drainfield Only 0 Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - ' © ❑ ❑ Z >50 ft. from surface water? - I: ❑ N Cleanout between building and tank? -- --N}At f 1]-J3- 0 0 ❑ V Tank baffles present? - 0 © 0 1- 24" access risers over each compartmen .B 0 In W Effluent filter installed?- y ❑ ® ❑ co Hagerman Septic tank capacity(working) 1,200 gal Manufacturer 9 CI D-box water level and speed levelers used? - - LI N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - 0 1. ❑ n?Z Check valves installed? - - ❑ 0 ❑ 04 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed (check one) ❑ 2 0 3 0 4 ❑ 5 ❑ 6 ❑Commercial/Other >10 ft. from foundation?- - 0 N/A 0 YES ❑ NO C >100 ft. from wells?- - ® 0 0 w >100 ft. from surface water? - - EN ❑ 0 ra: >10 ft. from potable water lines?- - ❑ ® ❑ z > 5 ft.from property lines and easements?- - 0 0 ❑ l >30 ft. from downgradient curtain/foundation drains?- - MI 0 ❑ CI Drainfield level and observation ports present - - ❑ ® ❑ NE Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® 0 Pump tank setbacks consistent with septic tank?- - 0 N/A 1 YES 0 NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z - El 0 ❑ < 24" access riser(s)and accessible from surface? a. Alarm or Control Panel Installed? - '�L1 �'lott�s e - ❑ El 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ® 0 n a Pump installed in ® Bucket or ❑ On Block or 0 Other a• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 45 gpm Squirt Height 5 ft Pump on time 2 minutes Pump off time 6hours Daily flow set at 360 gpd Updated 8/21,2018 Parcel# J Z .— — `3C0 5_ Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD NO - 0 YES Were existing septic components abandoned as part of this project? - If yes, please describe: y 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING u in the need of maintenance activities and Mutt development Typical Record enough to re-locate and proposed Midi de Ieo pm C,wells,waterlines, This is a permanentin: Or record and must ne accurate and descriptive tank location,North arrow.reserve drainfield,existing wells,o s contain: Drts.cl d&uts,an d ther maintenancen 8 layout.Sess pump create additional delays in final installation approval and related permas. wells,observation ports.deanouts,and other access points. Incomplete Record Drawings may 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 1 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. 03 icQi23 8 5 Si re of Installer Dbt e 9 -�.• CyJ 0f �G2551C� �� • t .,s ' Printed Name of Signee MASON COUNTY PUBLIC HEALTH if: • 1y mil' S106.i43 '•5�5.7 The undersigned approves this Installation Report and p._ .PAULA JOY JOH?iSON .y\ Record Drawing on behalf of Mason CountyPublic LrC1,(S1E ittt,,GNi�AE • . ibr,572 He ith: VrY\WiAlp -5(77717-Th 3 —t1—z� 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 U°oi1CC 812'2°8 a get yak seNn ckci,', ,-,-,_ t . c 6..Y _ ? 32232--15-90O34 Ic�v Sty --//i r D ).-c-N, / gi3s2. Q . • Futuve j -3 BR rtou.se l 1 ;-Ire 4o1 xs9 ' I ' �. — l 1 GO wIC CD ill:7r; 11 YOA)fwvij , - ' �� 3 ` x 35 ��\UM (2)• 3 x3p , ( —r ! r p. v 1_ - ,T O I Kv: O r r. Audio-Visual Alarm 0 Cleanout \` 01200 Gallon Septic Tank 2-Compartment with ` Effluent Filter O1000 Gallon Pump Chamber Ws'(V oue.,k-1- Si(T1...eh \ O Valve Control Box ,-/-5 APPROVED 1 . MAR 272023Wti ,,, ` MASON COUNTY ENVIRONMENTAL HEALTIh • RET ' %_. }. .i-; .- 64'0349 tir1 1:0 PAULA JOY JOHNSON ..: k , •• 8n1 10%4 1#: 3—c""?-2-S