Loading...
HomeMy WebLinkAboutSWG2023-00064 - SWG As-Built - 3/30/2023 CMason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00064 Parcel# 12330-51-00044 Applicant Name Cruz Pedro Alonzo Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 3044 Beards Cove Division:4 Lot:44 City, State, Zip Belfair,WA 98528 Installer Name Shumaker Construction Site Address 470 NE Larson Boulevard Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only U Repair ❑ Other System Type Pressure Bed Pretreatment Type >5 ft.from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - U] ❑ ❑ z >50 ft. from surface water? - - D 0 0 Cleanout between building and tank? - - ❑ 0 ❑ V Tank baffles present? - - ❑ ® ❑ a 24" access risers over each compartment?- - ❑ I ❑ tW Effluent filter installed?- - ❑ MI Septic tank capacity(working) 1,200 gal Manufacturer Existing Concrete 5 D-box water level and speed levelers used? - - © N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - 0 El El CQ Check valves installed? - - 0 Oil 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 IN 3 ❑4 0 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - _❑ NIA ❑] YES ❑ NO O >100 ft. from wells?- [C g - {1-WI' �, IH LI LI W >100 ft. from surface water?- ! LL >10 ft. from potable water lines?- 41 _44,k-2-7-w3- ®,3 ❑ ❑ Q > 5 ft. from property lines and easements?- 11 - l©i ® ❑ Q > 30 ft. from downgradient curtain/foundation d ains - - 0 El ❑Drainfield level and observation ports present - --- ---- -❑O I ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO • Pump tank capacity(flood) 1,287 gal Manufacturer Infiltrator Z < 24" access riser(s) and accessible from surface?- - ❑ © ❑ d Alarm or Control Panel Installed? - - ❑ I ❑ • Control Panel equipped with Timer/ ETM /Counter- - ❑ I ❑ a Pump installed in U] Bucket or ❑ On Block or ❑ Other a• Pump Make/Model Liberty 2800 Floats or 0 Transducer a Tank draw down 1.75 _, in/min Pump capacity 44 gpm Squirt Height 7 ft Pump on time 2 Pump off time 6 hours Daily flow set at 360 qpd U ddated 8'2,2C t 8 Mason County OSS Installation Report pg. 2 Parcel# 2330"51 '00Pfrit' ABANDONMENT RECORD _ ® Yes p NO Were existing septic components abandoned as par: of this project? If yes, please describe: Old AIh 1C d Alaan CCk ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES RECORD DRAWING This is a permanent record and must be accurate and descriptive enougho�ah ate�in tthe need of maintenance activities proposed and�c Ssre development dwells,Typical Recor Drawings contain: Drainfield&manifold onenation&layout.Septic/pump tank installation approval f w lts waterlines; permits. wells,observation ports,cleano.•ts,and other maintenance access points. Incomplete Record Drawings may create additional delays 3E-E. A—icx ® 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 forEo and att e Drawing is accurate. form and attached Record Drawing is accurate. 31zj12-5 A114 Signature of Installer Date Nts/-1 v- \- 1 Wei ',^ 04 e�e "64Printed Name of Signeeire...!!' '�` V� MASON COUNTY PUBLIC HEALTH ,..41111 14, ••. 0• ' 5 C0343 • f The undersigned approves this Installation Report and ,}=4&.` PAULA JOY JOHNSON. Record Drawing on behalf of Mason County Public ElteiirS f;t1bE- fGNE'f1•• ,r Health: 4i--cs 'Y n/ ` S/3`0 /LT 3-2%-z3 Signature of Environmennl Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8R1/2018 Sttea - 1 ao' SCALE : ,,:)-p, 0 %O to 30 4 ( S ®- As-�u1LT cOD~ °2 o 1 GR.uLP70`R.4M.oNz-0 0--) f o PAR.c 1. 12330-51-6009r 27 x lay' RI© ` .o o �}�i0 N� Lk�(ZSoN t3l�UD I 3$R. - o o F" J M ANv AvA ,Yu2.E'Dl Si HOMES Cr 1SJ s / o 0 0 a- rjrr"---I—j' 1 Ili Cl C-t-¢! V--;nn (Z� 0 I. ICZ2.5 9 D • prey. lo0.0w Bea5 -- N E �A SoN ���°— fri-t). IDAudio-Visual Alarmv:.,,!,-).,., Cleanout L s,-•;- -4.,) 'rX (-2) i 5`�i� r-,a, PAULA JOY JOHNSON .y�� 0 1200 Galloli Septic Tank LtC tS�f�Y�iE 7�1v�Ft` 2-Compartment-1� � ii R r1 Effluent Filter 3-v-E-2 S 0 1000 Gallon Pump Chamber APPROVED MAR 3 0 2023 MASON COUNTY ENVIRONMENTAL HEALTf RET