HomeMy WebLinkAboutSWG22023-00035 - SWG As-Built - 4/26/2023 l
Mason County OSS Installation Report pg. 1 c MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00035 Parcel# 22336-51-00008
Applicant Name Andrew Bickham Subdivision (Name/Div/Block/Lot)
Applicant Address 50 NE Bryan Ln
City, State, Zip Beifair,WA 98528 Installer Name BCS Development LLC
Site Address same Designer Name Jim llmney
INSTALLATION CHECKLIST
® Full System Installation ❑ Tank(s)Only ❑OramieId Only ❑Repair 0 Other
System Type Gravity Pretreatment Type
>5 ft.from foundation? - - ❑NsA ®YES ❑ NO
>50 ft. from wells? - • - - ® 0 0
Z >50 ft.from surface water? - - ® 0 0
H Cleanout between building and tank') - . El ® 0
U Tank baffles present? - -- - ❑ ® 0
£~L 24"access risers over each compartment?------- _ _ 0 IN
W Effluent filter installed?- -- - 0 ® 0
co
Septic tank capacity(working) 1500 gal Manufacturer Infiltrator
o D-box water level and speed levelers used? - - 0 NA ®YES 0 NO
O Manifold/D-box accessible from surface?.- - -- - -- - - - - -- - 0 ® ❑
Ow
[C 2" Check valves installed? - ® 0 El
d
2 Transport Line Size 4" Schedule/Class SDR35
Bedrooms installed(check one) 0 2 ®3 ❑4 ❑ 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- --- - ❑ N/A ® YES ❑ NO
O >100 ft. from wells?---
❑ 0
W >100 ft. from surface water?- - IN 0 CI
tLL >10 ft.from potable water lines?• - - - -- - ❑ U 0
Z >5 ft. from property lines and easements?. 0 NI 0
Q
CC >30 ft.from downgradient curtaintfoundation drains?- - Ill ❑ CI
Drainfield level and observation ports present - - - 0 PI
❑ Graveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - ❑ ® 0
Pump tank setbacks consistent with septic tank?- --- - - --
® N/A ❑ YES ❑ so
Z• Pump tank capacity(flood) gal Manufacturer
• 24"access riser(s)and accessible from surface?- - - - - - - - ❑ El 0
a, Alarm or Control Panel Installed? - - 0 0 ❑
Control Panel equipped with Timer!ETM/Counter- - - --- ❑ 0 0
°- Pump installed in 0 Bucket or ❑ On Block or 0 Other
Pump Make/Model 0 Floats or 0 Transducer
a. Tank draw down in/min Pumpcapacit
y gpm Squirt Height_ ft
Pump on time Pump off time Daily flow set at 9pd
Loda.eo W 1/2018
Mason County OSS Installation Report pg. 2 Parcel# 22336-51-00008
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - ® YES 0 NO
If yes, please describe.Septic tank pumped and abandoneed in place
Were all components pumped out and property abandoned per WAC246-272A-03002 - - - - - - - - ® YES 0 NO
RECORD DRAWING
Thi•I.a permanent record end must be accurate and du$ctlpttvs enough to re-Facet*/n the need of maintenance active.**and Muni development. Imre,Record
Drawings contar.. Drumhead d manadd auntedon it layout,Septdptntp tank kacahon,North armor,reserve drumhead,easing and proposed buildings, canon of wets.wwalerknes.
note,ohmwton p,otm.cteaoat t,as W of el to mtntn/vern access poises inc m pieta Record Le mums/rosy Matt aeseonr detlys to tetat aletaseoon approval and related monde
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t i APR 2 ti 2023
"1480Iv COUNTY ENVIRONMENTAL HEALTH
W EALTH
Q Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
1 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 cleered/appmved by both the designer shown hero hove boon 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.
3/31/2023
Signature of Installer Date
%1
Bill Bumbaloudh !e 1II
Printed Name of Signee ,. `o ' ►1
S: Fy
311
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MASON COUNTY PUBLIC HEALTH �� ,� r Aflf
The undersigned approves this Installation Report and rc. • 23, 3 � fl
Record Drawing on behalf of Mason County Public Itt�,�,';DE 7 R 11
Na h:
��A-Z, Expire far., 'C
i ',Al 1 ii/k_<-....1
Sign ure� ironmental Health Specialist Date
(stamp,signature and data)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE trxsa/edarztr:°ta
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