HomeMy WebLinkAboutSWG2021-00218 - SWG As-Built - 5/10/2023 c fro s -`7-J,3
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SwG 2O Z4 pp z( Parcel# ( Z Z3 2- 35r O ztJ
Applicant Name L/e:1 ie f44, (A Subdivision(Name/Div/Block/Lot)
Applicant Address 16 S`c , //7,T.14 'rf
City, State, Zip kiyACLu coati, ? 3'75/ Installer Name /t�(/Ct_. YRilfn(e1
Site Address 4/7 b i 1t2U/Ai s I(CCC Designer Name 7erIrk e-/z e 4--
INSTALLATION CHECKLIST
Full System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type . T4.-1trj) I?c ) Pretreatment Type
>5 ft. from foundation? - - 0 N/A Is ❑ NO
>50 ft.from wells? - - [] a"- ❑
Z >50 ft. from surface water? - - 0 Ea- ❑
H Cleanout between building and tank? - - ❑ a El
U Tank baffles present? - - ❑ 0' ❑
a24"access risers over each compartment?- - 0 a
t)
W Effluent filter installed?- 0--5 a- - - - - ❑ ❑' ❑
Septic tank capacity(working) gal Manufacturer tf��'Fer,-(
O D-box water level and speed levelers used? - - ,a kiA 0 YES 0 NO
oO Manifold/D-box accessible from surface?- - 0 0
mi Check valves installed? - - Er ❑ ❑
0Q (/
2 Transport Line Size 2 Schedule/Class t(4t!)
Bedrooms installed (check one) ❑ 2 1 s ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A [F-YES ❑ NO
CI >100ft.fromwells?- ;, "°' -" ;- E g ❑
Ltit _ _f.. _-_
W >100 ft.from surface water? ❑ a o
a: >10 ft_from potable water lines? .��.. - --- 0 ❑--- ❑
z � �� MAY-t 0�023--
>5 ft. from property lines and e is?- . ❑ Er ❑
>30 ft.from downgradient curtaynalefkliATefraiiMONMENTAL HEALTH 0 Cr ❑
ct
Drainfield level and observation po resent -jaw - 0 Ifr ❑
❑ Graveless chambers or Clean gravel used? (check one) •
Proper cover installed over drainfield?- - 0 [K 0
Pump tank setbacks consistent with septic tank?- - - 0 N/A YES ❑ NO
ZPump tank capacity(flood) gal Manufacturer
<< 24"access riser(s)and accessible from surface?• - ❑ 0�.,�/ 0
a Alarm or Control Panel Installed? - - ❑ l� El
• Control Panel equipped with Timer/ETM I Counter- - 0 0
d Pump installed in 0 Bucket or On Block or ❑ Other
0- Pump Make/Model /tp eR T Y ,- e Floats or ❑ Transducer
a. Tank draw down3�� ( (M. in/min Pump capacity 7f' qpm Squirt Height MilD27 •‘ ft
Pump on time AN[ t'Zse L Pump off time X.<5 Daily flow set at y gpd
updated 8rz1n018
Mason County OSS Installation Report pg. 2 Parcel# 12 2 3 2 2 3(4UZ.CI
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? • - 0 YES ® NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-272A-0300? - - YES ® 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. Typlcat Record
Drawings contain Dralnheld 8 manitold orientation 8 layout,Septic/pump tank location.North arrow.reserve dreintleld.existing and proposed buildings.location of welt.waterlines,
webs.observation ports.deanouts and other maintenance access points. Incomplete Record Drawings may create addrlional delays in final installation approval and related permits.
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DPRp � E
MAY 10 2023
tJiASON COUNTY EN\IRONMENTAL HEALTH
LBW
FA Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
i certify that 1 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 attar d Record Drawing is accurate. form and attached Record Drawing is accurate.
- 3-3o z.3
Signature of Installer Date
idle S—W(/NW =�14
Printed Name of Signet till�I 7-2 3
e b AQ 111
MASON COUNTY PUBLIC HEALTH ;;A:
9llll
The undersigned approves this Installation Report and = . it
Record Drawing on behalf of Mason County Publici �
He,aa o? oc
r/t 3 �� ITH' MO a PELZEL till
LICENSED DESIGNER
Sig at o Environmental Health Specialist Date
(stamp, signatureyend date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SiTE Updated 8/21/2018
DESIGN CAPACITY-460-GPO
OPERATIONAL CAPACT'-360-GPO
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\ / / A-125O GALLON SEPTIC TANS
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B-1250 GALLON PUMP TANK— ^:'.4! ASSUMED LOCATION Of / 328-9C+/-
ENISTLNG WATER LINE TO /
It 2232 RING PARCEL
2322390040 "'O°�.ap°.Tnit WI"II i eow'�r alrxc An ra«n n''S ni.W0007-iO s5 c'-M.
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SITE ADDRESS 470 E HARDINGS HILL RID
SEPTIC SYSTEM RECORD DRAWING PARCEL NUMBER 122322390020
LOT NUMBER LOT 2 OF 5P#838
CLIENT BRAD LANSING-20G-954-4082
WESTSIDE
NORTH SEPTIC DESIGN LLC.
KEITFi PEIZEL OWNER JAN 4 THERESA 005TERVELD
sQ' 293 208.9070 PO BOX 1709
0 30' T8IT®wt5T5Vice5ce C.cO0 PORT ORCHARD WA 98366
I I ro BOX 731049 PUYALLUP WA 98373
DATE 04-17-23 PAGE 2 OF 2
Traverse PC
Illommie
DY5IGN CAPACITY=480-GPD
OPYRATIONAL CAPACITY-380-GPD
FIARDINGS FULL RD::iE?:p>;>;;:i;::::::-:; <::::::;;:;:::.>;>:>:;: I O.<+•: '
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APPROVE
MAY 1 0 2023
MASON COUNTY ENVIRONMENTALJBW HEALTH
11-17-z3
a
3r os
0=gCENSED
DES.
IGNZEAREL C;PIRESOQ_78i
iA SURVEY.OM FEATURES TOPOGRAPHY EIEvnOMS S OfMCMMRAS ME PASEO OM ASSUMED WOW
PROVO.o0.O1 COW,SYSTEM
0 A ME MEMO.ONLY FOR iHE APPROVAL• RION
COR M OF TIS EMn WESi59[SEM DESIGGRECOUIMO3/NAT A I CESEO
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RP Of w�OP00SSMO LOT
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PROVO.. ESVVOP SPM SG . VSTSJOE ESSIVESrq tUK MRi UMEOMEMONS OR ACC,ACY
SITE ADDRESS 470E NARDINGS HILL RD
RECORD DRAWING OVERVIEW PARCEL NUMBER I22322390020
LOT NUMBER LOT 2 OF 5P#835
`I'! I 1 WESTSIDE
i I i i i I 1 i i I l 1 CLIENT BRAD LANSING-200-954-4082
'
NORTH SEPTIC DESIGN LLC.
KEITLi PELZEL OWNER JAN 4 THERESA 005TERVELD
0 50' 100' 233.208.907E PO BOX I709
KtMieWEsrsloEseroC.cOu PORT ORCHARD WA 98300
I J PO DDX 731049 ru0µwr WA 98373
DATE 04-1 7-23 PAGE I OF 2
Traverse PC