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HomeMy WebLinkAboutSWG2022-00404 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00404 Parcel # 22202-59-00004 Applicant Name Heather Reese Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 827 View Ridge Heights City, State, Zip Belfair, Wa 98528 Installer Name Keefe Harris Site Address 140 NE View Ct Designer Name Nathan Cleaver INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type__ Conventional Gravity Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A • YES ❑ NO >50 ft. from wells? - U .11. 4 -i Ill-1 - ❑ 0 ❑ Z >50 ft. from surface water? - -- CI0 ❑ H Cleanout between building and tank? - JUN 0 2023 - ❑ ❑] ❑ V Tank baffles present? - - ❑ ❑i ❑ d24" access risers over each compartme a_L'y - - - - ❑ 0 ❑ W Effluent filter installed?- - ❑ 0 ❑ Septic tank capacity (working) gal Manufacturer C1 D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ A ❑ coZ Check valves installed? - -- 0 ❑ ❑ oQ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - -- ❑ N/A © YES ❑ NO CI >100 ft. from wells? - - - - -- ❑ ❑■ ❑ W >100 ft. from surface water? - . ❑ X ❑ Er_ >10 ft. from potable water lines?- - ❑ 0 ❑ 4.Z > 5 ft. from property lines and easements?- ❑ © ❑ > 30 ft. from downgradient curtain/foundation drains? - - - ❑ 0 ❑ Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- •- ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ® N/A ❑ YES ❑ NO Y Pump tank capacity (flood) gal Manufacturer Z < 24" access riser(s) and accessible from surface? - • ❑ ❑ ❑ F- a. Alarm or Control Panel Installed? - - ❑ ❑ ❑ E Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a. M Pump Make/Model El Floats or ❑ Transducer a. Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time ______ Pump off time Daily flow set at gpd UpdM c 6,21,2C 13 Mason County OSS Installation Report pg. 2 Parcel # 22202-59-00004 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - ❑ YES Q NO If yes, please describe Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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: Drainfield S manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells.observation pens.cleanouts,and other maintenance access points Incomplete Record Drawings may create additional delays in final installation approval and related oermils © 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 form a tt ched Record Drawing is accurate. form and attached Record Drawing is accurate. ✓/A - 676/2 o Signature of Installer Date Keefe Harris Printed Name of Signee /_ ,- MASON COUNTY PUBLIC HEALTH `' !'a The undersigned approves this Installation Report and 22.y4~ Record Drawing on behalf of Mason County Public s Health: ''c s,00zs, NATHAN N CLEAVER •- I ICgN'if.r'F.'' y^EP - ,,,l ( (4(z -. -IP-E-S 6 (� Z y Signature of Environmenta Health Specialist Date (stamp, sig tat re and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated&2v20t8 , �'___z w `- I . 5 IY• w = e m I z uN}i Z LL p I' . g' o rc Qw4O H ZwAR o I- � I ,TF:� n ,d'n> K z Q I- ~� O Y�� �~ , _ m i! t NR�yi ��yy ; rr O wp, �Q Wm� SON HQ I , -.�WJ ;�('� C�' .s m Q'O CICNI JO eyU U N W W f - WC u W Z m p m 0 Q>QQ, a0 J I Z p g O < IWW 40 I- Q 4Q N S W N F w�O OdWV wQ wo � � � oc=i`b' o r olmi m UQap ZQ� H� 1 z>o g Q—( n wc�ow. oww 1 onU 0 mWw2 2ww U> �` Zom� mwz 0w2 a<ii ¢a O yOw bWNo awm 00 ODN �, nlpmwF.,Z ..CM to t8 w C Z O Z m U Q a m w Q a,Z Q RIjQZ Lu w > , mo7 I- z p tLz0,1 i_ i p ��tpi�ovi(7) < / yJ F- W yOz2� Z� r _In*IJgu F N \\______:,v /o-c] V Z EZ .gB o \ : 8 x�o.s ca z Y. k.r$`z mk x2g y Z t 4l ,, b� R ,�i a sg'. ��� �! 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