Loading...
HomeMy WebLinkAboutSWG2023-00112 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT I ORMATION Permit Number SWG 2023-00112 Parcel# 32232-30-60000 Applicant Name Dale&Sandy Fassio Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 25 City, State, Zip Union,WA 98592 Installer Name Joe Fassio Excavating Site Address E Spruce St, Union,WA Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity Trench Pretreatment Type >5 ft.from foundation? - - ❑ N/A El YES ❑ NO >50 ft. from wells? -- - Z >50 ft. from surface water? - - -- -14 4, '�--E i� - - - - El ❑ ❑ F Cleanout between building and to , ❑ 0 ❑ 0 U Tank baffles present? - - _MAY_I,7-Z. 3- -It. - --- ❑ ❑■ ❑ H 24" access risers over each comp- ent?-- L.) - ❑ I ❑ a III Effluent filter installed?- By - ❑ ■❑ ❑ N Septic tank capacity(working) 1,200 gal Manufacturer Hagerman O D-box water level and speed levelers used? - - 0 N/A ® YES ❑ NO i DO Manifold/D-box accessible from surface?- - ❑ I ❑ co Check valves installed? - - ❑ 0 0 ciQ 2 Transport Line Size 4 inches Schedule/Class 3034 Bedrooms installed(check one) ❑ 2 ❑ 3 M 4 0 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - II 0 ❑ W >100 ft. from surface water? - - © ❑ ❑ u. >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z >5 ft. from property lines and easements?- - ❑ ® ❑ Q Q` > 30 ft.from downgradient curtain/foundation drains?- - I ❑ ❑ Drainfield level and observation ports present - - ❑ a ❑ IN Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® ❑ tank setbacks consistent with septic tank?- - ❑ N/A ❑ YES No Pump tank c ' (flood) gal Manufacturer Q24" access riser(s) and a ible from surface?- ❑ ❑ ~ a Alarm or Control Panel Installed? - ❑ ❑ 2 Control Panel equipped with Timer/ ETM /Cou - - - ❑ ❑ ❑ D d- Pump installed in ❑ Bucket or ock or ❑ a. 2 Pump Make/Model ❑ Flo or ❑ Transducer i1 Tank draw in/min Pump capacity gpm Squirt Height ft mp on time Pump off time Daily flow set at d .. dated 6.212C18 0 1 Parcel# 22, 2- O- O 0 Mason County OSS Installation Report pg. 2 �3 ABANDONMENT RECORD El YES 4 NO Were existing septic components abandoned as part of this project? If yes, please describe: YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 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 tank location,Norm,,arrcw.reserve drainfidd,existing and proposed buildings,location of wells,waterlines. Drawings contain' Drainfidd 8 manifold rnentation 8 layout.Septic/pump +n fatal installation approval and related permits. wets,observation ports, earicw ,,and other maintenance access points. Incomplete Record Drawings may ceeate additional delays 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 4� 7 /44 j O 510VZ3 yyrr .ekt, Sig re of Installer Da e P Printed Name of Signee + .,•.� MASON COUNTY PUBLIC HEALTH % 4, The undersigned approves this Installation Report and s,00aa9 Record Drawing on behalf of Mason County Public �;.j.: PAULA JOY JOAISON ' l't �XiSSfc;NEft" Health: b q (�� �''"�Fxatu� 13 �r(/�1 5-t 5--2,3 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 JpeitG°arz12°'8 M i\`j (,c_t -. Ste' Dew & Sand) FaSS;o farce 1*3223a-3o-(00000 Spruce Sf crl LA SCo, tie: „7; 9Q. -6 pro,PoSe>3 1 1 t 1 S C. o 20 40 to0 80 RV Prk:,q_ n 1 0 \ c sWq-}cr1;�� 1-0 be � I -k S k4vf i-c' wit tf r '°� 1 \ ID' 04 all S eQ-t1 C \.„, Driv e xt fi _._ C 0 m � w.sa f o ✓ rit. _. . lot' ~ -‘CA-.A" ,- , 4 t xi s+ins we S+erg Fro fQr+i vo-1/4-ec 1;ix to be ►MOVrd too wf f,'°"A- gQun�ar� Ltiht A•a' uc�rn (5) 3'x �o' Fr ;,rnar ���,cAe i dra;A et d -iv vnc� c Sr.lkh 5 o .c. wi-f-r) reserve 4�� ,), above . �� , .,�. J �IIr Lam , 1 � '. .0349 i�. .J:14. PAULA JOY JOHNSON .y% OCleanout 1 -t 5- . t 5 —Z1 S -o O2 1,200 Gallon Septic Tank 2-Compartment with Effluent Filter 03 D-Box with speed-levelers and cover to surface 1 �� APPROVED IS,,oc,,F, v JUN092023 MASON COUNTY ENVIRONMENTAL HEALT1 RET v v i