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HomeMy WebLinkAboutSWG2022-00312 - SWG As-Built - 6/28/2023 CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00312 Parcel # 123305200020 Applicant Name RJ Peabody Subdivision (Name/Div/Block/Lot) Applicant Address PG Box 555 City, State, Zip Burley WA 98322 Installer Name Jason Schauer Site Addrec GI E Schooner PI, Bolfair Designer Name Jim zimny C,OI INSTALLATION CHECKLIST Q Full System Instailation ❑ Tank(%)Only ❑ Drainfield Only D Repair 0 Other System Type Pressure Drstntiution Pretreatment Type >5 ft. from foundation? - - ❑ N/A ® YES ❑ NO >50 ft, from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ ill Q Cleanout between building and tank? - - El 0 El 0 Tank baffles present? - - ❑ Iiii ❑ a24-access risers over each compartment? • - El II El 111 Effluent filter installed?- - ❑ MI ❑ V) Septic tank capacity (working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - - -- -- - - - • ® N/A ❑ YES ❑ NO DJ O Manifold/ID-box accessible from surface?- - El IN co Check valves installed? - - ❑ ® ❑ oa Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 03 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A il YES ❑ NO 0 >100 ft. from wells?- -- - - - - ❑ ® ❑ w >100 ft. from surface water? - - ❑ II ❑ LL >10 ft. from potable water lines?- - ❑ IN ❑ Z - 5 ft. hunt Niupeity line, dnJ cdxnucnt ?• - ❑ ® ❑ a cr > 30 ft. from downgradient curtain/foundation drains? • - ❑ I ❑ 0 Drainfield level and observation ports present - - ❑ ® ❑ PI Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed overdrainfietd?- - ❑ lit ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A kii YES ❑ NO Pump tank capacity(flood) 1250 gal Manufacturer Hagerman Q24'access riser(s) and accessible from surface?- - ❑ I El 1-- a Alarm or Control Panel Installed? - - ElIC El 2 Control Panel equipped with Timer/ ETM/Counter- - 0 I ❑ n n- Pump installed in ❑ Bucket or pi On Block or ❑ Other __ a. Pump Make/Model l ! '1 .' - piFloats or ❑ Transducer a., lank draw down 2 in/min Pump capacity nu qpm Squirt Height 5' tt Pump on time I mm 5 secs Pump off lime 4 hrs Daily flow set at 210 gpd Mason County OSS Installation Report pg. 2 i arcs rY ( l < <` r Z r>�'� ABANDONMENT RECORD Were exls6ng septic components abandoned as part of this p•o;ect? • YEE NO If yes. pleas©de;.cnbo: 'Nero all components pumped out and properly atrtndonod per WAG246.2/ZA-03OO? • YES Li NO RECORD DRAWING IMa is a parmanant rotor)and it accw•ta and dory4rt-ra enough to ra•lot.aia In ttr nerd tit asalararanCa actreiUea and MMuta dsveiVra.ti, Tp(aplr RKur:1 :?,rwria uryarr, txan'elo b rrrredl;trk+t:a S Lryctie.S*iX.._,t:V0.0 Corn ka axn W.tf an,.,mare.dreustW.aaaarrp+ J V4a+rad taAlnpa,brabon at walk w9.Ynes. .PCs rtsaa vrlur ports,derrotris oral onar raartersare x rasa pout* Ow la.c is Record(Varney may rreaN a.riar..s deaeys on PAW..Ulalnn approval and milled Oao' 61_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 ths?.coptic elusion 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate e. Signature pl Installcr Date �t•,s� 4w�/' Pnntod Name of Signee t % MASON COUNTY PUBLIC HEALTH �- r � l v^ The undersigned approves this Installation Report and loss Record Drawing on behalf of Mason County Public Allan h. . Health: ;E °DE s r;sY I( Signaturu of Enwonrnv;ttat Henrttt Somalis; Dato (stamp. signature and data) This FORM MAY SE SCANNED ANO AVAILABLE FOR PUBLIC VIFW ON THE MASON COUNTY WFB stir ucerads.txtr 4 w .a r o ri.- 2 ♦ _p ♦ . ♦ • ♦ , ♦ . ♦ V, •♦\ ' cD 1, 1 ♦♦ W \ I \ N Viminnim \ rn > w > O Oct o • N v a • . rt — 0 Ca► 8 0 ---- -- 3 -�-lv O r w (a _ �+ .' re m N a �--..... ♦♦ • !/ ' /� OD • N ♦ i / / 'NJ. 0 \ ♦\ / / r �O �, J \ ,\\ 1 � r /' l0 N�♦ 00 \\ / / / v� / 0ai °\ \\ 0 \ \ \ s C / = \ \\ to Fir/ \\ \ i In ay APPROVED \ r � 1 � AJUN 2 3 2023 ' ` 1 c � 1 `1 rr� 1 E t vs I c i v MASON COUNTY ENV1RONMENTAL HEALTH 1 a- ( I0- .- - ( f 1 \\ r 1 i ` i\ K7 oo v, x p / , ►" roN -w �' 'C — �7 So O �' ,‘, /C N \ \ O !t) O .., `" < E. .? -li `,7 Ott' ,, / , / v / w \\ ♦ o o o, /�`',, / // 3�l\ O . n ,,. : ,/ / ./ i