HomeMy WebLinkAboutSWG2021-00416 - SWG As-Built - 4/27/2023 Not VIA r) --
Mason County OSS Installation Report pg. 1 �� MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00416 Parcel# 22113-31-90033
Applicant Name Dan Feist Subdivision (Name/Div/Block/Lot)
Applicant Address 31 Green Way
City, State, Zip Grape 'view,Wa 98546 Installer Name Jamie Workman
Site Address Same Designer Name Micah Halverson
INSTALLATION CHECKLIST
® Full System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type ATU-Pressure Trenchs Pretreatment Type NuWater BNR-500
>5 ft. from foundation? - ❑ NIA No YES ❑ NO
>50 ft. from wells? (� (� " ❑ II ❑
Z >50 ft. from surface water? - G-I - t 4-" 0 ® ❑
Cleanout between building and tank? - - - - ,S, - N * "tz� ❑ ® ❑
U Tank baffles present? - - - - - - - - - ❑ ® 0
a24" access risers over each compartment?- - - - - II El- ❑
W Effluent filter installed?- By - - - - :-] ❑ ❑
co
Septic tank capacity (working) 500+ NuWater Jai Manufacturer Sound Placement
G D-box water•level and speed levelers used? - - ® N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?- - 0 IR 0
mZ Check valves installed? - - 0 UI ❑
6Q 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) ❑■ 2 -_ E 4-._ _ lr',• El N/A IN YES El NO❑Commercial/Other
Z�
>10 ft. from foundation? - t
Cl >100 ft. from wells? '' AN 2 � 2023 ❑ ® 0
J >100 ft. from surface water? - - El II Elu. >10 ft. from potable water lines?- �� - 0 ® ❑
Z > 5 ft. from property lines and easements?- • By.• - ❑ IN El
12 > 30 ft. from downgradient curtain/foundation drains?- - ❑ IN ❑
Drainfield level and observation ports present - - ❑ I ❑
❑ Graveless chambers or U] Clean gravel used? (check one)
Proper cover installed over drainfield? - 0 ® 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES 0 NO
Pump tank capacity (flood) 1233 gal Manufacturer Sound Placement
Z
Q 24" access riser(s) and accessible from surface?- - 0 ® ❑
H
a Alarm or Control Panel Installed? - - 0 0 0
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ PI ❑
M
n- Pump installed in U] Bucket or 0 On Block or ❑ Other
O. Pump Make/Model Liberty 250 ® Floats or El Transducer
O.
a Tank draw down 2" in/min Pump capacity 45 qpm Squirt Height 5 ft
iDrc 1 1 on time 1min Pump off tine 6hrs .flow setpd
11
Mason County OSS Installation Report pg. 2
Parcel# 2.2 1 I 3 ——51' `WQ 3 3
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -
YES rj 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. Draintield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve dreinfield,existing and proposed buildings.location of wells.waleds
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits
Lco4"o p sstA 00 - 11.0-%‘‘t s 40 &a\-C.•
1,5VOL.r Av. xk- oh /0cc- +t04c.5 b“-e-C. OPerc.4-.oct. P P R 0 V E
APR 2 7 2023
MASON COUNTY ENVIRONMENTAL HEALT
JBW
g 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 andnd Mason
aso Countyuty Public
ub i Health and meet all
and Mason County Codes.
s
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.
dVe",43 00011----c---•„„ i:
,+,'�
Signature of Instal'le`r� Date
iff Printed Name of Signee i `�
111 MASON COUNTY PUBLIC HEALTH i i g ` ‘11
The undersigned approves this Installation Report and i f 6tooso0 ��Record Drawing on behalf of Mason County Public ;�+ LICENSED p AMM I
He
(-A; LIA 4-7-7-2-5
Si a r(Environmental Health Specialist Date (stamp, signature and date)
FMAY BE SCANNEDMason
ILABLE FOR PUBLIC VIECounty
HE MASON COUNTY WEB SITE Updated ertrzote
PrintedTrom
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