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HomeMy WebLinkAboutSWG2021-00518 - SWG As-Built - 7/18/2023 Mason-County OSS Installation Report pg. 1 C, .., MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00518 Parcel # 323047590043 Applicant Name torn noble Subdivision (Name/Div/Block/Lot) Applicant Address Po Box 129 City, State, Zip Long Beach wa 98631 Installer Name House Brothers Site Address 835 n Hamma Ridge dr Designer Name Halverson INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type i7icSSu(C. Pretreatment Type ,k/c,,,, L >5 ft. from foundation? - - ❑ N/A Et YES ❑ NO >50 ft. from wells? - •- ❑ >50 ft. from surface water? - ❑ ® ❑ Z HCleanout between building and tank? - - ❑ ❑ o Tank baffles present? - - ❑ ® ❑ d24"access risers over each compartment?- - ❑ M ❑ W Effluent filter installed?- ❑ ❑ tl) -Septic tank capacity(working) 12SO gal Manufacturer H( r3 D-box water level and speed levelers used? - - 121,N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - El ® ❑ OOz Check valves installed? - - ❑ ® ❑ 0 Q It E Transport Line Size 2 Schedule/Class '1O Bedrooms installed (check one) ❑ 2 ® 3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A [2 YES ❑ NO >100 ft. from wells?- - ® ❑ W >100 ft. from surface water? - ❑ El Li >10 ft.from potable water lines?- - ❑ CZ ❑ Z > 5 ft. from property lines and easements? ❑ El ❑ 2a' > 30 ft. from downgradient curtain/foundation drains? Drainfield level and observation ports present - - ❑ © ❑ /gi Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ EZ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Pump tank capacity(flood) 1 1.00 gal Manufacturer WC3 < 24"access riser(s)and accessible from surface?- - ❑ gl ❑ a. Alarm or Control Panel Installed? - - ❑ Cif ❑ E Contra! Panel equipped with Timer/ ETM /Counter ❑ gl ❑ n- Pump installed in ❑ Bucket or ® On Block or ❑ Other 2 Pump Make/Model A• mtillnnG(cA. A/`II5 E] Floats or ❑ Transducer `1 O t }, in/min Pump capacity 5//C gpm Squirt Height 5 ft I Pump o n time r1, 75 nrL.� _%.,ke Pump off time 1R�ia"J Daily flow set at 27 0 gpd JUL 1 8 2UZ3 Updated8/21'2018 MASON COUNTY ENVIRONMENTAL HALT DJA Parcel# 323047590043 - _ Mason County OSS Installation Report ABANDONMENT RECORD YES 0 NO Were existing septic components abandoned as part of this project? - If yes, please describe: NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0YEs 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 contact Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfteld,existing and proposed buildings.locaton of wells.waterlines wells,observation ports,cleanouts..and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related perrn ts. Record Drawing Attached ,Ar ay , CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with l certify that the system has been installed in accor- the septic design stamped 'APPROVED"by Mason dance with the septic design stamped 'APPROVED"by I 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. / 7if&v c- _ 7/6/23 Signature of Installer Date �! a Jc:C Wu;SC' .::r� .• % 7 f 1 7 I` Printed Name of Signee �� �,,, W.,.,: MASON COUNTY PUBLIC HEALTH ��' s `•.u;:, S,•• d' The undersigned approves this Installation Report and !��: aDttr.i�,d.,,l •; Record Drawingon behalf of Mason CountyPublic `''1,,,L-ti�71„_. "uNterc Health: ®VE u;•;< 4_, 7//7/20 rof Environmental Health S eci � signature and date) e o p ��a1�023 (stamp, THIS FORM MAMYVGVNfftti FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8,21,20'R DJA HEALTH RECORD DRAWING continued E-----] _. \ oO cc. 1 , ,..., Dn..' a.).. c_.(_,,..,1 cS --� . . i / .ti`lV . i \, �/ �� / \'• , e AY,/ \r / .1/) 7L/3 _,Z.,i. 4`.. ?...: , . 4 • :i Pi' ADAM J.HUNTER • A■ ■ ROVE it_ 1 8 9i3 i MASON COUNTY ENVIRONMENTAL HEALT! MA