HomeMy WebLinkAboutSWG2023-00143 - SWG As-Built - 7/24/2023 Mason C,,unty OSS Installation Report pg. 1 C MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00143 Parcel # 123094200020
Applicant Name Jennifer A Babcock Subdivision (Name/Div/Block/Lot)
Applicant Address 60 NE Bear Creek-Dewatto Rd
City, State, Zip Belfair, WA 98528 Installer Name Solid Ground -Dave Needham
Site Address 60 NE Bear Creek-Dewatto Rd Designer Name Caliber Septic- Richard Bazzell
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only 0 Drainfield Only 11111 Repair ❑Other
System Type Standard Gravity Pretreatment Type
CO E---,_r
>5 ft. from foundation? - - ❑ NIA I YES ❑ NO
>50 ft from wells? - 0 II 0E-
Z >50 ft. from surface water? -- -- - CI II CIrr
H
Cleanout between building and tank? - - [3 I ❑ _
V Tank baffles present? - - 0 II 0 C
P 24' access risers over each compartment?- - 0 ■ 0
w Effluent filter installed?- - 0 ❑ r`
N
Septic tank capacity (working) 1250 gal Manufacturer Hagerman
F 0 D-box water level and speed levelers used? - - ❑ N/A ®YES ❑ NO
oO Manifold/D-box accessible from surface?- - 0 ® 0
m Z Check valves installed? - - 0 0 IIII
a 2 Transport Line Size 4' Schedule/Class SCH40/3034
Bedrooms installed (check one) 0 2 ®3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - 0 WA II YES ❑ No
Q >100 ft. from wells?- - 0 U 0
W >100 ft from surface water? - - El IN
a: >10 ft. from potable water lines?- - ❑ RI 0
Z > 5 ft from property lines and easements?- - 0 ❑
d > 30 ft. from downgradient curtain/foundation drains? - - ❑ Pi ❑
o
Drainfield level and observation ports present - - 0 II 0
0 Graveless chambers or ] Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 I 0
"
Pump tank setbacks consistent with septic tank?- N/A 0 YES ❑ NO
Y Pump tank capacity(flood) gal Manufacturer
Q 24'access riser(s)and accessible from surface?- - 0 ❑ ❑
H Alarm or Control Panel Installed? - - ❑ El ❑
°` Control Panel equipped with Timer/ETM/Counter- - 0 ❑ 0
CL Pump installed in 0 Bucket or 0 On Block or 0 Other
a'• Pump Make/Model 0 Floats or 0 Transducer
a Tank draw down in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
UpdNMd 671r201II
Mason County OSS Installation Report pg. 2 Parcel# 123094200020
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - Q YES ti NO
If yes, please describe.Concrete slab tank abandoned per code
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - E■ YES 0 NO
RECORD DRAWING
This Is a permanent record and mint be accurate and descriptive enough to re-locate In the need of maintenance actHFUas and future development Typcal Record
Dnswngs contain Draa field 8 manifold orientation&layout.Septic/pump tank location.North arrow.reserve dranr.eld.existing and proposed bulldogs.Iocahon of wells.waterines
wails obaervatlon ports,delimits,and other maintenance*crass ponte Incomplete Record Drawngs may create additional delays in foul installation epprovsl and related perms
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1111 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 and attached Record Drawing is accurate. fqm and attached Record,:rawing is accurate.
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ao Signature of Installer Date % �� �P ,'+
Solid Ground Sitework LLC- David Needham k/ or „Sy .4. 1
i � . 1 Z
Pnnted Name of Signee ,
MASON COUNTY PUBLIC HEALTH L. 21037126 ,I'
The undersigned approves this installation Report and O`�`I H -D :A 'rl
Record Drawingon behalf of Mason CountyPublic " ' '
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Heal •• � !F !�/L�
!A 7 Y23 ° qZ5/2 3
Sig to vironmental Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SiTE tidied 6R1r2Cle
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