HomeMy WebLinkAboutSWG2023-00162 - SWG As-Built - 7/24/2023 -64A100311I
Mason County OSS Installation Report pg. 1 0 MASON COUNTY PUBLIC HEALTH
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APPLICANT! PERMIFORMATION
Permit Number SWG 2023-00162 Parcel# 223365100005
Applicant Name George Fouts Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 858
City, State, Zip Beltair,WA,98528 Installer Name Solid Ground Sitework LLC
Site Address 130 NE Bryan Lane Designer Name Advantage Perc 6 Design
INSTALLATION CHECKLIST
0 Full System Installation 0 Tank(s)Only ❑Grainfield Only •Repair 0 Other
System Type Gravity Bed Pretreatment Type
>5 ft from foundation? - - ❑ N/A pi YES ❑ NO
>50 ft. from wells? - - 0 e 0
Z >50 ft. from surface water? - - 0 ■ 0
H Cleanout between building and tank? - - 0 El 0
u Tank baffles present? - - ❑ ® 0
d24- access nsers over each compartment?- - 0 IN ❑
W Effluent fitter installed?- - 0 ❑
IN
Septic tank capacity(working) 1150 gal Manufacturer Unknown
9D-box water level and speed levelers used? - - ElWA pi YES 0 NO
III ❑
0 0 Manifoki/D-box accessible from surface?-
- 0
u.
a?z Check valves installed? - : • 0 0
OQ t.
aTransport Line Size 4 Schedule/C- . .3034
Bedrooms installed(check one) 0 2 Q 3 ❑4 RS - I�l, Commercial/Other
>10 ft.from foundation?- - -- -,` WA 0 Y NO
O
>100 ft from wells?- --*`--, 0 N 0
-t >100 ft_from surface water? - ° 0 IN ❑
W -_ -
W >10 ft. from potable water lines?- --- -. \1(. 0 IN ❑
Z >5 ft from property lines and easements?-- - .----• El PI ❑
d >30 ft from downgradient curtain/foundation d ?- - 0 NI 0
O G'
Drainfield level and observation ports present--- 0 IN ❑
0 Gravetess chambers or pg Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 11 0
Pump tank setbacks consistent with septic tank?- - N N/A 0 YES ❑
• Pump tank capacity(flood) gal Manufacturer I
z r- 0
< 24-access riser(s)and accessible from surface?- - ❑ ❑ ❑ r
^� ry
aAlarm or Control Panel Installed? - - 0 0 0 __
2 Control Panel equipped with Timer/ETM/Counter- - CI CI ❑
O
o- Pump installed in ❑ Bucket or 0 On Block or ❑ Other r�
II• Pump Make/Model ❑ Floats or ❑Transducer rt ,7
d Tank draw down inlmin Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at qpd
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Mason County OSS Installation Report pg. 2 Parcel# 223365100005
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - El YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES El NO
RECORD DRAWING
This Is s permanent/*coed and must be accurate and descriptive enough to re-locar In shoe need or maintenance activities end Muni development Typical Record
Orawngs=ntan Drarn(Mld$marigold onentN,on S layout.Septic/pump lank location North arrow.memo dranGeld.esola.g and proposed buddogs.Iocaton or wells_waterlines.
web.ObearvataiX1 porta.deana+u.and other maniensnn access pants Incomplete Record Dra raga may crags adda+onaldelays In trial s1MYahrxr approval and related permds
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Q 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 5347,„4,4./ OS 3b- 3
Signature of Installer Date
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David Needham 05-30-2023 jr).
Pnnted Name of Signee i • 11;+
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MASON COUNTY PUBLIC HEALTH /\�; If •
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%h �12:)033 '�sl
The undersigned approves this Installation Report and � ; 123033
Record Drawingon behalf of Mason Public LICE •.r_0 DESIGNER 1
County ♦ .r.r• *r ♦♦ ♦ ♦ W1014.
Health{: Exp;r44;74,:1,1..ZJ
7:2lf/2)
S' vironmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE mad BO1f2O15
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