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HomeMy WebLinkAboutSWG2023-00133 - SWG As-Built - 8/11/2023 3 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00133 Parcel # 42211-44-00390 Applicant Name Karl& Teresa Miller Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 42 I� jV, - City, State, Zip Hoodsport, WA 98548 Installer Name T. J. Good [T V � U� 'U 1 Site Address 330 N. Schoolhouse Hill Rd. Designer Name Dale L.T a Io 2 5 2023 n - �J INSTALLATION` ECKLIST Q Full System Installation El Tank(s)Only 0 Drainfield Only ❑ Repair El Other System Type Trenches Pressure Pretreatment Type N/A >5 ft. from foundation? - - ;.❑; /A YES El NO >50 ft. from wells? - ,'- -- S j III CIZ >50 ft.from surface water? - t( -'ti< .40 — t[�Ja 0 4 Cleanout between building and tank? - L.J1 ® ❑ h- C? Tank baffles present? - -By - 0 ® ❑ d24"access risers over each compartment?- MI 0 N Effluent filter installed?- .- ❑ II Septic tank capacity (working) 1,200 gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ No O Manifold/D-box accessible from surface?- - ❑ ® ❑ mz Check valves installed? - - ❑ ® ❑ Od 2 Transport Line Size 2 inch Schedule/Class Sch. 40 Bedrooms installed (check one) ❑ 2 0 3 ©4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO 0 >100 ft. from wells?- - ❑ ® ❑ W >100 ft.from surface water? - - ❑ II IT >10 ft. from potable water lines?- - ❑ ® El — > 5 ft.from property lines and easements?- - ❑ U ❑ i > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑ Drainfield level and observation ports present - - ❑ UI ❑ ❑ Graveless chambers or LE Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1,200 gal Manufacturer Hagerman < 24" access riser(s)and accessible from surface?- - ❑ ® ❑ a. Alarm or Control Panel Installed? - - ❑ RI 2 Control Panel equipped with Timer/ETM / Counter- - ❑ ❑ ❑ 13- Pump installed in ❑ Bucket or ® On Block or ❑ Other Q" Pump Make/Model Liberty 280 ❑ Floats or 0 Transducer 1 a Tank draw down 2 in/min Pump capacity 44 qpm Squirt Height 8 ft Pump on time 3 min. Pump off time 5 hrs. 57 min. Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# \— 1�� `3'(� ABANDONMENT RECORD Were existing septic components abandoned as part of this p -- 11 YES NO If yes, please describe:�� _\St\ �C rc l� l\ -- Were all components pumped out and Iy abandoned per WAC246-272A-0300? - - ® YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locale in the need of maintenance activities and future development typical Record Drawings contain: Draintieid&manifold orientation&layout,Septic/pump tank location,North arrow,reserve draintield,existing and proposed but/dings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Inoamplete Record Drawings may create addttlonai delays In final installation approval and related per miA. APPOy ! AUG 1 1 2023 - MASON COUNTY ENVIRONMENTAL HEALTH 1 JBW a Record Drawing Attached I 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 1 further certify that all infonmation contained on this I further certify that all information contained on this form n attached Record Drawing( is accurate. form and attached Record Drawing Is accurate. di ` � �1 Signature of Installer Date if G.' ...'Ai. . .cicli-ovv Goo s .„le-a<m. v.,. *iv.Nt V " Printed Name of Signee i 's- i �? 1 c'V . MASON COUNTY PUBLIC HEALTH �:I.": S The undersigned approves this Installation Report and �`"• Stoo214 V1 Record Drawing on behalf of Mason County Public ,► Q. - 6ALE L. TAHJA t He .' ltCEN D b SIGNER + I 41 <—I1-2`3 EXrIn: — r Sign vironmental Health Specialist Date (stamp, signature and date) J THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updetid 8/7t12o18 ci IA • r .T�e,� s� \��er' 'r3c10 ?V-C-OV A 'cix-)0,\\) 1 vn . , .. `l3C� �. c�ao 0\r \\1 P-A.. .. �c�� 3 ` \I a a�\jo, `\ vl _,_ 36 c.1-3,\Q..., ,--.. —t 1 (4,..,>„„ -e-----"...------------ c___ _)- \ --\--e___ ,. \(..,g__, . \ram .�1ES�.r\I .. AV- \nk �0.�cil, G�� \\ - \oQc4 C \ eit\N ee..'� T-\\'cvr\„( 1 ay Il \ i \ '� s � �4 \ ....-- ........ /0, ' y �. t::T.: 'ss. f \ /.- ---. .....? All t\ \ , l _ tr y,SI NER `ref >. ....,• �� _rI'V r 4-R7 �� 1 V 4. \ / \ l O 0 O \ \ \ \ \ •%\ • '�� \ \ ',l\• C \ 4. " • \ \ '. \ \ \ \ r. 0 \ \ \ \ a,• \ \ • \ \ 4 • \ � / . (. . D C 1 \t, I 1 lb:lb ...-L { m N C)w C %' , \\p 1