Loading...
HomeMy WebLinkAboutSWG2021-00028 - SWG As-Built - 8/28/2023■mion Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00028 Parcel # 2231941000010 Applicant Name WILSON & PENELOPE SAPP Subdivision (Name/Div/Block/Lot) Applicant Address 100 NE LAKE CHRISTINE RD City, State, Zip TAHUYA WA 98588 Installer Name BILL BUMBALOUGH Site Address 100 NE LAKE CHRISTINE RD Designer Name MIKE JERKOVICH INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - 0 El • Cleanout between building and tank? - - ❑ ❑■ ❑ ✓ Tank baffles present? - - ❑ ■❑ ❑ a24" access risers over each compartment?- - ❑ {. ❑ W Effluent filter installed?- - ❑ ❑ ❑ N Septic tank capacity (working) 1200 gal Manufacturer HAGERMAN _0 D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ 1. 0 032 Check valves installed? - - 0 ❑ ❑ OQ E Transport Line Size 2 Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- - ❑ I. ❑ 7 W >100 ft. from surface water? - - RR El ti >10 ft. from potable water lines?- - ❑ I ED c g 4:- > 5 ft. from property lines and easements?- - ❑ . Lt] G-7 • •. • dient curtain/foundation drains? - - ❑ 0 R — I Drainfiel. le'el`. rbservation ports present - - ❑ 0 41104v2tsjs chambers or ❑ Clean gravel used? (check one) t u Proper cover installed over drainfield?- - ❑ © ❑1 MASOV O�UNTY CNVIRUN� EN ,. a - �� PurpgAank s asth consistent with septic tank? - - El N/A n YES ❑ NO • Pump tank capacity (flood) 1200 gal Manufacturer HAGERMAN < 24" access riser(s)and accessible from surface?- - ❑ El ❑ 1-- Alarm or Control Panel Installed? - - ❑ 0 ❑ a 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 LI D a Pump installed in ❑ Bucket or • On Block or ❑ Other d• Pump Make/Model LIBERTY 290 • Floats or ❑ Transducer 0- a Tank draw down 2.75 in/min Pump capacity 66 gpm Squirt Height 3.5' ft Pump on time 1.01 Pump off time 3.59 Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 2231941000010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES M 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: Drainfield&manifold onentation&layout,Septic/pump tank location,North arrow,reserve drainfieki,existing and proposed buildings,location 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 permits. ! • Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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 /further certify that all information contained on this for and ttached Record Drawing is accurate. form and attached Record Drawing is accurate. May 2. 220 'VI SignatureofInDateBill Bumbalouah = �i Printed Name of SigneeA %4' c �1 MASON COUNTY PUBLIC HEALTH N VE q The undersigned approves this Installation Repoiand ��• 5100385 Record Dr wi, ngoeh alf of Mason County PubV G 2 8 �423 0 s MICHAEL D.JERKOVICH 9h S UCENSED DESIGNER Health. MASON COON c N\\‘‘‘‘NNNS, �N���\X�, �� .. VIROM,IENT vzpxoJA AL HE EXPIREe:8/11/2025 HEALTH Date:8/11/2023 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 RECORD DRAWING (continued) SEE ATTACHED I APPROVED AUG 2 8 2023 MASON COUNTY ENVIRONMENTAL HEALTH DJA I f--- ---•--•---•-••-----•--•--=r�-- -. mao O �� y mS � • CD410 oF-0. 0 cc) wj p D AW m m m r_ Z r p oo AszT m m p T n' 70 bm 0=2 r ▪ f o o A v.) n D o ., w - rn -o o9 t C./) ' i • I . TJ-- zA ZmOnCO m m Zr- NyzZ v m m m �"'1 I O z An O x o A Z m 2 z rzn II T j i Z N o AT O z p I p aw i I 33 D p CC • I Z i\ I rn N I C I Z w I`/ n i j r Ag �, f I r W VIIC + , T I j I 1 I7:1 I I I A I I 1,,khor.-- + d I iOA Ocn t D —O \i � ¢ I O CO m i Cn wl N IlIAl l > 7:1 0 I y r00 ro r I s CI CI cn cc m ` J r ' ; o MD; rminN o " m�� z N2NTC m kti/t. 00,111%, � 444)04 �pt t o-., *rTi 0 -` o C O I B! ZAvAxz yn N nNNo Om i I r\.) 71) I i mono o� � I m �m ma m D^' CO \C\ .7,Ez zt -' .(g 1:::;1 I c n H 2� in gp O/ \\ 1 « )Gp-� O ' TA4-- z zv z n ;mc�jO mp t Am Am h c,r 0 - �O =pOc)�gam "rnmtamooy2= A A pOZ' Tl oPa�mO co _ Zw Vl i2 m <mom+• N� o A A in-.../ m A-rn O, O �(T2 Zw ZA 1CD\ Ap \ A m s O 73 \CO' Z D m a \ N O >ii r z �� o p fTl m r ' N D 'II N 2 w �\ - G) \ \ \ m A m _ Z o _ � III\ - z N o r" z N o m m \ o \ \III b� ;- O?N v . O;N N-( `ti p \ a W A A y CH ?A t r •m C) u) I w m C) O C A <w CN << OGI) ^ilk� I� O A A -' m 0 A A fit o o o co r ) . D p a P,p F p p CQ O m O m M 11 mn \ n III rN- z m z 2 2 N \IU w m a �3 J D tbo• y m m� O z - 0 m z O z O N ,,, l p n m m m N p p [;-1:77.-------„, \ z .I,I N 7 m O r ~ c)p -,m r p p - ti ~ p z Of 10 „y \` C .w -O r �= N —O \ , pp lx7 S[1 a D rn O A, >a G7 A- 1- D n w CI A 7 / /,� Z -m_� A� CD O I� A R. V A rn N 4-1 O Of rn 1°� N III -� • rr,'H! m . O gU v, A m z WILSON & PENELOPE SAPP '(' .,, laL`o �;, (/) s n I:fix .^Y � 4'''' 1 .. C17 100 NE LAKE CHRISTINE RD TAHUYA WA 98588 ;:; A $& ccd 0 PARCEL 2231941000010 d ^r,