HomeMy WebLinkAboutSWG2021-00229 - SWG As-Built - 9/15/2023 1
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00229 Parcel # ;321 U4-EiU-00096
Applicant Name MATTHEW BROWN Subdivision (Name/Div/Block/Lot)
Applicant Address 31 E WESTWOOD LN E ALDERBROOK G&Y DIV 11 TR 36
City, State, Zip UNION, WA 98592 Installer Name JERRY UPSON
Site Address 31 E WESTWOOD LN E Designer Name LAWRENCE PURDUM
INSTALLATION CHECKLIST
Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type I'HhSSUHE UIS 1 HIl3UTIUN Pretreatment Type ATU (TL B)
>5 ft. from foundation? - __ ❑ N/A 2YES ❑ NO
>50 ft. from wells? - i{j=4-iF-H-WI-r M CI
Z• >50 ft. from surface water? - - ❑ CI
• Cleanout between building and tank? - -- I- S.Eg-1-5- 2a1-3- ❑ El, ❑
LAI
U Tank baffles present? - CICIa 24" access risers over each compartment. .By \� ❑ ® ❑
W Effluent filter installed?- - El ❑ ❑
co
Septic tank size 500 gal Manufacturer Hagerman
o D-box water level and speed levelers used? - - [ NIA El YES ❑ NO
0O Manifold/D-box accessible from surface?- - ❑ ❑
ME Check valves installed? - - ® ❑ ❑
oQ 4U
2 Transport Line Size 2-IN Schedule/Class
Bedrooms installed (check one) ❑ 2 TE 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
CD >100 ft. from wells?- - ® ❑ ❑
W >100 ft. from surface water? - - ❑ X ❑
T. >10 ft. from potable water lines?- - ❑ IQ ❑
Z > 5 ft. from property lines and easements?- - CI B CI
d > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑
o
Drainfield level and observation ports present - - ❑ 1g1 ❑
❑ Graveless chambers or aa Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ It ❑
Pump tank setbacks consistant with septic tank? - - Cl N/A ® YES ❑ NO
• Pump tank size 1,250 gal Manufacturer Hagerman
Q 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑
~ Alarm or Control Panel Installed? - - ❑ ❑ ❑
'l'"ta,;: •
nel equipped with Timer/ ETM/Counter- - CI CI CI
te
a- Pump ins' Ilkft Bucket or ❑ On Block or El Other Pump vault
414SO i PFolut ip2 ke/Model Orenco PF500511 0 Floats or E] Transducer
N��'NEN,,Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 5 ft
".,I%'tA"�,
A>1mp drrtlrne. 1 min 20 sec Pump off time 4 hrs Daily flow set at 351.84 gpd
Updated 8/21/20,,8
,
•
Mason County OSS Installation Report pg. 2 Parcel# 32104-60-00096
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑■ YES ❑ 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 orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additonal delays in final installation approval and related permits.
SEE ATTACHED
• Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 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. form and attached Record Drawing is accurate.
0
e9 ze
9/14/23
Signature of Installer Date
Jerry Upson tc
t
Printed Name of Signee '4 E® P�. •
oI �k.,a 9-�
MASON COUNTY PUBLIC HEALTH S �`" � �y
The undersigned approves this Installation rReport an7EP 51023 '►'?� , �`
1
Record Drawing on behalf of Mason Count¢P11b1OUH . ��r
E IRONPAENTA Lawrence U.Purdum
Health: n`'^ L HEA(T LttNSEb'DE�d��
/ — 7//5/l ?3 ri EXPIRES �s,�zs
Si' ure 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
i8RR ai 0 UP? !
N P
as ,r`gi; s? l
AM g
S 03.18'25"W- 180.00'
i,
N1py ..,Ow
----- -- �•1p'M 'cloy
D R I V E W A Y
m _
N v \\\ \\\\\ 11,1 I\ \ LI l ! rn
io
R
14 U
op si
O \ 1\ 1 ¢-v A A
0 NI
0 II CD
GO 0
b ,\\^,\,\1 \, 1 ^7
Z - \\\,\ \\\\1 IIl o r
`\,\1\I\\\ G \ d
iA
glill"11
Co 0
; O
,94.691 -3�•Z4 LL•40 S
Z 'u>-I mOm000O 0UV D,OOr00000 O
0-4x opp }{�XOZ DNZ=;K A�� DD D
zm
N In0CD snrmVK Om '-' Dn ny sN F = x)zz<D m o0=IRo� �o1055zNx D DOKmrmOOOZxr\ r , '\
=ZA — m Df I, rp mmmDrn
D m � 1ml xyx l ? ,- > T A
- . 0AmA m* m NNOWOm Z Z ; 2A.. � �Om2;DpnOOynmmOrZmZ D 0NM r, "
A xD = O �DjOANZOA (3 O\lnOmmm -
OA { W m0�m \n NO pNyO\�� O� ^NNOrrAZ
mOm
oo
Z o; N
CO (nW O OD ; > - Zm m Z MZ 0D?Z� ZZA C r 1N6
m M -.0 1pr-VMZN W Z O 0ZZ- Oy m IH 00m m -I il
.... m VI
00 0 pm$ O - vn N 8In m
m r A ODD O f O 0
z co D y r D T� N
p I -4
O m t 0 0 0 rI A
0
co Z Z A
A m O O
ym x Z
co _-.._......--- mm D
O z
Z // 0
g c7
FHifi!) O m
a Iibt I. Z N ® s R v� p��// ; N
4 0 n w dell/\ $
n
x