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HomeMy WebLinkAboutSWG2023-00297 - SWG As-Built - 9/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023- 00297Far l# 12305-50-00030 Name LARRY&SHARON APt...„,----- Applicant �Subdiviion ( `ame/Div/Block/Lot) Applicant Address 12683 SILVERDALE WW cEp 1c,�2��1 SZ4 City, State, Zip SILVERDALE, WA. 98383 J �IQs me arule-_ SHUMAKER CONST 4' . O?O� Site Address 71 NE TIGER WAY E, BEL AIR,W W•_ er Name ROD LEFT /L ? INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑Other System Type_____p_reSS`A— Pretreatment Type >5 ft.from foundation? - - ❑ N/A k YES ❑ NO >50 ft.from wells? - - ❑ 0 ❑ • >50 ft. from surface water? - - ❑ ■❑ ❑ z Q• Cleanout between building and tank? - - El 0 ❑ U Tank baffles present? - - ❑ 0 ❑ H 24"access risers over each compartment?- - ❑ ❑■ ❑ a_ W Effluent filter installed?- - ❑ ■❑ ❑ to Septic tank size I 2 SO gal Manufacturer 665.4...c 0%04v ❑ D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO �OJ Manifold/D-box accessible from surface?- - ❑ 0 ❑ m Z Check valves installed? - - ❑ ❑ 0 ❑< 402 Transport Line Size o2" Schedule/Class Bedrooms installed (check one) ❑ 2 Cl 3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO >100 ft.from wells?- - ❑ 0 ❑ 0 1.1., >100 ft. from surface water? - - ❑ 0 ❑ L >10 ft. from potable water lines?- - ❑ 0 ❑ Z 5 Q > ft. from property lines and easements?- - ❑ ❑� El IY > 30 ft. from downgradient curtain/foundation drains? - - ❑ ■❑ ❑ cl Drainfield level and observation ports present ❑ ICJ ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant wit✓ e iic tank? - - t ❑ N/A ❑■ YES ❑ NO {jeo d O�(�a c+ p•Atio n • Pump tank size 1000 / gal M�nufac rer HAGERMAN < 24" access riser(s)and accessible from surface?- - ❑ ® ❑ ~ d Alarm or Control Panel Installed? - - ❑ II ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ D C- Pump installed in 0 Bucket or ❑ On Block or ❑ Other a• Pump Make/Model ORENCO PF 5005 0 Floats or ❑ Transducer n. Tank draw down 2.75 in/min Pump capacity gpm Squirt Height 10' ft Pump on time 59 SEC Pump off time 3 HR Daily flow set at 479 gpd Updated E21/2018 Mason County OSS Installation Report pg. 2 Parcel# 12305-50-000030 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Q YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q■ 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,Septiclpump tank location,North anew,:reserve drainfield,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. ce 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. - r3/Z.0 Signature of Installer Date C Ma /41_ C-e Ma Printed Name of Signee MASON COUNTY PUBLIC HEALTH - J f� The undersigned approves this Installation Report and 1. LEFT F; Record Drawing on behalf of Mason County Public �tvsED DEstONER -. /i///////x/iis Health: c PIRE:i 12115t�U ei\--r- rv\i0C4 vvi ct/a7 f 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 uPdatad 812:2c15 b * * * * * * D o o z D D ✓' o r-r m m O r 7 rli, -z -I y o DDZo m N ` (1; f a � � = m O X O K 1;! -10 mn DDJ A m �'D7y <mf11; rdD 'C j- 5 O --ix —If \ � D m n1 � n . z D zm z- m0 � 0= m O 0 Fri O z r Fri Z7 ° m TI a :) y -;.. 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