HomeMy WebLinkAboutSWG2022-00012 - SWG As-Built - 11/13/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG LULL-00012 Parcel # 4231ab000UUJ
Applicant Name Jeff:loggers Subdivision (Name/Div/Block/Lot)
Applicant Address 5255 E mercer way
City, State, Zip Mercer Island WA 98040 Installer Name Jack Johnson
Site Address 231 N Potlach dr north Hoodsport 1 Designer Name Dale Tahja
INSTALLATION CHECKLIST - -
❑ Full System Installation ®Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other
System Type Pump to gravity Pretreatment Type
>5 ft. from foundation? - ❑ N/A Q YES ❑ NO
>50 ft. from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - ❑ ill ❑
H Cleanout between building and tank? - - ❑ MI
U Tank baffles present? - -- ❑ ❑ In
H 24"access risers over each compartment?- h i " - ❑ MI ❑
a
W Effluent filter installed?- - ❑ ❑ MI
CO
Septic tank capacity (working) 36" x 60" gal Manufacturer Orenco
O D-box water level and speed levelers used? In N/A ❑ YES ❑ NO
aO Manifold/D-box accessible from surface?. MI ❑ ❑
u.
02 Check valves installed? - - o ❑ ❑
Oct
f Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) LE 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ® N/A ❑ YES ❑ NO
O >100 ft. from wells? - ® ❑ ❑
W >100 ft. from surface water? ® ❑ ❑
LT >10 ft. from potable water lines?- -- IN ❑ ❑
Z > 5 ft. from property lines and easements?- - Q ❑ ❑
Q
K > 30 ft. from downgradient curtain/foundation drains? - - Q ❑ LI
O Drainfield level and observation ports present - - . ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - El ❑ ❑
Pump tank setbacks consistent with septic tank? - - ❑ NIA NO YES ❑ NO
• Pump tank capacity (flood) gal Manufacturer Orenc936"x 60"
4 24" access riser(s)and accessible from surface?- - ® ❑ ❑
F-
a Alarm or Control Panel Installed? - - ❑ • ❑
f Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ IN
7
O. Pump installed in ❑ Bucket or ❑ On Block or 0 Other bottom of tank
f Pump Make/Model Liu=ttj LLS IMMM In Floats or ❑ Transducer
a=. Tank draw down _ ___in/min Pump capacity gpm Squirt Height __ft
Pump on time Pump off time Daily flow set at gpd
Updated 80 i40+e
Mason County OSS Installation Report pg. 2 Parcel u 432 I8 - So
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES ® NO
If yes. please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? . 0 YES 0 NO
RECORD DRAWING
Thee Is a permanent mooed M must be accurst'and demetplive enough to nbrde M the need of mall blwn Dabbles—future development Typcel Renard
Drawings wntdn Unmfol&maMdd orientation&layout Septic/pump rank baton Nora snow,reserve Teinrpp,cram,and IXWceed NAtlings,buedn of Bells watelmas,
veils,obsenaNa ports,meanwb and olio maintenance accask µans. Noomplele Record Orawmgs may neate a0.Xbnal delays In final Insl4Xation eppovel and metaled penals.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
/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
l further certify that all information contained on this I further certify that all information contained on this
forprpnd a ed Record Drawing is accurate. form and attached Record Drawing iS accurate.
I I
NW\ 1l'I - )-3
S na ore of I taller Date
i
acK 'x'nA$aln
Printed Name of Sgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health.
Z f`641 1 l 1312-3
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Wowed arntxma
'- or :--&j Bogs
1 t, -' \ )-t93\ ' ooaos
1 'h \ �x� \.ak CvS\n\Man is N . 3 \ n\
! h
I ,. LE 5i14 ebetr : ��'�� �`Q t1
. Sco\e. '
r
err = 1 �$ �.
A \ �
.z ,_ ._ awns � a1 ,
o N Sr.
r)r2S !c 1?
Es ,•
b
desk �k 4- ,
<
v
. �� • ote `.
ei
io 'T�,� re5er v�
_ 1?n'I ve
0,4
v R
40
c• r ,i
•
O'- *DALE L. T t'11 NOV 13 2023
too.
Lrcsy: siG WR " +e+ MASON G ��r :w'SCwP,T4L��trl - .
EXP$ s 5�. - 'VI% PET
...