HomeMy WebLinkAboutSWG2022-00005 - SWG As-Built - 11/14/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG Zort- Do OO Parcel # 22212-50-07001
Applicant Name Ascent Builders LTC Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 427
City, State, Zip Port Orchard, WA 98366 Installer Name Ron Hemley$<obiz
Site Address 61 E. Ellinor Peak Place, Belfair, Designer Name Rod Left
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only D Repair 0 Other
System Type _ Standard Pressure Pretreatment Type _
>5 ft. from foundation? - ❑ N/A ®YES ❑ NO
>50 ft.from wells? - 0 IN 0
Z >50 ft. from surface water? - 3-r 0 NI 0
F Cleanout between building and tank? - El 0
U Tank baffles present? ‘;" ❑ • 0
I- 24"access risers over each compartment?- ❑ ❑ Q
0_
W Effluent filter installetl?- 0 0 0
0
Septic tank size 1250 gal Manufacturer _ Hagerman
O 0-box water level and speed levelers used? - ❑ N/A 0 YES ❑� NO
p0 Manifold/D-box accessible from surface?- - 0 0 0
mZ Check valves installed? - 0 0 ❑
GQ
2 Transport Line Size 2 _ Schedule/Class Ho _
Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? ❑ N/A IN YES 0 NO
O >100 ft. from wells?- 0 ® ❑
W >100 ft.from surface water? - - 0 Pi ❑
it >10 ft. from potable water lines?- - ❑ S ❑
ZQ >5 ft.from property lines and easements?- ❑ • 0
d > 30 ft.from downgradient curtain/foundation drains? - 0 A ❑
• Drainfield level and observation ports present - - 0 III 0
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ D 0
Pump tank setbacks consistent with septic tank?- 0 WA 0 YES 0 NO
`1 Pump tank size _ 1250 gal Manufacturer _ Hagerman
Q24"access riser(s)and accessible from surface?- ❑ IN ❑
~
a Alarm or Control Panel Installed? - ❑ U ❑
• Control Panel equipped with Timer/ETM /Counter- -- - ❑ CI 0
7
1 Pump installed in 0 Bucket or ❑ On Block or ❑ Other
C f Pump Make/Model Liberty 290 0 Floats or ❑ Transducer
d Tank draw down _ 2" in/min Pump capacity 22 gpm Squirt Height_ _ 8+ ft
Pump on time 51sec Pump off time- _ 31.rs _ Daily flow set at _357.8 gpd
Vyda ne B/L/QO1B
Mason County OSS Installation Report pg. 2 Parcels s]3l c SO-O700I
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project' - ❑ YES NO
If yes, please describe.
Were all component pumped out and properly abandoned per WAC246-272A-03007 p YES [] NO
RECORD DRAWING
This Is a permanent record and must be accurate and aeecnptive enough to M«ne In the need of maintenance ecuvrcka and future development. Typical Record
Dmrvn9e mnlein. DNnfiap&manifold orientation&'synth,Septic/pump Tank location,Nit snow.reserve dreMaeld.existing end proposed buildings.Nutlon of wells.wale)lnea,
wets,obeeweton pone.deenoub,end other mcntenaNQ access points. Incomplete Ref Ord Orasinga may create additions delays In fuel installation approval and mkted pcntits.
IRD ecord Drawing Attached
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 ail
and Mason County Codes. State and Meson County Codes
I further certify that all information contained on this I further certify that all information contained on this
fo a atZhed eco Drawing is accurate. form and attached Record Drawing is accurate.
SigneturA[f Installer Date
14C.�t Yh't
Printed Narne of Signee J '.
w
MASON COUNTY PUBLIC HEALTH Ja cue
x_EFT 4
The undersigned approves this Installation Report and ."e tr,PHSEOI 3NER
Record Drawing on behalf of Mason County Public x•,�EXPIRES�1512A
y
Health.
, l I I fz3
Signature of Environmental health Specialist Date (stamp. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW DN THE MASON COUNTY WEB SITE Ila5Nda2112a1e
D O O Z D D
r
r �1 m r r
O
C Z m =
D D Z O C C my
n O O -I m xi m m z �
umi g m Z m m � �
p -0 z O O m 00
O
73
cn• En m A m � c rn
D A X m y D C
A � � 0
m m m z z z pi
am
73
m � u) nH7 -< 0
m > ZO S � � i.
O D c O z Z0 = f— O
D D - -0 mm n 2 Z7
w < Z m Z 0 0 0-E ^� -C
O 77 O O m � �O Z i n _, �7 z m ,,jj " o
O• O K m T 0 �7 - i T i w
D < co m Cn N - m
proI
m m m 0 O � z n 5, 0
O m m D CD Op � x • 103.60' •
D D m O CO 0
m A m O z O Z
coo co m < —iz
= o •
A o am a mo 0
c� Cr) � �0 m o 0
m m m " � - m
A5;1 I
2 m C I
Z
73 � 0 � ``__
• °L C' m
0000 I
m
II
H• o o �. wml I I I I m A H r Ozm 0 MD aZ
�o
r rC Oj!
7• vm0 mynmrlill o . A I it o
C m C 0 a _ p Z <<. . C
z
G N m
G
T,• Z y n n y 1F,"_
7 O
DI D CD
103.60' •
MI m 71 XIr
m 17111
m _a
.) 1
N Cm o
D
oI m N
m N m
r Z 0
Z W
J o c N cn
33 r N C)
m 0 Om co >
w r
O• I m cn
m ; a
m •''��4
m F•444
oi
o m v �{;pt,H
hm ��i
Gal)
rn
cm 0")
m A CO Z zW $p,////...
mm w � 0 I
Cr, C D r C
-0 '-,A-, WR No
ti W co
O W A 0
0