HomeMy WebLinkAboutSWG2021-00455 - SWG As-Built - 10/27/2023 Mason County OSk Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG 2021-00455 Parcel# 42307-50-00137
Applicant Name Bryan Truttmann Subdivision (Name/Div/Block/Loti
Applicant Address 1024 Makah PI LAKE CUSHMAN#2 TR 137 , S 47/237
City, State, Zip Fox Island,WA 98333 Installer Name Arrow Excavating
Site Address 230 N Potlatch Dr N, Hoodsport Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
Q Full System Installation ❑ Tank(s)Only ❑ Dra'mfie'd Only 0 Repar ❑ Other
System Type Shallow pressure Pretreatment Type
>5 ft.from foundation? yivis Vat uSe a'+ Q N/A ❑ YES ❑ NO
>50 ft. from wells? ll ❑ ❑
2 >50 ft from surface water? - - I 0
ct Cleanout between building and tank? - - ❑ 0 ❑
U Tank baffles present' - - 0 ® ❑
H 24"access risers over each compartment? 0 In ❑
O.
W Effluent filter installed?- 0 0 0
cn
Septic tank capacity(working) 1,060 gal Manufacturer Infiltrator
O D-box water level and speed levelers used? I NIA 0 YES j,NO L— o'j
�O Manifold/D-box accessible from surface?--p'� 1 1_ ❑ NI I' Ivl
m- Check valves'installed? {'u^M ❑ ® r'f1
ppa Y c
2 Transport Line Size 2 inch Schedule/Class 40 •t r N
Bedrooms installed(check one) ❑� 2 I-1 3 ❑4 ❑ 5 ❑6 ['Commercial/Other I q
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>10 ft. from foundation?- r`a r''�' 44
- ® NlA ❑ YES NO C4
CI >100 ft. from wells? In ❑ U
W >100 ft. from surface water? ® ❑ -c—=7
IT >10 ft. from potable water lines?- ❑ Q 0 7
Z > 5 ft.from property lines and easements? ❑ Q ❑ 7
re > 30 ft.from downgradlent curtain/foundation drains>- - Q 0 ❑
Grainfield level and observation ports present . ❑ ® ❑ 1
• Graveless chambers or 0 Clean gravel used? (check one) /
Proper cover installed over drainfield?- 0 I 0
Pump tank setbacks consistent with septic tank? 0 N/A ® YES ❑ NO
2 Pump tank capacity(flood) 1,287 gal Manufacturer Infiltrator
F• 24' access riser(s) and accessible from surface' 0 ® 0
a Alarm or Control Panel Installed? - ❑ II ❑
• Control Panel equipped with Timer! ETM /Counter- ❑ II 0
C Pump installed in si Bucket or 0 On Block or D Other
a
O Pump Make/Model Liberty 253 ❑ Floats or IITransducer
d Tank draw down 1 inch In/min Pump capacity 25 gpm Squirt Height 6 ft
Pump on time 2 minutes Pump off time 6 hours Daily flow set at 200 gpd
I.pda.ed a 2 1,2GIS
Mason County OSS Installation Report pg. 2 Parcel# ¢2301- 50 ' 00 131
ABANDONMENT RECORD
Were existing septic components abandoned as part of This project? ❑ YES cA 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 rn the need of maintenance activities and future development Typical Reoor
Dressings contain. grainfield&manifold orientation&layout.Seaucpdmp tank location.Ncr arrow.reserve draaneld.existing and proposed buildings,beaten of wets,watedines,
wets,obsemuon ports,deanoets,end older maintenance access points. Incomplete Record Drawings may create additional delays in final estada(m approval and related permits.74 .
Record 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 ail 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 a a'f tf/ttached R rtl Orewi s accurate. form and attached Record Drawing is accurate.
11/4) ` 23
nature of Installer Date
c n C i 1 10.AA d ., '
Pnnted Name of Signed �E e �4� a
MASON COUNTY PUBLIC HEALTH ii
•
GI]oaai
The undersigned approves this Installation Report and a- PAULA JOY JOHNSON
Record Drawing on behalf of Mason County Public rICeNSES- .(
Health:
Signature of Environm ntal Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upda.ed emrzo1e
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