HomeMy WebLinkAboutSWG2022-00125 - SWG As-Built - 10/22/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00125 Parcel # 519085000066
Applicant Name Michael Wiggins Subdivision (Name/Div/Block/Lot)
Applicant Address 101 W Satsop Dr
City, State, Zip Elma Installer Name Rick Stevens
Site Address 101 W Satsop Dr Designer Name AdamHunter
INSTALLATION CHECKLIST
I. Full System Installation tEl Tank(s)Only ❑ Drainfield Only ❑ Repair El Other
System Type pressure distribution Pretreatment Type
>5 ft.from foundation? - - ❑ N/A t YES ❑ NO
>50 ft. from wells? - 0 II 0
Z >50 ft. from surface water? ❑ ® El
f Cleanout between building and tank? r .,I,H,fit,, 0 In El
U Tank baffles present? - ' ❑ il 0
a24" access risers over each compartment? ❑ e 0
W Effluent filter installed?- . . - ❑ 0
N
Septic tank capacity (working) 1000 gal Manufacturer concrete Miles
0 D-box water level and speed levelers used? - - • N/A 0 YES ❑ NO
oO Manifold/D-box accessible from surface? - 0 II
cE Check valves installed? - 0 In ❑
OQ
t Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) 112 223 04 05 06 0 Commercial/Other
>10 ft. from foundation? - - ❑ N/A ® YES ❑ NO
G >100 ft. from wells? - 0 ® 0
W >100 ft. from surface water? - - El 1111 ❑
IE >10 ft. from potable water lines?- - 0 Q ❑
QZ > 5 ft. from property lines and easements?- - 0 0 ❑
c2 > 30 ft, from downgradient curtain/foundation drains? - 0 It 0
o
Drainfield level and observation ports present - - ❑ Q ❑
• Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ Q ❑
Pump tank setbacks consistent with septic tank? - ❑ N/A ® YES ❑ NO
Y Pump tank capacity(flood) gal Manufacturer concrete/ Miles
< 24" access riser(s)and accessible from surface?- ❑ UI 0
~
a Alarm or Control Panel Installed? - 0 0 0
f Control Panel equipped with Timer/ ETM /Counter- ❑ 0 ❑
D
a Pump installed in ❑ Bucket or a On Block or 0 Other
O.• Pump Make/Model Zoeller 4hp Floats or 0 Transducer
0.
a Tank draw down 2.5 in/min Pump capacity gpm Squirt Height 24 ft
Pump on time 1.5 in Pump off time 6 hrs Daily flow set at 240 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 519085000066
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES Q NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-03007 - - ❑ 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 a layout SepedpunP tank location.Norm arrow reserve dremfeld existing and proposed buildings.location of wets,waterlines.
weld.observation ports cleanouts,and other maintenance access po„ta mcomolete Record Drawings may create additional delays in final installation approval and related permits.
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
1 certify that I installed the system in accordance with 1 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 c that II fewna - n contained on this I further certify that all information contained on this
form a d a ecord Drawin is accurate. form and attached Record Drawing is accurate.
O6/08/22 z: v
Sig at re o In ler Date '
hews
Rick Stevens
Printed Name of Signee 5.
-.o .
MASON COUNTY PUBLIC HEALTH J ;�
The undersigned approves this Installation Report and ao-'\ a nry per.
Record Drawing on behalf of Mason County Public L i'.`J't• i
Health: r
7'
, Z
Qi-rw v,_if1/4w) 0 17.-3V2-3
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 Updated 8..112018
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