HomeMy WebLinkAboutSWG2022-00524 - SWG As-Built - 11/16/2023 Mason County OSS Installation Report pg. 1
r MASON COUNTY PUBLIC HEALTH
r
Permit Number SWG 2022 00524
Parcel# 1210552-00199
Applicant Name Remee Rorback
Applicant Address 61 E Treasure Island Dr
Subdivision (Name/Div/Block/Lot)
City,State, Zip Allyn Wa.98524
Site Address 61 E.Treasure Island Or. Installer Name ShumakerConst.
Designer Name PioneerneerDI
Dipp in
INSTALLATION CHECKLIST
®Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair
System Type_ e El Other
YP Pressure
Pretreatment Type Nu wale_ rs 50�>5 ft.from foundation?
>50 ft.from wells? - - ❑ern vas 0 ao
Z >50 ft.Prom surface water? ❑ 0
$ Cleanout between building and tank? 0 III 0
O Tank baffles present? - - 0 II 0
f0.
' 24'access risers over each compartment?- 0 El
LB Effluent fliter installed?. 0 0
co
Septic tank capacity(workin ❑ ® 0
g)_ BNR 500 el Manufacturer HAGERMENS
9 [Monk water level and speed levelers used? -
00 Manlfold/D-box accessible from surface?- N/A ❑res 0 NO
Ga Check valves installed? - 0 0 ID
f Transport Line Size 2" 0 ❑ II
—�_ Schedule/Class 40
Bedrooms installed(check one) IMI 2 ❑3
>10 ft.from foundation? ❑4 ID ❑6 ❑Commercial/Other
0 >100 ft.from wells?- ❑WA I YES 0Na
W >100 ft,from surface water? 0 0
i >10 ft.from potable water lines? 0
0
w >5 ft.from property lines and easements? 0 IN 0
LE LE >30 ft.from downgradient curtain/foundation drains? 0 0
Drainfleld level and observation ports present - ❑ IN ❑
0 Graveless chambers or a Clean gravel used? (check one) 0
II ❑
Proper cover Installed over drainfieltl?
Pump tank setbacks consistent with septic tank? 0 0
= Pump tank capacity(good) 1250 ❑ NIA YE8 0 NO
f 24"access riser(s)and accessible from surface? Manufacturer HAGERMENS
6 Alarm or Control Panel Installed? 0 0
f Control Panel equipped with Timer/ETM/Counter- _ ❑ 0 ❑
7 0 0 0
1 Pump installed in
Bucket or ❑ On Block or 0 Other
O.
Pump Make/Model LIBERTY 257
Tank draw down 1.25 I!Floats or 0 Transducer
S in/min Pump capacity 50
Pump on time Pump
Squirt Height 9' ft
Pump off time Daily flow set at
qpd
upda,warz,aov
Mason County OSS Installation Report pg. 2 Parcel# 12105-52-00199
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project?
If yes,please describe: 0 YES ® NO
Were all components pumped out and properly abandoned per WAC248-272A-
03007 -______ . ❑ yag ❑ NO
RECORD DRAWING
nu.a.peml.nam record and mar be.came and d..drlyllw enough to neonate In the need m mnm.new weenies and
ord
0.ewi,T contain: MOONY&mnibtl oS.m.tlun r."WW.y&ctdNnp lank location.Nardi n future co.development okwatman.tt
w.I..absen :on pony,cyvmup.and other meimeng:m moms Drawings
Ma.tead.uyrypand rill eleMnogpmlbn olwls,ed psmth
PoMI. I�mnpea Record ammiye may[:aals.Ueaonel delays In flnylneyWGaneppmyl and related pnrN.,
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER
DESIGNER/ENGINEER
I earthy 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
and Mason County Codes. mySe endf Mason County Public Health and meet all
I further certify all information contained on this State end Mason County Codes
form and a /further certify that all information contained on this
�tacbed�RecomDrawing is accurate, form and attached Record Drawing is accurate.
-
Signature of Installer It�`
`l�n tit at
,, Defe/
Fa \) II•I•“r r at �reA ttf C
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Printed Name o/Srgnee r, -,Y
1` ., ,\jam.. r
MASON COUNTY PUBLIC HEALTH �J,I "r '
The undemignetl approves this Installation Report and Ip
1
Record Drawing on behalf of Mason County Public II.
Health: •f 'E%GIREBI r••
Signature of Environm oral Health Specialist Dete
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uptled.rsleola
I�¢
TREASURE ISLAND OR/I/E k4- " atfr. -
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\ EAPAES
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\\ 7 PROPOSED
\\\ I BUILDING
\, p AREA CLEANOUT
\\\\ I\ PROPOSED TANKS
LOCATE WATERLINE \ /\ C
�• O PROPOSED
10'+ FROM SEPTIC \ \\ \ \ \O •
\ 2 BEDROOM
COMPONENTS \ \ \\ -- — \ DRAINFIELD
& SEPTIC LINES \\ \ ' _� 6
FOUNDATION SETBACK \ i a 1
(10'TO DRAINFIELD 1\ \ \\ 1
5'TO TANKS) 1\\ \ \ p� /-- ___
AP l!-n RQ\'{- "_f I \
NOV 1 6 201 -----i \
NsSO4 CL_ W N -
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All
AN ASBGILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, INC CUSTOMER RORABACK 034CI. EI: TESTHOLE2 TEST HOLE 3:
DARTOMER: RENEE0199 33+GI5 304 Ivn
34'TH. 3UF TILL
SEPTIC DESIGNS ADDRESS 6IE TREASURE IS DR FOOTS TO34 KOOTS1O30
31183 E MASON eEN50N 0.D GRMEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE
OFFICE-3604261803 FAX-360-427-2353 SHEET: ScrE PLAN SCALE I'=20' ..mOccroka. DES R O'°E'°OW®°'E WnTIAP6"'a"'AThOW°