HomeMy WebLinkAboutSWG2022-00445 - SWG As-Built - 11/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00445 Parcel # 22233-50-00012
Applicant Name Daniel Long Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 1999
City, State, Zip Gig Harbor,Wa98335 Installer Name Pacific Specialty Contracting
Site Address 4250 Mason Lk. Dr. W. Designer Name Bob Payne
INSTALLATION CHECKLIST
• Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type ATU - Drip Pretreatment Type Nu Water BNR 500
>5 ft.from foundation? - - 0 N/A Ill YES ❑ NO
>50 ft. from wells? ❑ 0
Z >50 ft. from surface water? - - 0 ill
✓ Cleanout between building and tank? - - 0 INI 0
U Tank baffles present? - - ❑ MI ❑
C24"access risers over each compartment?• 0 II 0
W Effluent filter installed?- ® 0 ❑
to
Septic tank capacity(working) 1150 gal Manufacturer Haggerrnan
o D-box water level and speed levelers used? ® N/A 0 YES El NO
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0 Manifold/D-box accessible from surface?- ❑ e ❑
mZ Check valves installed? - - 0 ® 0
occ
2 Transport Line Size 1" Schedule/Class 40
Bedrooms installed (check one) 0 2 1113 ❑4 0 5 ❑6 0 Commercial/Other
>10 ft.from foundation? - ❑ N/A . YES ❑ NO
G >100 ft.from wells?- • 0 Mi ❑
W >100 ft.from surface water? - ❑ NI D
it >10 ft. from potable water lines?- 0 I! 0
QZ > 5 ft.from properly lines and easements?- - 0 0 in
K > 30 ft.from downgradient curtain/foundation drains? - ® 0 0
• Drainfield level and observation ports present - - 0 In 0
El Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? - El • ❑
Pump tank setbacks consistent with septic tank?- 0 N/A . YES El NO
• Pump tank capacity(flood) 1500 gal Manufacturer Haggerman
Q 24"access riser(s)and accessible from surface? ❑ • 0
t•a Alarm or Control Panel Installed? - 0 III ❑
2 Control Panel equipped with Timer I ETM/Counter- - 0 III 0
tl Pump installed in 0 Bucket or ❑ On Block or 0 Other Flow inducer
1• Pump Make/Model Turbin Floats or 0 Transducer
a
Tank draw down in/min Pump capacity 8 gpm Squirt Height ft
Pump on time 3.6 min Pump off time 1 hr Daily flow set at 360 qpd
updated BR V301B
Mason County OSS Installation Report pg. 2 Parcel a 22233-50-00012
ABANDONMENT RECORD
Were exist ng septic components abandoned as part of this project? YES ® NO
II yes. please describe
Wore all components pumped out and properly abandoned per WAC246.272A-03007 ❑ YES NO
RECORD DRAWING
This Is x prmm•M Word and must be ewuas and deadline's enough to aleuu In Oa need of msintenence MINS*.and future development ry'v:al Rear()
Draw^ijst a. Ora n ski A^lwdne wa .al on d cosy Smn<wmtlan./saner. Nom arr.w'exo✓seeed.,nmry m]p'c m.d'v.ionv.• .u<el'un ul wets waletlnee
ae.a*tvrvr nA pot leenn4,4 n+miw na.+.arance rr rasa'Ants mrmpk1e Recnd nrawm0•ma,delta dlmu d 4 yt n'm4 nstaMlgn apnuval nM eaupn Mrm.t.
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with /certify that the system has been installed in actor-
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 Meson 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer Date ;-`
Marc Combs a'
a '
Printed Name of Signee yI f" ', _
e:,y L •
MASON COUNTY PUBLIC HEALTH SC L i"'R •
ge
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health: - '
(t(7IzJ
Signature of Enmmnme I Health Speciahsl bate (stamp.signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 401*ie21 xle
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AN ASBUILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
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SEPTIC DESIGNS ADDRESS: 4250[MASON LK DR W 41+ III I 35+ III I.
3083E ate ON BEN..'RI>. GRAPRIEN,l\A 98540 DESIGNER: ROBERT H.PAYSSE
OFFICE 300 420 180 3 IA\ 3(304272353 SI REST: ASBUILT SCALE I"=40' +. cs,s.«E..o.a,sw,s.�E FasiVisumitrolg