HomeMy WebLinkAboutSWG2022-00318 - SWG As-Built - 10/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00318 Parcel# 12229-43-00020
Applicant Name JORDAN TURNER Subdivision (Name/Div/Block/Lot)
Applicant Address 230 E NELSON ROAD
City, State, Zip ALLYN, WA 98524 Installer Name JACK JOHNSON
Site Address SAME AS MAILING Designer Name ALEX PAYSSE
INSTALLATION CHECKLIST
Q Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type CONVENTIONAL GRAVITY Pretreatment Type-
>5 ft. from foundation? ❑ N/A Q YES ❑ NO
>50 ft. from wells? - - ❑ IN ❑
Z >50 ft. from surface water? - ❑ 0 ❑
H Cleanout between building and tank? ❑ 0 ❑
U Tank baffles present? - - ❑ 0 ❑
a• 24" access risers over each compartment? ❑ 0 ❑
W Effluent filter installed? ❑ 0 ❑
CO
Septic tank capacity(working) 1500 gal Manufacturer HAGERMAN
D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO
0J
0 Manifold/D-box accessible from surface? ❑ 0 ❑
mZ Check valves installed? - - 0 ❑ ❑
0<
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑� 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- ❑ N/A 0 YES ❑ NO
O >100 ft. from wells? ❑ 0 ❑
W >100 ft. from surface water? - ❑ 0 El
E >10 ft. from potable water lines? - - ❑ 0 ❑
QZ > 5 ft. from property lines and easements?- ❑ I.I ❑
K > 30 ft. from downgradient curtain/foundation drains? ❑ II ❑
Drainfield level and observation ports present - ❑ IN ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? ❑ I] ❑
Pump tank setbacks consistent with septic tank? IN N/A ❑ YES ❑ NO
Y Pump tank capacity (flood) gal Manufacturer
< 24" access riser(s) and accessible from surface? ❑ ❑ ❑
aAlarm or Control Panel Installed? ❑ ❑ ❑
2 Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - - - ❑ ❑ ❑
3
0- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
2 Pump Make/Model ❑ Floats or ❑ Transducer
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8m12018
Mason County OSS Installation Report pg. 2 Parcel tt 12229-43-00020
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? 0 YES a NO
If yes,please describe:
Were ell components pumped out end properly abandoned per WAC246-272A-0300? - 0 YES ❑ NO
RECORD DRAWING
ml.le•seasoner&neon end wW M ecarna end einealpave anent le iNwws M the need M s.MMwma rankle—Mute d•MePtint Typical Renard
Dn*'P ra.da' Drv,Md I mended anent/Dal&eyoe 3WedTeM lank ku&n,WP arrow.name eu* d.existing end proposed tunings,Ionian al wY,naWlwm,
wens.Observation pa domain..rid are nation ante awn pOiM. emrrwa Rennin Dianna nnnr leers adenoma men In ma newaaw'Mann an rased wait.
APPDyE
OCT 0g2023
.;ASON COUNTY ENVIRONMENTAL HEALTH
JBW
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that installed the system in accordance with I certify that the system has been installed In scoot-
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 hem 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 certify that all information contained on this I further certify that all information contained on this
for rend a ad Record Drawing Is accurate. form and attached Record Drawing is accurate.
( 9-27-2023
S na re on taller Date
Jack Johnson
Printed Nana of Signee
MASON COUNTY PUBLIC HEALTH LfGANS •'�
.y : • -
The •.
undersigned approves this Installation Report and
i V
Record Drawing on behalf of Mason County Pudic f,Y out wc%0ans tr.
2/ :rrW
/aaa
Sig-at Q incremental Health Speclahst Date (stamp, signature and date)
•
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE I'P°^ed aa'nata
_ RECORD DRAWING
1 At
GRAPEVIEW LOOP 1 NEW HOME �'.
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I I FUTURE RV DROP
BZ - .3'
Z - 53.5' 15005EP1lClANK
I CZ - 69.5'
I
I DZ - 64'
I AB - 54' 0 O Z
___ CD - 54' .
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