HomeMy WebLinkAboutSWG2023-00320 - SWG As-Built - 10/27/2023 Mason County OSS Installation Report pg. 1 OCT 1 1 202?ASON COUNTY PUBLIC HEALTH
APPLICANT/ P IT&8vi.
R ATJON
Permit Number SWG 2023-00320 Parcel # 22134-11-02010
Applicant Name Medene 8 Kent Cobb Subdivision (Name/Div/Block/Lot)
Applicant Address 705 Navel Ave.
City, State, Zip Bremerton. WA 98312 Installer Name T.J. Goos
Site Address 1041 E. Sunset Hill Rd. Designer Name Dale L.Tahia
INSTALLATION CHECKLIST
• Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type Gravity Trenches Pretreatment Type
>5 ft. from foundation? - .. - - - ❑ N/A in YES 0 NO
>50 ft. from wells? - ❑ e ❑
2 >50 ft.from surface water? - - 0 II
$ .I Cleanout between building and tank? - jL 1,s -- -:- ❑ II
U . Tank baffles present? - ❑ ® 0
a24"access risers over each compartment?.- - _----_-. 0 El
Li!N: Effluent filter installed?- ❑ II 0
Septic tank capacity(working) 1.250 gal Manufacturer Hagerman
O D-box water level and speed levelers used? - - ❑ N/A IN YES ❑ NO
OLL Manifold/D-box accessible from surface?- - ❑ I ❑
W Check valves installed? - - II 0 0
2 Transport Line Size 4 inch SchedulelCtass 3034
Bedrooms installed (check one) III 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A ® YES ❑ NO
C .. >100 ft.from wells? ❑ ® ❑
W >100 ft.from surface water? - - ❑ Ill ❑
ir >10 ft.from potable water lines? - 0 ® 0
2 > 5 ft.from property lines and easements?- - ❑ II
a
OtIN CI 0
o
> 30 ft.from downgradient curtain/foundation drains? - -
Drainfield level and observation ports present - 0 ® 0
- ® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 I 0
Pump tank setbacks consistent with septic tank? - ❑ N/A 0 YES 0 NO
Y Pump tank capacity(flood) gal Manufacturer
< 24"access riser(s)and accessible from surface? - ❑ ❑ 0
~
a Alarm or Control Panel Installed? - - 0 0 0
j Control Panel equipped with Timer/ETM/Counter- - 0 0 ❑
a. Pump installed in 0 Bucket or 0 On Block or D Other
aPump Make/Model ❑ Floats or 0 Transducer
a Tank draw down in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated e212018
Mason County OSS Installation Report pg.2 parcel 4.,,\I —\1_,( b
ABANDONMENT RECORD
Were adding septic components abandoned as pet of Ws project 0 YES ® No
If yes, please deserter
Were ea components pumped out and properly abandoned per WAC2/6-272AU300? - 0 VETS 0 NO
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
I certify that I installed the system In accordance with I tardy that the system has been installed in sxor-
the septic design stamped'APPROVED'by Mason dance with the septic design stamped APPROI#ED by
County Public Health and that any deviations shown Meson County Public Health end that any deviations
hem have been cleared/approved by both the designer shown here have been dearecireppmved by both
and Mason County Public Health and meet as State myself and Mason County Public Health and meet all
end Mason County Codes. State and Meson County Codes
I Nrthercandy that all Information contained on this I further certify that all information contained on this
form and attached Record Drawing Is rate. tom and attached Record Drawing is accurate.
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Signature or instiller Date =it— . tr
t t let/ $ ' Oa�P %Apr
Panted Name of Signe° r f, ' pe `e. . S
MASON COUNTY PUBLIC HEALTH Q "2�11
The undersigned approves this Installation Report and at 214 v.
Record Drawing on behatof Mason County Public r O 'er DALE L.TAHIA - III
LICENSED 0ESIGNER 1
Health: II :C�L�,- rr.;-...'- .J.
atui�(� ivt I°l i-7 (z Exi- __ -
of *water Health Spate Date (stamp,signature and data)
THIS FORM MAY BE SCANNEDMon AVM ARE F FOR PUBLIC VIEW ON THE MASON COUNTY WE2 SITE uWaeeafac"
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APPROVEDso
OCT 17 2023
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