HomeMy WebLinkAboutSWG2022-00216 - SWG As-Built - 10/17/2023 Mason County O55 Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANTTPERMIT INFORMATION
Permit Number S'WVG tD1.2- OOZI b Parcel # 12330-32-90262
Applicant Name PDC Contracting Subdivision (Name/Div/Block/Lot)
of
Applicant Address PO Box 4 0� k"
City, State, Zip Wauna,WA 983%- Installer Name Rod Left
Site Address 260 NE Chinook Dr, Beltair Designer Name Final Vision
\: 41-STALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type __ _ Gravity Pretreatment Type_ _
>5 ft.from foundation' - - - ❑ N/A 0 YES ❑ NO
>50 ft.from wells? - - ❑ 0 D
Z >50 ft.from surface water? • - - - - - ❑ 0 ❑
FQ- 0 ElCleanout between building and tank' - - - ❑
C1 Tank baffles present? - - ❑ El 0
H 24"access risers over each compartment?- ❑ 0 ❑
W Effluent filter installed? - ❑ 0 ❑
co
Septic tank size 1200 _ _gal Manufacturer Hagerman
O D-box water level and speed levelers used? - • ❑ N/A Q YES ❑ NO
J
rAO Manifold/D-box accessible from surface? - ID 0 ❑
u.
cal- Check valves installed? al ❑ ❑
0< 40
2 Transport Line Size 4" - Scheoule/Class _
Bedrooms installed (check one) ❑ 2 0 3 0 4 ❑ 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- - ❑ N/A 0 YES ❑ NO
O >100ft.from wells?- ----- 0 ID ❑
W >100 k. from surface wate0 - ❑ g ❑
E >10 ft. from potable water lines?- - - - - ❑ 0 ❑
ZQ > 5 ft. from property lines and easements?- - ❑ 0 ❑
id > 30 ft.from downgradient curtainffoundation drains? - ❑ ® ❑
cl
Drainfield level and observation ports present - - - ❑ UI ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ' ❑ 0 ❑
Pump tank setbacks consistant with septic tank? - - 0 NIA ❑ YES ❑ NO
Y Pump tank size - ._ gal Manufacturer
Z
< 24" access risers) and accessible from surface?- - - IN ❑ ElF
d Alarm or Control Panel Installed? - - " - - . ❑
2 Control Panel equipped with Timer/ETM/Counter • ❑� U ❑
m
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other. --
EL• Pump Make/Model ❑ Floats or ❑ Transducer
0_
a Tank draw down in/min Pump capacity gpm Squirt Height ft
— --
Pump on time _ __ Pump off time __ Daily flow set at gpd
Mason County OSS Installation Report pg. 2 Parcel to
ABANDONMENT RECORD _.
Were existing septic components.Abandoned as part of this project? D YES MI NO
II yes, please describe: I
Were all components pumped out aSd properly abandoned per WAC246-272A-0300? - - D YES D No
'l `. RECORD.DRAWING
This Is a permanent record and must be z culate and descriptive enough to re-locate in the need of maintenance actrmes and inure.development `yonel Record
Drawings waken Dramfeel IS mendole onentaeolt S.layout Sepedpump lank Weapon e Horn anti. Tess've oamneld ending and proposes buildings,location at wells waterlines,
wens oaservatlm purls,ueanouft anti other mainlenance access prang Incomplete Record Drawings may wale ammonal delays in anal installation approval and mimeo min,en
M./Regard Drawing Attached
_ l CERTIFICATION OF INSTALLATION
INSTALLER ll, DESIGNER/ENGINEER
I certify that I installed the systend in accordance with I 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/approveer 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. I State and Mason County Codes
I further certify that all lnforrnaborlcontained on this I further certify that all information contained on this
form nd ached Record Drawing is accurate form and attached Record Drawing is accurate.
Si nature of installer Date
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t J 0. l%'1 tr 1)[.dlGJTL -
Panted Name of Signee Vt.
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MASON COUNTY PUBLIC HEALTH 7 t)=4The undersigned approves This Installation Report and ,� 'V mi
ucENS iDESIGNEH
Record Drawing on behalf of Mason County Public min min r mp
Health. �[Q �7 —7 EXPIRES f2H51 Zy
Signature of Fnvironme)ffal Health Sp II( l (�! `
l (stamp,signature and date)
lHIS FORM MAY BE SCANNED AND AVAII C RLE FOR 2UBLIC VIEW ON THE MASON COUNTY WEB SITE updat . 2t12ma
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