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HomeMy WebLinkAboutSWG2023-00442 - SWG As-Built - 12/22/2023 silk Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00442 Parcel # 22206—42-90080 Applicant Name Michele Holmes& Cole Staley Subdivision (Name/Div/Block/Lot) Applicant Address 231 NE Waterhill Rd.. Q t" !�s\ City, State, Zip Tahuya, WA 985 �lS Installer Name Keith Chamberlin Site Address 231 NE Waterhill Rd �,r f 2 2.013esigner Name Rod Left INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only Drainfield Only ❑ Repair ❑Other System Type Pressure Trench Pretreatment Type__ >5 ft. from foundation? - - ❑ N/A ❑� YES ❑ NO >50 ft. from wells? - - El 0 ❑ Z >50 ft. from surface water? - - ❑ 0 ❑ < Cleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ 0 ❑ 1— 24"access risers over each compartment?- - ❑ 0 ❑ n. W Effluent filter installed?- - ❑ 0 ❑ cn Septic tank size 1250 gal Manufacturer Hagerman o D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - ❑ ® ❑ LL m 2 Check valves installed? - - 0 El El 0Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A 0 YES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ WIII 0 El>100 ft. from surface water? - - LT >10 ft. from potable water lines?- - ❑ 0 ❑ Z >5 ft. from property lines and easements?- - ❑ 0 ❑ a ❑ ® ❑ cc > 30 ft.from downgradient curtain/foundation drains? - - Drainfield level and observation ports present ❑ ❑ ❑ Q Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ "I Pump tank setbacks consistant with septic tank? - - ❑ N/A D YES ❑ NO • Pump tank size 1250 gal Manufacturer_ Hagerman _ < 24" access riser(s) and accessible from surface?- - ❑ IN El ~ Alarm or Control Panel Installed? - - El ® ❑ a il 2 Control Panel equipped with Timer/ETM/Counter- - ❑ ® ❑ a_ Pump installed in © Bucket or ❑ On Block or ❑ Other_ a• Pump Make/Model Liberty 290 3/4 HP- 1 Ph 115V ❑■ Floats or ❑ Transducer p_ a Tank draw down 1.5 in/min Pump capacity 39 gpm Squirt Height +6' ft Pump on time 61 seconds Pump off time 2 hours Daily flow set at 475.8 gpd Updated 84'212018 . l k. • Mason County OSS instailation Report pg. 2Parcel# 2� "—4'7,'6tME5C) ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [] YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES ❑ NO RECORD DRAWING ' This is a penn:nent record and must be accurate and descriptive enough to relocate In the nood of maintenance activities and future development Typical Record Drawings cnntat2 f)rain5etd&manifold orientation&layout.Septiclpump tank location.North arrow,reserve dralnfield,existing end proposed buildings,location of wells,waterlines, wets,rihcr-rvabon pols,cieanou:s,and other maintenance w-ess points. incomplete Record Drawings may create additional delays in final Ins',uP.abon approve!and related permits. 1 bRecord Drawing Attached r. E CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 certify 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 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 1 further certify that all information contained on this Drawing is accurat e. form and attached Record Drawing is accarato. anti nd attached Record -.2S', /7 x-2-73 Signature of Installer Arw . a i► o, a 7t�y 1 p � rT 7 JR LEFT a ,74, UCENSKIDESIrjecR a ik ''' l/ a, exei t .yr s 12/151_ L x Signature of'Environmental lid-th Specfatist Date (stamp,signature and,:,te; • ,,.r ; �p.:ak..J eRirler9 _.-.�. .. a tu�uc vlewr f�f iH�fu>,soN coun�wss SITE a.''' , \ Aki- ? fit. j Z 0 O II _' * r�tJ1 PI r�t1 N v r • .0 r ° ° Z > ➢ U) m I� Ii' p b Z i f In " II ^ 'ram " �'j •+ "' M. 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