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HomeMy WebLinkAboutSWG2023-00037 - SWG As-Built - 12/11/2023 D � Dec Mason County OSS Installation Report pg. 1 MASON COUNTY PU IC IgLc1�1QZ3 APPLICANT/ PERMIT INFORMATION �/V� Permit Number SWG 2023-00037 Parcel # 12330-54-00024 Applicant Name RJ Peabody Inc Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 565 BEARDS COVE DIV 7 LOT: 24 City, State. Zip Burley, WA 98322 Installer Name Final Vision Site Address 101 NE Jolly Roger Ln, Belfair Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repar ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑■ ❑ ❑ Z >50 ft. from surface water? - - 0 Li CI < Cleanout between building and tank? - - CI0 CI0 Tank baffles present? - - ❑ 0 ❑ d 24" access risers over each compartment?- - ❑ El ❑ tW Effluent filter installed?- - CI 0 ❑ Septic tank capacity(working) 1,200 gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - DI 0 ❑ QQ Check valves installed? - �`A'` - ❑ ❑■ ❑ E Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO 0 >100 ft. from wells?- - 0 ❑ ❑ J >100 ft. from surface water? ❑■ ❑ ❑ W ir.Z >10 ft. from potable water lines?- - ❑ 0 ❑ Q > 5 ft. from property lines and easements?- - ❑ Q ❑ ..� y ce > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑to n Drainfield level and observation ports present - - ❑ • ❑ c", 0 ® Graveless chambers or ❑ Clean gravel used? (check one) (..,; Proper cover installed over drainfield?- - ❑ ■❑ ❑ G N Pump tank setbacks consistent with septic tank? - - El N/A ® YES ❑ NO I w I Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z a 24" access riser(s) and accessible from surface?- - CI © ❑ aAlarm or Control Panel Installed? - - CI © ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ 0 ❑ 0 a Pump installed in ❑ Bucket or 0 On Block or ❑ Other d Pump Make/Model Liberty 290 ■❑ Floats or ❑ Transducer d Tank draw down 3 in/min Pump capacity 66 gpm Squirt Height 4 ft Pump on time 1.35 min Pump off time 6 hours Daily flow set at 360 gpd JrcaYc 52 2.:','%i i Mason County OSS Installation Report pg.2 Parcel I230 -51 otso2t Were existing septic components abandoned as part of this project? - - YES VI NO . if yes, please describe: Were all components pumped out and properly abandoned per W:AC24S-272A-0300? - - YES NO This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development TypIcal Record Drawings contain: D a field&manifold orientation&layout Septic/pump tank location,Noll,arrow,reserve dro need,existing and proposed holdings,location of wells,waterlines, wells,ohservadon ports,deanouts,and other maintenance access points. Incomplete Record Drawings may cease additional delays in final installation approval and reeed,^.errni6. r Record Drawing Attached INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system,in accordance with 1 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 1 further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 9ws4..S4,414/— [Cr)/17 � Signature of Installer i Date i ' Printed Name of Signee J f 'ca. p1 •,,' -1 r) MASON COUNTY PUBLIC HEALTH ��,'• A-.• v r' $? !Jr.t t The undersigned approves l� �' .:• .�'It g this Installation and -e . r, Record Drawing on behalf of Mason Cou PROvkb Q PAULA JOY JOHNSON:-Y`t, Lit^E��ramr���i�'a��sab Hea a�l - 3;iiIZ/ If/2073 DEc 1 • t2-c -z3 ff-' nature of Environmental Health Sped NC gate '/ 2023 (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAlLA i i O 1C VIEW ON THE MASON COUNTY WEB SITE ucdeed amncis DMA AZ lit ACTH . _ __ Niz )01.t>1 ' CAL : i'- 20 o o to 2a 30 '� wA�r � - �o_sUIL-T , ?6\Bo2Y INC, (, ,6\ 12330-5Lt - 000 L. port li Marra qe J O1 NE 1GLLy 2obfg Pro foSfd I 35R o0 S DtCt. i CP In 1 • — — — APPROVED. - i DEC 1 1 2023 0 — _ MASON COUNTY ENVIRONMENTAL HEALTH V/ l 5% ; DJA SLOPE. 0 ( 3-) 3'x5O' p 1MPc\QNI D'PAIN FIEl) 'CYL. NC4 co cc J C. w tT (.Z S Audio-Visual Alarm j' 11 Q Cle2noUt ,. 3 1200 Gallon Septic Tank „,,,,,,° Z�ro O2-Compart-*Went with =� '�� ' ^. Effluent Filter ^ .c-P FAULA 5JO 3J4O3 1d r�LiC flS' ti15i..615h- 'iO 1000 Gallon t p 1.ChaTber 0 Valve Control Box Z-t-2,3