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HomeMy WebLinkAboutSWG2023-00088 - SWG As-Built - 12/18/2023 AFC � 7 20 MASON COUNTY PUBLI 23 Mason County OSS Installation Report pg. 1 114 APPLICANT! PERMIT INFORMATION Permit Number SWG 2023-00088 Parcel# 22336-54-00065 Applicant Name RJ Peabody Subdivision (Name/Div/Blockll-ot) Applicant Address P.O. Box 565 LYNCH COVE#4 TR 65 City. State, Zip Burley,WA 98322 Installer Name Final Vision Site Address 50 NE Katherine Ct, Belfair Designer Name Arrow Septic Designs INSTALLATION CHECKLIST 0 Full System Installation 0 Tank(s)Only 0 Drainfeld Only ❑ Repair ❑ Other System Type Gravity Trench Pretreatment Type >5 ft.from foundation? - - ❑ NIA 0 YES ❑ NO >50 ft. from wells? NI 0 ❑ Y >50 ft. from surface water? 0 ❑ ❑ z ■ 0 < Cleanout between building and tank? - ❑ o Tank baffles present? - 0 0 0 F- 24" access risers over each compartment?- - ❑ • ❑ a 0 0 0 W Effluent filter installed?- u) Hagerman Septic tank capacity (working) 1,200 gal Manufacturer g 0 D-box water level and speed levelers used? - - ❑ N/A ® YES 0 NO 0 �O Manifold/D-box accessible from surface?- _ 0 0 0 �` "'J OD 2- Check valves installed? l�vI ❑Q 4 inch Schedule/Class • 3034 • Transport Line Size tr ,( ■ 456 Commercial/Other Vi,Pt1214d3-v 'fl o ttd4 Bedrooms installed (check one) ❑ 2 ❑ 3 0 0 0 ❑ i vz- c 4 >10 ft, from foundation?- - ❑ N/A 0 YES �0 >100 ft. from wells? 0 0 0 -la 00 fit. from surface water? - - 0 ❑ 0 w >1 LL 0 1 � ■ >10 ft. from potable water lines?- - ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ x > 30 ft.from downgradient curtain/foundation drains?- - 10 ❑ 0 ❑ It ❑ Drainfield level and observation ports present ❑ 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © ❑ tank setbacks consistent with septic tank?- - 0 NIA ❑ YES NO • Pump tank c (flood) gal Manufacturer Z ❑ Q 24" access riser(s) and a ible from surface? ❑ ❑ r-Q. Alarm or Control Panel Installed? E 1.7 • Control Panel equipped with Timer/ ETM /Coun a Pump installed in ❑ Bucket or ock or a• Pump Make/Model ❑ Floa or ❑ Transducer Tank draw in/min Pump capacity 9Pm Squirt Height ht ft G. Pump off time Daily flow set at d mp on time Used 8/21;2018 2233- 52k_ CLOGS. Mason County OSS Installation Report pg. 2 Parcel# 3NMENTR 0 . :, _...:;.. . . 0 YES � NO Were existing septic components abandoned as part of this project? If yes, please describe: ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - ❑ YES 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: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location,of wells,waterlines, wells.observation ports,clear.outs,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related oermi s. - hi(Record Drawing Attached CORTIEIC ITION 1141STAJAATION INSTALLER DESIGNER/ENGINEER I certify that I installed the systemiln 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 cieared/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 form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. P"*.s/t, AAffr1,1/--- 1 DI 1/7 2-3 ,A.,1?.. Signature of Installer ` Date ,4, 7.�,P\ cJ 4dPvt ,Sl/ 'CtLt V f a, 6, .mil. Printed Name of Signee j '2 tip' `i` MASON COUNTY PUBLIC HEALTH f • ^' J ,, '� The undersigned approves this Installation Report and ,C•' 't"sly ?i. '•�' PF ULA JOY JOHNSON '•. Record Drawing on behalf of Mason County Public 4' " '' i � •IIC�ftS�ti'1?1=SIGNEi�" S cc�Y' iii Health: EXPIRES .19-iti\C°6\1C-31/1 1 ,f( fZ 3 LC' — L,—LS Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018 v Flo+ Ptah . RJ P(abocly INC Pcirctt 2233(2-54-oo0(95 NI 50 NE lcq-finer; vt•e CI' i i o• i , J t -1-;Y c.v.,cA t eS @ S' 0 .C 0 io 2o 30 40 �o. k i -tom R•e52v,1•e. `D210 u3 Neu 1 Cleanout & mk, ., O O 1,200 Gallon Septic Tank 0 2-Compartment with Effluent Filter ko 0�• e-- QD-Box with speed-levelers /,` ,)1vand cover to surface , �" ' / 0 die Zo2 1 , CP ‘ b:30,3))6 St. igL 1�(� loam. \ �$ „Lei. `2\0 1' g$ \. itt APPROVED f/ or%'.4 � °� - •�� r.40 Y�'�PAULA6JOY3J�OHN50N '�0 MASON COUNTYDEC ENy118RONMENTAL2023 �� t=a � , HEALTH �, RET to-04 -23