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HomeMy WebLinkAboutSWG2020-00243 - SWG As-Built - 12/19/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00243 Parcel # 22224-75-90060 Applicant Name Broussard Home Services Subdivision (Name/Div/Block/Lot) Applicant Address 2912 304th E TR6 OF SURV 10/100 EX LOT:1 OF SP#1425 S 41/143 City, State, Zip Graham, WA 98338 Installer Name All Things Septic • 4 Site Address 41 E Coon Dr N, Belfair Designer Name Arrow Septic Designs INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? - r___ _ ❑ NIA El YES ❑ NO >50 ft. from wells? - Z >50 ft. from surface water? - 0-.t - El • ❑ F• Cleanout between building and tank? - 4EC 4-2-EO.3- -- ❑ X ❑ U Tank baffles present? - - ❑ It ❑ a � 24" access risers over each compartment?- 1 - ❑ 0 El LU Effluent filter installed?- `_ _ ❑ ❑ ❑ N Septic tank capacity(working) 1,250 • gal Manufacturer Norwesco 0 D-box water level and speed levelers used? - - ❑■ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - El © ❑ u. m— Check valves installed? - ❑ ® ❑ CIQ E Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 0 4 ❑ 5 0 6 ❑Commercial/Other • >10 ft. from foundation?- - 0 N/A ElYES ❑ NO ❑ >100 ft. from wells?- - ❑ El ❑ W >100 ft. from surface water? - - ❑ El ❑ ti >10 ft. from potable water lines?- - ❑ ❑ Z Q > 5 ft. from property lines and easements?- - 0 0 ❑ cc > 30 ft. from downgradient curtain/foundation drains?- - MI ❑ 0 Drainfield level and observation ports present - - ❑ ® ❑ ■ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ LI ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A gg YES ❑ NO Y Pump tank capacity(flood) 1,250 gal Manufacturer Norwesco Z < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ d Alarm or Control Panel Installed? - - ❑ IN ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ d Pump installed in ❑ Bucket or IF On Block or ❑ Other d PumpMake/Model Liberty290 � 0 Floats or ❑ Transducer Tank draw down 1.5 in/min Pumpcapacity acit P y 45 gpm Squirt Height 5.5 ft Pump on time 2.5 minutes Pump off time 6 hours Daily flow set at 480 gpd .:Panted 6.2:23t8 Mason County OSS Installation Report pg. 2 Parcel 222 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Ei YES 4,NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. 'ypical Record Drawings contain. Drain=teld&manifold orientation&layout,Septic:pump:ark location,North arrow,reserve drainfteld e>risting and proposed buildrgs.location of wells,waterlines, wells.observation ports,deanouts.and other maintenance access points. incomplete Record Drawings may create additional delays in final installation approval and related permits. Ix Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I 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 I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Recor Drawing is accurate. �Q/2lZG�L a-t ed't -' 12/4/2023 Signature of Installer Date N7. �� Bernie Strawn o �,tiA Printed Name of Signee 191 MASON COUNTY PUBLIC HEALTH stc.see 4,1'i PAULA JOY JOHNSON . • The undersigned approves this Installation Report and C X bIGN0fi' .b Record Drawing on behalf of Mason County Public �, ���% Health: Signature of Envir ealth Specialist Date si nature and date) (stamp. g THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 1f201a l = LIv S Sox 5 0 �r r 2" - . ?C*.A.PCV a.).D-29- "IS- TO(00 4 ,. : —. Ns � � Se-Qi-A5 - q?5Zg i EP n(hcS 1z-z.i, 0.t- 1' 0C WikkA recfOe5 ih }mat it 4tv` ` 561 u--- `� _---- kin L.� `� �'y•• � 2 - i, E.^ it -- a , h4 a Y gQ- O ON R, g •-LiCri�tSEt)).e 1014 Ft ,4 3ro' 52 ' I fi 3 4.S I 1 i 1 2-72�?) J - / R 0 Audio-Visual Alarm I .m.......- _ (3 Cleanout sc ci 12S 0 Gallon Septic Tank �,44/itto i,.: f 2-Compartment with c Effiuent Filter 04 12.50 Gallon Pump Chamber OValve Control Box . s CGOh Dr JV (fp' rca d ea S►'h,,vt t APPROVED 20.0c� DEC 19 2023 N../ MASON COUNTY ENVIRONMENTAL HEALTH, ��� � RAT Lam - �.-,..