HomeMy WebLinkAboutSWG2022-00579 - SWG As-Built - 12/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00579 Parcel # 22221-53-00030
Applicant Name Vincent Kurz Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2655 Twanoh Falls Add #1 Lot: 30
City, State, Zip Belfair, WA 98528 Installer Name South Shore Construction
Site Address 71 E Christmans Tree Place Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
• Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO
>50 ft. from wells? - - It ❑ ❑
Z >50 ft. from surface water? - - 0 ❑ ❑
H EX
between building and tank? - - ❑ 0
U Tank baffles present? - - ❑ I ❑
a 24" access risers over each compartment?- - ❑ ❑■ ❑
W Effluent filter installed?- - ❑ X ❑
N
Septic tank capacity (working) 1,250 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - - [1 NIA ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ 00
mZ Check valves installed? - - ❑ ❑■ ❑
oQ
5 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? 1 (� ❑ N/A •J YES ❑ NO
>100ft. fromwells? � - El ❑ ❑
W
>100 ft. from surface water? - - El ❑ ❑
it >10 ft. from potable water lines?- �EC 2 0 2023 ❑ 00
Z > 5 ft. from property lines and easements?
Q - - - - ❑ 0 El
( > 30 ft. from downgradient curtain/foundati h'drair&?- - - --_--_-__.--!--- Q ❑ ❑
ci
Drainfield level and observation ports present - - ❑ • ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ . ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO
• Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
Q 24" access riser(s) and accessible from surface?- - ❑ • ❑
H
a Alarm or Control Panel Installed? - - ❑ 0 ❑
E Control Panel equipped with Timer/ETM /Counter- - ❑ El ❑
D
a• Pump installed in ❑ Bucket or On Block or ❑ Other
a.• Pump Make/Model Liberty 280 ❑■ Floats or ❑ Transducer
a
Tank draw down 1.5 in/min Pump capacity 29 gpm Squirt Height 5 ft
Pump on time 3 min Pump off time 6 Hours Daily flow set at 360 gpd
.;,.dated S2i 2J18
Mason County OSS Installation Report pg. 2 sl- Coo 3
Parcel# - - - - - --------
, . • - ABANDONMENT RECORD
III
Were existing septic components,abandoned as part of this projed? 6 YES 0 NO
If yes, please describe: -Saitx-Ak OG, 'bie•Ovcs-e5.1.-.akok,,,,k2K.4._
Were all components pumped out and property abandoned per WAC246-272A-0300? II YES 0 NO .
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.. , • , . • RECORD DRAWING . , . . : ;•.: . .
diveixneent.
This is a pormazent record arid must be accurate and descriptive enough to re.locate in the need of maintenance activities arid future io Typical Raoul
Ccr"ingt contain: Orainstia&manifold orientation&layout,Septc/purnp tank location.North arrow.reserve dreanfreld.existing and proposed euXings.kication of well watertnes,
wadi,Observation pens,clefekalis,and otter rnairderusnce axe=points. incomplete Record Drarvings may...mercer additonri delays in falai instaltation approvoi and related permits.
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• . • • 0111 Record Drawing Attached
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--7:.,77'::...-1.-:•;:z.f..;:rt.;";.:::.;- .'_----• :.CERTIFICATION OF INSTALLATION .:.. A:'''. .srs4i.• ::-.1 ,c_1-::"T;-11,::.'•:22':'•-•'.- ' •
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in a ccxx-
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
for4i att ed R rawing is a rate. form and attached Record Drawing is accurate. ..
Signature of Installer Date
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#-.. .v..A<4...:)Q;:-A-j't\•
Printed Name of Signee
—: -4" ic. 0 •:?•:)..,,,,
MASON COUNTY PUBUC HEALTH -411 Vir,' f
V iig
The undersigned approves this Installation Report and k"--71 -3 4.9 S.
Record Drawing on behalf of Mason County Public ,J-1,5.. .'.PAULA JOY JOHNSON. V1,
Lt_Ortk$RMIhr,_.cr4 V
Health: •QJyQ
C6I1 12120 h._3
Signature of Environ Health Specialist Date (stamp, signature and date)
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY INES SITE Up Sesd 81211418
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0 Audio-Visual Alarm \ 11131
3 Cleanout
0 1200 Gallon Septic Tank A
2-Compartment withlo
Effluent Filter ;- — , _
O4 1000 Gallon Pump
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__ . APPROVED
DEC 2 0 2023
-*),MASON COUNTY ENVIRONMENTAL HEALTH 30
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a PAULA JOY JOHNSON
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