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HomeMy WebLinkAboutSWG2021-00451 - SWG Application / Design - 12/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00451 Parcel # 42216-52-00107 Applicant Name Trever Garrett Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 4808 Lake Cushman Div:12 Lot:107 City, State, Zip Bremerton,WA 98312 Installer Name Oien Construction Site Address 90 N Kingsway N, Hoodsport Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A U] YES ❑ NO >50 ft. from wells? - - 0 ❑ ❑ Z >50 ft. from surface water? - -- ❑■ El ❑ HCleanout between building and tank? ---- -t-% - - - - ❑ CI ❑ U Tank baffles resent? - .74 „ , - ❑ 0 ❑ N 24` access risers over each compartment?-'-- eir-V-l - ❑ 0 ❑ W Effluent filter installed?- Hagerman cn , Septic tank capacity (working) 1_00U gal \ nufacturer Ha 9 0 D-box water level and speed levelers used? ��. - 0 N/A ❑ YES ❑ NO J O Manifold/D-box accessible from surface?- - ❑ U co Check valves installed? - - ❑ 0 ❑ thQ 2" Schedule/Class 40 E Transport Line Size Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 0 6 ['Commercial/Other >10 ft. from foundation? - - ❑ N/A © YES ❑ NO o >100 ft. from wells?- - 0 ❑ ❑ W >100 ft. from surface water? - - 00 ❑ u. >10 ft. from potable water lines?- - ❑ ❑ ❑ > 5 ft. from property lines and easements?- - ❑ 0 ❑ a Ce > 30 ft. from downgradient curtain/foundation drains?- - IN ❑ ❑ 0 Drainfield level and observation ports present ❑ IN ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24- access riser(s) and accessible from surface?- - ❑ I. ❑ H a Alarm or Control Panel Installed? - - ❑ I ❑2 Control Panel equipped with Timer/ETM /Counter- - El 0 ❑ D CI- Pump installed in ❑ Bucket or 0 On Block or ❑ Other 2 Pump Make/Model Liberty 253 0 Floats or ❑ Transducer a a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 8 ft Pump on time 1.5 min Pump off time 6 Hours Daily flow set at 228 gpd Upca:ed E,2 /20t8 Mason County OSS Installation Report pg. 2 Parcel# 1- 12Z1b ..�'L - 0 10 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ❑ YES ® NO If yes, please describe: ❑ No Were all components pumped out and properly abandoned per WAG246-272A-0300? - ❑ YES RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to reaocate in the need of maintenance activities and future development. Typical Record Drawings contain. Drairfield&manifold orientation&layout,Septic.Jpump tank location,North arrow,reserve dratnheld,existing and proposed ouildings,locator of wells.waterlines, wets,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final insailaticn approval snd related permits. 0 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 eccor- 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 fo andattached Record Drawing is accurate. form and attached Record Drawing is accurate. ' �, /Z�t�Zvzr� '. Signature of Installer Date 4 .':.ts,;4% 51itat 01 e✓t of reeNv.1O ; Printed Name of Signee g•CTr ir..may*r� -f i r ,�, .A. MASON COUNTY PUBLIC HEALTH F s ✓`. S.OG34� :c � The undersigned approves this Installation Report and Y� PAULA J.0Y J.O.HNSON••. Record Drawing on behalf of Mason County Public �•uit iSc�Y�SIGNEEt c Health: owit� bilit �Yl (Z/V1z3 [ 1-Li -V3 Signature of Environment l Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated`..2 halls Irever (7trre-ft- , 4r , , D. ?a rcel l 1b-s2-66/6? ( 3) 3 n ifs Pf) ,Ma !y Rio N K;n9swa N. +if r c lu S C 5� G-C Srifie: ),, - ZGi ( 3x33.5R \re en ( s L /0 z Q 30 ya APPROVED \ DEC 2 0 2023 �\ MASON COUNTY ENVIRONMEtiTAI HEALTH \ RET 1, • p. 0 i% \ Cti CX \ 045c\fr'0,ze, Ig Q \ ,, 2_____,,.....„,,, 2 .)C)\— Ir' c.: Q ' t2o. .Z A /Cm Audio Visual Alarm 0 ‘DoSt =:..41., ,; O Cleanout li ` .;s/%• O3 1000 Gallon Septic Tank rl y,,��, �ri i • r • �<;. 2-Compartment with y*?.. Sic349 f �"rim64stlirc.51.40t44fc.. �' PAULA JGY JN ��(� Effluent Filter {�s ��� � O 1000 Gallon Pump Chamber 1 2�i Z 3 3 Valve Control Box