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HomeMy WebLinkAboutSWG2023-00209 - SWG As-Built - 2/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2023-00209 Parcel # 222302390032 Applicant Name Alderbrink LLC Subdivision (Name/Div/Block/Lot) Applicant Address 6721 Cascade Ave City, State, Zip Gig Harbor,WA 98335 Installer Name Josh Peterson Site Address 11511 SR106 Union WA Designer Name Cindy Waite INSTALLATION CHECKLIST E Full System Installation ®Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? - - ❑ N/A © YES ❑ NO >50 ft. from wells? - ❑ ❑ Y >50 ft. from surface water? - - ❑ 0 ❑ H Cleanout between building and tank? - ❑ / ❑ U Tank baffles present? - ❑ } U ❑ ■ ❑ 1:: 24" access risers over each compartment?- - - ❑ 0 ❑ W Effluent filter installed? IZ� -CoYlkYKjr t -,vr - -f-' --a �t rli Septic tank capacity (working) -�Ql0- gal Manufacturer 9�s=,tz'4-( Roth YES NO 0 D-box water level and speed levelers used? - - 0 NIA ❑❑ 0 -.-10 Manifold/D-box accessible from surface?- ❑ ❑ ❑ m Z Check valves installed? - ❑ Ci Q Schedule/Class 2 Transport Line Size S the Bedrooms installed (check one) 0 2 0 3 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- ❑ N/A ❑ YES ❑ NO >100 ft. from wells?- - El El O 0 0 W >100 ft. from surface water? - ❑ El ❑ LL >10 ft. from potable water lines?- El El 0 Z > 5 ft. from property lines and easements?- - ❑ d > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ 0 o Drainfield level and observation ports present - - ❑ 0 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) ❑ ❑ ❑ Proper cover installed over drainfield?- - Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO Pump tank capacity (flood)_______--gal Manufacturer 2 Q 24" access riser(s) and accessible from surface? ❑ 1=1 CI ❑ 0 I~a. Alarm or Control Panel Installed? 0 E Control Panel equipped with Timer/ ETM /Counter- d Pump installed in 0 Bucket or ❑ On Block or ❑ Other a 0 Floats or CITransducer Pump Make/Model ft a. Tank draw down in/min Pump capacity gpm Squirt Height Pump off time Daily flow set at gpd Pump on time Updated8012018 Parcel# 222302390032 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - YES 40 If yes, please describe: !h Lfl 11A-1•le-- �ES ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? 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. Typical Record Drawings contain Drainfield&manifold onentation&layout.Septic/pump lank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells.observation ports,cleanoutS,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation app-oval and related permits. ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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 ail State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify th-t all information contained on this 1 further certify that all information contained on this form and atta• ed Record Drawing is accurate. form and attached Record Drawing is accurate. Si. e of Installer Date i Tinted Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: ccm Signatu 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 m 210018 ellj §E ig 1 4; A' ‘21:!,, i W ; z 1 i'-' CI) °il[XIS .'' Lg NI ci,] ttil .it 0 s � k 1 XY �._ , f \ 4,..,,‘,a . q ;s7; T .n .. •�Tp. ,p lIi� p• • o Y oi q § L , ,�� .fig S v d 44. X le +.0 11 G. .4 ' .';4? i•P ..t., nt + o :1 \\ 411 Z All IV \ x il ..›, iP •-• / it 3 a 1* , e:) 4-- ss,? iq ,- AL ,, y _ x= ‘\ IV/ , istc. . •N , Ist:-P? , ... , 1..4 • ill h; \ pv ,.„ 1-' 1 .. t1 1*o JofA,A+� 4 �� `.i F 1..r .. i ,G+, -r\-I. 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