HomeMy WebLinkAboutSWG2023-00242 - SWG As-Built - 2/7/2024 •
CLEAR FORM
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLIANT/ PERMIT INFORMATION
Permit Number SWG 2023-00242I Parcel # 321343100050 4
Applicant Name Robert Flat Subdivision (Name/Div/Block/Lot) F FB
Applicant Address 113E Terrace Dr RF�� 6 20?�
City, State, Zip Belfair, WA 98528 Installer Name RIct1 Moore i`F0
Site Address 1161 E. Mason Lake Rd Designer Name Jim umn y
INSTALLATION CHECKLIST
ID Full System Installation 0 Tank(s)Oily ❑ Drainfield Only ❑Repair ❑Other
System Type Pressure Disribution Pretreatment Type
>5 ft. from foundation? - - - 0 N/A ®YES 0 NO
>50 ft. from wells? - L - ❑ ® ❑
Z >50 ft. from surface water? 4. 0 ill
Q Cleanout between building and tank? - - 0 ® 0
I—
U Tank baffles present? - + - 0 M 0
1-:: 24" access risers over each compartment?- 0 IN
W Effluent filter installed?- - 0 ® ❑
co
Septic tank capacity (working) 1?00 gal Manufacturer Hagerman
CI D-box water level and speed levelers used? - - ® NIA ElYES ElNO
�O Manifold/D-box accessible from surfac4?- - ❑ ❑
m z Check valves installed? - - - LI ® 0
OQ
2 Transport Line Size 2" Schedule/Class Sch 40
Bedrooms installed (check one) ❑2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ NIA ®YES ❑ NO
CI >100 ft. from wells?- - 0 ® ❑
WMN El>100 ft. from surface water? - - 0
u. >10 ft. from potable water lines?- - ❑ ® 0
Z > 5 ft. from property lines and easements?- - 0 ® ❑
LC > 30 tt. trom downgradient curtain/tour ation drains? - - ❑ IN ❑
• Drainfield level and observation ports Pi-esent - - 0 IN ❑
II Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 II ❑
Pump tank setbacks consistent with se ►tic tank?- - 0 N/A ® YES 0 NO
Y Pump tank capacity (flood) 1000 gal Manufacturer Hagerman
Q24" access riser(s) and accessible from surface?- ❑ ® 0
~ Alarm or Control Panel Installed? - - ❑ I 0
a
• Control Panel equipped with Timer/ETVt/Counter- - ❑ II ❑
n
O. Pump installed in 0 Bucket or e On Block or ❑ Other
O..
• Pump Make/Model Liberty 1280 I Floats or 0 Transducer
a Tank draw down 2 in/min ; Pump capacity a0 gpm Squirt Height t0 ft
Pump on time 1 min 45 Sec Pump off time 6 Firs Daily flow set at 270 gpd
Updated Hie 12C1 0
•
Mason County OSS Installation Report pg. 2 Parcel# �cic.� 1 OO ��
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES a NO
If yes,please describe -
Were all components pumped out and property abandoned per WAC246-272A-0300? - - 0 YES ❑ NO
lRECORD DRAWING
This n a permanent record and mutt be accurata and Aeitcnptrve enough to r.locate in the need of malnlenanee acI fief and rututa development. Typrtat Recred
Draw•nds cadan Ora.Nreld a.nanSd:d ont,lasen&4ryool Sept.ey.np task tocs+,on NOM a rw..reser.e o•s,MId esn•..g and proeosad w.uvgs.atr.dn of wrjs .Baer,s
WC S.aos<.vat on ports.clean.::° a'O(N:1C.meaO anCe atCtss pouts .cor'-p+=te I+COara tna.vngs may V ca:e aa.7a, -Lal allays.n rna.ostadae on appwal ar:d re+s::d ye,r 4:
3-Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER!ENGINEER
1 certify that I installed the system in acgordence with 1 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
J further certify that all inl ation contained on this I further certify that aft information contained on this
fo n alta ed Re fug is accurate. form and attached Record Drawing is accurate.
/? i'7y
Signature of Installer /7 Date
1 C� r
Printed Name of Signee !f
MASON COUNTY PUBLIC HEALTH /��!� r�
The undersigned approves this Installation Report and ? / f
Record Drawing on behalf of Mason County Public 'moor
hCr'."►UIFSI iER
y 000 sU/ I/
4 Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY GE SCM NEDANO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE "`3s"Q azvvte
Scannrad with CamScanner
•
N p
0 0 ,
N
II
152' v
a) v i
C I188'05 r N Rs v j
a, 0 a .
E
a,
In
O , ar
a,
• `C I
C
`_ I s?
IS'fL
reserve 211 Ryo, :1
i 56
i
SOreserve
reserve 50 v
,
ro
I reserve _^3
C /� �-------- �\
4.0
a)
Q a JaMod Ib91 / f : �� ��
d / •i o \ ca � o
J / % • C \C\U C O
C / / ++ •' \J O 0
tr�Ji1 v+ O
ON / / ,•.7 '.. sr. C rtfr,
I / b 4 v 0�c 2 m
1 1! rn. ' . — -Jrm
It
I; oQrH EN ♦ Q L 15 ♦♦ , C.
% i''!i8
••% \ / c a
oc
\\ O // /9 x �'
\ \\ C�/ O C., ,V.:
/ ) v
p]
goy i.L4t
'SFr �Fyl ��
. + '9
q�y4l 1y4 ,,
v
0