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HomeMy WebLinkAboutSWG2022-00121 - SWG As-Built - 2/23/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00121 Parcel# 222065400041 Applicant Name Daniel and Sarah Subdivision (Name/Div/Block/Lot) Applicant Address 351 Yates Rd Tahuya River Valley Community City, State, Zip Chehalis, WA 98532 Installer Name Daneil and Sarah Rmasev Site Address 110 NE River Rd Tahuya 98588 Designer Name Jim Zimny-APD Designs INSTALLATION CHECKLIST o Full System Installation ❑Tank(s)Only ❑Drainfield Only 0 Repair 0 Other System Type Gravity Fed Pretreatment Type Effleunt Filters >5 ft.from foundation? - - ❑N/A ]YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft.from surface water? - - 0 IN H Cleanout between building and tank? - - El ® El o Tank baffles present? - 0 III d24"access risers over each compartment?- r E7-13 0 RI 0 W Effluent filter installed?- 0 © 0 co H >- {t Septic tank capacity(working) 1250 a gitL-' MerIul Purer Hagerman Precast C1 D-box water level and speed levelers used? --7...t; —_❑ NIA ©YES ❑ No O Manifold/D-box accessible from surface?- - 0 El ❑ mZ Check valves installed? - - ❑ ® ❑ 6Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) 0 2 0 3 ®4 ❑ 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - ❑ NIA 0 YES 0 NO >100 ft. from wells?- 4 ® ❑ W >100 ft. from surface water? - 1)- 11-Q-1- � , ® 0 LT >10 ft.from potable water lines?---- Ali: ® ❑ ' z >5 ft. from property lines and easeme --MAR--1-2-2.024-- 4tivi ® CId >30 ft.from downgradient curtain/four curtainifour#099 'dtR0lGIolEN1 rREAL I] 0 Drainfield level and observation ports present ----orBvw----- 0 0 0 El Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ IN 0 Pump tank setbacks consistent with septic tank?- - 0 N/A al YES ❑ NO ZPump tank capacity(flood) 1250 gal Manufacturer Hagerman Precast < 24"ar`r. ss riser(s)and accessible from surface?- - ❑ ® 0 a Alarm or Control Panel Installed? - - ❑ ® ❑ 2 Control Panel equipped with Timer/ETM/Counter- - 0 ® ❑ n tl Pump installed in ® Bucket or 0 On Block or 0 Other a'• Pump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 3 in/min Pump capacity 60 gpm Squirt Height na ft Pump on time 1 minutes Pump off time 4hrs Daily flow set at 3600 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 222065400041 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES I.1 NO If yes, please describe:_ Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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 More development. Typical Record Drawings contain: Drainfieki&manifold orientation 8 layout,Septic/pump tank location,North arrow,reserve drainfreld,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 approval and related permits. 4/aPPROVEf� :'4 MAR 12 2024 MASON COUNTY ENVIRONMENTAL HEALTH JBW o 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 Record Drawing is accurate. Zr'vN "1-114(Z,11 Signature of installer Date fn 2CA :114 Printed Name of Signee I; 'Af�� •' �V MASON COUNTY PUBLIC HEALTH 1,:• ;`�,m,'1 The undersigned approves this Installation Report and y •f u�111 0.' zr as cytl Record Drawing on behalf of Mason County Public ? L1i_v^_, 4,1ny�� + Healt ... ,��<� �_�z_ 2- (c(- Zc(:. Signs : e ironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 82t2018 r RECORD DRAWING (continued) — _ I 0 > Power's c w k. Z \ 2 8' a oc 4 9S 58' 4 60' e- Bedr000m 10' reserve Home 5' Q 1250 gallon Septic tank H 60' `r �2 C�? In t rv,r t J 1250 gallon Pump Tank 15 (.Vtitroi Pox I ftpPROVEfl .. , ,,,,, ,.1„ MAR 1 2 2024 ,= �, . y a sN�� MASON COUNTY ENVIRONMENTAL ��e +c 2 J BW HEALTH %2 2 33 �ti�, �O .m�Zim�ry , LICE'S_t DESIGNER , ��� ``- <'-zz ......4t 2-lu- ZH