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HomeMy WebLinkAboutSWG2024-00034 - SWG As-Built - 3/26/2024 DocuSign Envelope ID:075A25D5-B951-479E-9581-6E51AC394AAB te Mason CountyOSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH P APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2024-00034 Parcel # 42216-51-00147 Applicant Name KIMLER. WILLIAM E Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 1748 LAKE CUSHMAN #10 TR 147 City, State, Zip HOODSPORT WA 98548 Installer Name LOGAN SPEAR Site Address XXX N Kokanee Ridge Dr Designer Name MICAH HALVERSON INSTALLATION CHECKLIST X❑ Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair [' Other System Type GRAVITY-BED Pretreatment Type >5 ft. from foundation? - - ❑ N/A X❑ YES ❑ NO >50 ft. from wells? - -i- ' - ❑ ❑ ❑ Z >50 ft. from surface water? - - ❑ 00 HCleanout between building and tank? - - - - ,i-- -air - - "4.- - - - - ❑ 0 ❑ U Tank baffles present? - &____:_-____—_—:---\ - . ❑ 0 Eld24"access risers over each compartment?- CI ® ❑ W Effluent filter installed?- By- - ❑ ❑ ❑ cn Septic tank size 1 OBD gal Manufacturer ROTH 5 D-box water level and speed levelers used? - - ❑ N/A x❑ YES ❑ NO p0 Manifold/D-box accessible from surface?- - ❑ 0 ❑ OOZ Check valves installed? - - ® ❑ ❑ oQ • E Transport Line Size 4 S Class 3034 Bedrooms installed (check one) ❑ 2 ❑6 ❑Commercial/Other >10 ft. from foundation? - �'- - - - ❑ N/A 0YES ❑ NO C1 >100 ft. from wells? - izli -4 N' - ❑ ❑ ❑ —> >100 ft. from surface water? - - So- -o - ❑ ❑ ❑ W u. >10 ft. from potable water lines?- - - - - -. - - ❑ 0 ❑ 1. z > 5 ft. from property lines and eas-.,,--nt�?- --z '-- - ❑ x❑ ❑ a ❑ ® ❑ � > 30 ft. from downgradient curtain/ft;���,;_:• d��ls? - - Drainfield level and observation ports • ,ere - ❑ ® ❑ ❑ Graveless chambers or ® Clean gr iel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ Pump tank setbacks consistant with septic tank? - - 0 N/A ❑ YES ❑ NO Pump tank size gal Manufacturer < 24" access riser(s) and accessible fro surface?- - - - -_-- - ❑ ❑ ❑ F- a. Alarm or Control Panel Installed? - - ❑ III 2 Control Panel equipped with Timer/ ETM /Cpan - ❑ ❑ ❑ Cl- Pump installed in ❑ Bucket o!,›Et On Block or _ E Pump Make/Model / LI Floats or ❑ Transducer 0. a Tank draw down ✓' in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 DocuSign Envelope ID: 075A25D5-B951-479E-9581-6E51AC394AAB Mason County OSS Installation Report pg. 2 Parcel# 42216-51-00147 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - © YES El NO If yes, please describe:Dug out and disposed of. Were all components pumped out and properly abandoned per WAC246-272A-0300? - - © 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 future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank 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 approval and related permits. APPROV '''' MAR 2 b il;:i4 MASON COUNTY ENV'R:—I..i- ;r ^tr :r. r>y 11 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 forzogs4Atttoched Record Drawing is accurate. form and attached Record Drawing is accurate. Y-0-941A. 4112,riti-L 3/5/24 —�t1-1J,VZI-VD ouar iFi Date I Signature of Installer -t,l• I . 1.4, ti i, ill I npan Spear "A II Printed Name of Signee 4/if 4 1 0 4 S,, t1 MASON COUNTY PUBLIC HEALTH ,'4' a`' S It The undersigned approves this Installation Report and 1 144,w 51 / %Record Drawing on behalf of Mason County Public /?wcTl 00409 w.: vERso>y i LICENSED DESIGNER 1 Health: 01 LI �_ / EXPIRES:CWI& As Signature . Ell. mental Health Specialist Date (stamp, signature and date) g � � ( p 9 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/2 1120 1 8 �0g�o^�o� 0 m /� • N 3_ p 0 N O (D d(D p rn 7 • 3�U N 2-3 , , (D d 3,2 (b N ca m ? x 0 P, N N d N 3 5- �• 'O 3.6 a U.13 d N 3 rn �.y. (D •d .7 co Lb 0. X D) (f1 p oa. 3 O N.3 3 _. 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Parcel#42216-51-00147 SHEET NUMSE PO Box 1519 Shelton Wa 98584 M KIMLER, WILLIAM E Mailing: PO BOX 1748 LAKE CUSHMAN #10 TR 147 11 HalversondesignlIcgoutlook.corn HOODSPORT WA 98548 REVISION 4.