HomeMy WebLinkAboutSWG2023-00144 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00144 Parcel# 12207-75-00410 8-,�—
Applicant Name Jacob Kennedy Subdivision (Name/Div/Block/Lot) r � 1�74
Applicant Address 200 E Rasor Ln Rf11 �f!
City, State, Zip Beltair,WA 98528 Installer Name South Shore Construction
Site Address same Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Full System Installation ❑Tani Only ❑ Grainfield Only ❑ Repair ❑Other
System Type Gravity Bed Pretreatment Type
>5 ft,from foundation? --- --- ❑NIA ® Yes ❑ No
150 ft.from wells? ---- - - - - ❑ ® ❑
Z >50ft,from surface wate ? - - -- - - - - - - - - - - - - - - - - �--- ❑ El
H Cleanout between building and tank? - - - - - - - -- - -- - - --- ❑ ❑� ElC.) Tank baffles present? -- - --- - -- - - -M1A _9_9_2i 4 ❑ ® Elf- 24"access risers over each compartment?- - -- -------L ❑ El
wEffluent fitter installed?- - -- - - - - - -- - - - - - - -- - -- - I ❑ ® ❑
fA -
Septic tank capacity(working) 1,250 gal Manufacturer Hagerman
o D-box water level and speed levelers used? ---- - - - ---- - --- ❑ NIA ® Yes ❑ No
DO Manifold/D-box accessible from surface?- - - - - -- ---- --- - - -
❑ ❑
mZ Check valves installed? - - - --- - -- - - - - - - - - ---- -- - - -
❑ ❑
O¢
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑CommerciauOther
>10ft.from foundation?- - - - - - - -- - - - - - - - - ------ - - - ❑ NIA DYES ❑ NO
>100 ft. from wells? ❑ ® ❑
w >100 ft.from surface water? ❑ ® ❑
EL >10 ft.from potable water lines? ---- ---- - - - ❑ ® ❑
Q
>5ft. from property lines and easements?--- ------ ----- - - ❑ x ❑
X >30 ft.from tlowngratlient curtain/foundation drains?-- - -- - - - - - ❑ IN ❑
Drainfield level and observation ports present - - --- ❑ ® ❑
❑ Graveless chambers or M Clean gravel used? (check one)
Proper cover installed over drainfield?-- -- -- ------ - ---- - - ❑ ® ❑
tank setbacks consistent with septic tank? ❑ NtA ❑ Yes No
Y Pump tank ca flood) at Manufacturer
Q24-access risers)and a Is from surface? - ❑ ❑
~ Alarm or Control Panel Installed? - - - ❑ ❑
p- - - - - - --- - - - ---
M Control Panel equipped with Timer/ETM/Coun -- -- - - -- ❑ ❑ ❑
a Pump installed in ❑ Bucket or ock or ❑
a Pump Make/Model ❑ Rod r ❑ Transducer
a
Tank draw in/min Pump capacity gpm Squirt Height ft
mp on time Pump off time Daily flow set at
�wsee arzrrzoia
Mason County OSS Installation Report pg. 2
Parcel# l220 l--7S - O04('0
ABANDONMENTRECORD
NO
WeR exstrg septic mmponents.abandoned as part of this Pml .___.__-____ _. YE8
If Yam.please describe:
Were all componerns Pumped Oct and PrOPerty abandoned per1NAC24e-272A-03002 -----"' ❑ YES *0 ,
RECORD DRAWING
Tw x a r M .mm w min e..swu.ne a smva..«w.pn m r.+wu m uw ne.e er winww.+.crr+�xn.m nwn a..."r Tn➢ ^emi°
o,xn,a®v..u.n..a��.m®vim �a.mavw•.mv>��.eaimw.e.w:�swinrm�:n�s'°"�°�o°'"'�`
Record DmvIng AnedW
-': '4•. =:r;`a RTIFICATION.OF INSTALLATION , . . -
INSTALLER DESIGNER(ENGINEER
1 certfy that I installed the system in accordance with I car*that the system has been installed in a=
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 deate&approved by both the designer shown here have been dearv&&ipproved by both
and Mason Ccunly Public Health and meet all State myself and Mason County Public Healh and meet all
and Mason County Codes. State and Mason County Codes
f furthercefdfy that all information contained on this 1 further certify that all information contained on this
Xfoa edR cawingisa carats. form and attached Record Drawing is accurate.
g^arure of Installer Date
Pitnted Name of Signs
MASON COUNTY PUBLIC HEALTH f
The undemigr d approves tha lnslallanon Report arrd
Record Drawing on oehaff of Mason County Public .:� J
PAULA JOY JOHNSON'•.
Health: L i Neil",
� r5I2A 3G1-
Signature of En,,,,nantal Hdalth SPMWist Date (stamp,signature and tlate)
iHISFORM Wy aE SCANNED ANDAVARABLE FOR PUBIJc VI ON 7HS MASON CMNtt WES SRE
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APPROVED
APR 03 2021
MASON COUNTY EN�RONM /
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>�••••''V�' n 1,200 Gallon Septic Tank
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� 2-Compartment with Effiuent FIl:
51a041 D-B°x with speed-levelers
PAULA JOY JOHNSO
"C and cover to surface
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