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Home My WebLink AboutSWG2022-00459 - SWG As-Built - 4/9/2024 Mason County OSS Installation Report pg. 7 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWGo7-02Z-004SJ Parcel# "557-2, OZ-7 ODSOp Applicant Name Skyler Bosley Subdivision (Name/Div/Block/Lot) Applicant Address 2205 Crystal Springs Rd.W. City, State, Zip University Place, We 98466 Installer Name Owner Site Address 8159 NE Belfair Tahuva Rd Designer Name Bob Payees INSTALLATION CHECKLIST ■ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type standard pressure Pretreatment Type >5ft.from foundation? -- -- -- ----- -- -------------.- ❑ WA ■yEs NO >50ft.from wells? - _ _____ ______ _ _ __ ___ _ _ _ ___ __ . ❑ S ❑ 'd >50ft.from surface water? -__ _____ __ __ __ __ __ __ __ _. ❑ ❑ FCleanout between building and tank? ------------------ - ❑ ❑ V Tank baffles present? --- -- -- -- --- -- -- - - -- -- --- -- ❑ a24"access risers over each compartment?---------------- ❑ ❑ yW Effluent filter installed?--- -- - - --------------- --- - - ❑ ❑ Septic tank capacity(working) 1500 gal Manufacturer Haggenman C4 D-box water level and speed levelers used? - --- ---------- - NwA ❑YES El NO OLLManifold/D-box accessible from surface?------ - --------- - ❑ e ❑ 04 Check valves installed? - --- ---------------------.- ❑ ■ ❑ Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 54 ❑5 ❑6 ❑CommemiaYOther >10ft.from foundation?----- ------ - - - - -- E] WA NWe NO >100 ft.from wells?------- -- - - - ------- ---------- 0 ❑ W >100 ft.from surface water? -- ___ _ _ _ _ _____ __ _______- ❑ ❑ u. >10ft.from potable water lines?------- --- --------- - -- ❑ E ❑ Z >5ft.from property lines and easements?--------------- - ❑ E ❑ >30 ft.from downgradient curtain/foundation drains?-- --- -- --- e ❑ ❑ Dreinfield level and observation ports present --- - -- - - - -- - -- E] Graveless chambers or E Clean gravel used? (check one) Proper cover installed over drainfield?--------- ---- ----- - ❑ ❑ Pump tank setbacks consistent with septic tank?------------ - ❑ Nu 0 YES ❑ NO Y Pump tank capacity(flood) 1500 gal Manufacturer Haggerman Q24"access deans)and accessible from surface?------------ - ❑ ❑ IC Alarm or Control Panel Installed? - - ------------------ - ❑ 0 ❑ Control Panel equipped with Timer/ETM/Counter- -- -- -- ---- ❑ ® ❑ 4 Pump installed in a Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty 290 ® Floats or ❑Transducer f aTank draw down 2 in/min Pump capacity 60 gpm Squirt Haight 60" ft Pump on time i min. Pump off time 4 hm. Daily flow set at 360 gpd upa.sanveov Mason County OSS Installation Report pg. 2 Parcel 3 , ABANDONMENTRECORD Were existing septic components abandoned as part of this project? - -- ------ --- -- - YES NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? ------- - ❑ YES NO RECORD DRAWING mle Ie a pemlanam record and muva ba...and aeecrtpiw aneuah In we-ad W mnmananu ecdM..and NWn ft.ia nerd. TMcal Ramm Dm ,.contain: DmNMk 6 menlbq orlentatim 61ayoN,aepYtlpump rank bmrlan,NaM error,neerve EnIMIaM,eabfinp eM prcpree0 Wiplrea bcalbn W xelly,wemrpnes, wellso WNMOnportsc muLLandomermalntwn acmes WI . Ircwnpkta Record Drawings may ueateaddional delays in AralInahllabonapproval and muted permits. 2<`Oord 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 dearedtapproved by both the designer shown here have been c/earad/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 attach d Record Drawfog is accurate. form and attached Record Drawing is accurate. ' !- 1� Z Signature stellar (( /�� Date \ SK.�I-P.V �aSlel. `^kU1'd`CBrU4^Q� 1 ,�4'. Printed Neme of Signee �^ a MASON COUNTY PUBLIC HEALTH V The undersigned approves this Installation Report and r Record Drawing on behalfof Mason County Public ER Health: EXPIRES Signature ofErivironmenfaiLlaafth Spedarist Data (stamp, signature and date) THIS FORM MAYBE SCANNEDAND AVAILABLE FOR PUBLICVIEWONTHE MASON COUNTYWESSnE epdaadvetrtate I I I I � I I I I i DRAINFIELD I 4 @ 50' LATERAL5 W/ RESERVE BETWEEN j \ 9'* O/C W/ 50' I \\ ATTN. ZONE j APPROX. \ \\ � I I ATTN. ZONE �\� `\ \ •\ I (50WWNSIDPE) N F4t'' i r ccreeR'+"n"wnw ± �— 90 LXUIn-�'S' (TO PROP.11ND 2"5CH. 40 TRANSPORT LINE RT C/o � \ 111111�� NEW HOME AP VED 5EPTICTANK& APR 09 2024 PUMPTANK MASON COUNTY ENVIRONMENTAL HEALTH REr AN ASBUILTI INSTALL SIGNOFF FEE WILL BE CHARGED AT TINE OF INSTALLATION PIONEER. DIGGING, NC. P'Ap +FR: a276-0'a TEST HOLE I: TEST S Ez M5TES HOLE3 PARCEL x 37202-7600500 31.111 078❑ . 0 1111, 31t 111 �TW. 1Sf'IIlI. SEPTIC DESIGNS ADDRESS: SIMBELFARTAENTARD ROJIJ-31 R�vrsx It\(.-3s 3083 E MAkJN BETy'JN RD. GRAPWIEW,WA%S* DESIGNER: ROBFRT H PAYSSE OFFICE-WM2b11tl)3 FAX-3N4272353 SHEEP. ASBIID.T SCALE 1'=20 e�mwr�K. m ua nue:isu[ ov o..Fu