HomeMy WebLinkAboutSWG2023-0192 - SWG As-Built - 4/12/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00192 Parcel# 12206-75-90030
Applicant Name Josephine Baltan Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 1615
City, State, Zip Belfatr,We 98528 Installer Name Arrow Excavation
Site Address 320 E.Alderwood Dr. Designer Name Bob Paysse
INSTALLATION CHECKLIST
Full System Installation ❑Tank($)Only ❑ Drainfleld Only ❑Repair ❑Other
System Type ATU-Pressure Pretreatment Type NuWater BNR 500
>5 ft.from foundation? --------------------------•• ❑ NIA AYES ❑ No
>50ft.from wells? - -- ------------------------- - ❑ ■ ❑
Z >50ft.from surface water? ------------------------ ❑ ❑
FCleanout between building and tank? ------------------ - ❑ ❑
U Tank baffles present? -- -- ---- ------------------- ❑ ❑
a24"access risers over each compartment?---------------- El ■ ❑
1W Effluent filter installed?---- --- -- ----------------- - ❑ ❑
Septic tank capacity(working) NUwater 500 pal Manufacturer Haggenman
O D-box water level and speed levelers used? ----- ---------- eMA We NO
gO Manifold/D-box accessible from surface?---------------- -U.
❑ ® ❑
mZ Check valves installed? ---- ------------- -------- - ❑ ❑
G
Transport Line Size 2' Schedule/Class 40
Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑5 ❑6 ❑Commemlavother
>10 ft.from foundation?- --- --------------------- - ❑ WA ® YES NO
>100ft.from wells?- -- -------------------------- ❑ (♦ ❑
W >100 ft.from surface water? ---------- -------------- ❑ ® El
ri >10ft.from potable water lines?---------------------- ❑ ® ❑
Z
a >5 ft.from property lines and easements?- -------------- - ❑ ® ❑
d >30ft.from downgradient curtain/foundation drains?---------- ❑ ❑
Drainfield level and observation ports present -------------- ❑ ® ❑
❑ Graveless chambers or E Clean gravel used? (check one)
Proper cover installed over drainfeld?-- ---------------- - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WA YES ❑ No
Y Pump tank capacity(flood) 1200 at Manufacturer Haggerman
AQ24"access riser(s)and accessible from surface?------------ - ❑ ❑
Alarm or Control Panel Installed? -------------------- - ❑ ® ❑
IL
2 Control Panel equipped with Timer I ETM/Counter----------- ❑ ❑
a Pump installed in a Bucket or ❑ On Block or ❑ Other
d Pump Make/Model Liberty 253 ❑ Floats or Transducer
S Tank draw down 1-5 Infmin Pump capacity 37.5 gpm Squirt Height 60+ ft
Pump on time 1 min. Pump oBtlme 4 hrs Daily flow set at 240 gpd
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Mason County OSS Installation Report pg. 2 Parcel N 12205-75-90030
ABANDONMENTRECORD
We. a WIN seplic componemi proloct? - -- - - - -- - -- ' ❑ Yea ❑ NO
d yes. please describe'.
Were all raenponente Wmpnn 0ut and pmpally ntlandoned per WAC246272A-0300?-- --"" ❑ YES No
RECORD DRAWING
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pwieG mXs.: INmbNf�nenbf ae,neta awrtd 5efl'N✓. b. pun.,a N�e� an�'r.. .ee>.n na G'ro'rmlp J'W' . . . '. ":wY .n:.
oa►mrabnl�Ie.tlWa4N.antl War mYnlanv�i.saw arw.. rmrvee wwn o.w+a. woo.a.aaaar N.s...Nr..+vim. w,�..,.l.i..�o.�'"",
❑ Reco d Drawmg Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I eerd fy that i e slalled the system in accordance with i certify that the system has beon instamod m accar-
me sepdc design stamped'APPROVED'by Mason dance with the septic design stamped'APPROVED"6y
County Public Health and that any deviations shown Mason County Public Health and that any deviations
he,have been cieeredhpproved by both the designer shown here hers been cleareaVapproved by both
and Mason County Public Health and meal am State myself and Mason COunty Public Health and meet am
and Mason County Codes. State and Mason County Codes
I further mrbfy met as information con ad on this i further certify that am information contained on this
form end aaa Record wm apeure a. form and attached Record Drawing is seco-W
l7
ollnftaYsr Date
John Gillian
Printed Name of Sranee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Insfallatson Report and aoaearsloe,
RecordDrawing on banal/of Meson County Public
x Aaaaa
Health: EXPIRES
Sense"o/Envaommemel aeon Specialist Data (stamp.alglteallB and da1B)
THIS FORM MAY BF SOANNED MO AVAILABLE FOR PUBLIC VIEW ON THE wASON fbUNTY was am a^°W'H.oaR
OB PORTS I
u CLEANOUTS
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VALVE BOY
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APPROVED
APR 12 1024 1
MASON COUNTYEN I,RONMENiAIHEALiN
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PIONEER. DIGGING, INC ,•,hi I I =Q1116I
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hw: as wu� ♦FU inr.vlw�. v.. ix,u I)i,l & ROOMTELPAYSSE
ASRUIT SCALE P-H9