HomeMy WebLinkAboutSWG2022-00087 - SWG As-Built - 3/11/2024 Mason County OSS Installation Report pg. 1 �A SON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00087 Parcel # 22302-41-0
Applicant Name Anthony Raymond 8 Lisa Grim Subdivision (Name/Div oc ot)
Applicant Address 1301 Marage LN Ft 01
City, Slate, Zip Silverdale,WA 98383 Installer Name Bo R#% _Russ Cgnsixuctien
Site Address 321 NE Toonerville Dr, Befair Designer Name Frank Marcinko
INSTALLATION CHECKLIST
■ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Gravity Pretreatment Type
>5 ft.from foundation? - - - - - - -- - - - - - - - - - -- ❑ NIA ■YES NO
>50ft.from wells? - -- - - - - - - - -- -- - - - - - - - - - - - - - - - ❑ ■ ❑
Z >50 ft.from surface water? -- - - - - - - - - - - - - - - - ❑ ■ ❑
fCleanoul between building andlank? - - - - - - - - - - - - - - - -- -- ❑ ■ ❑
V Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ■ ❑
a24"access risers over each compartment?- - - - - - - - - - - - - - - - ❑ ■ ❑
W Effluent filter installed?-- - - ❑ ■ ❑
U)
Septic tank capacity(working) 1250 gal Manufacturer Sound Placement
O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ■ YES ❑ No
�J
O Manifold/D-box accessible from surface?- - - -- - - - - - - -- - - - - ❑ ■ ❑
m
C— Check valves installed? - - - - - -- - - - - - - ■ El ❑
Q
f Transport Line Size Schedule/Class 3034
Bedrooms installed (ch ) `r El ❑6 ❑Commercial/Other
>10 ft.from foundation? CCu- _ _ _ _ - - - - -- ❑ NIA ■ YES ❑ No
>100 ft.from wells?- - - J� - j ,�. - - - - -- ❑ ■ ❑
W >100 ft.from surface water? htLa� - - - - - - ❑ ■ ❑
ILL >10 ft.from potable water lines?- - - - - - -- - - - -:- -- - - - - - - ❑ ■ ❑
Z > 5 ft.from property lines and easements?- - - - - - - - - - - - - - -- ❑ ® ❑
>30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ■ ❑
Drainfeld level and observation ports present - - - - - - - - - - - - - - ❑ ■ ❑
❑ Graveless chambers or ■ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - -- - - - - - - - - --- ❑ ■ ❑
Pump tank setbacks consistent with septic tank? - ---------- - - ■ NIA ❑ YES NO
`1 Pump tank capacity (flood) gal Manufacturer
Q24"access riser(s)and accessible from surface?- - - - - - - - - - - -- ❑ ❑ ❑
H
a Alarm or Control Panel Installed? - - -- - - - - - -- - - - - - - - - - - ❑ ❑ ❑
f Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - -
IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
CLPump Make/Model ❑ Floats or ❑ Transducer
IL
Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
apdmed emndre
Mason County OSS Installation Report pg. 2 parcel u 22302-41-00010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- ❑ YES Q NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- ❑ YES ❑ NO
RECORD DRAWING
rids la a pa.a...—M and muar ba auerale and Eax.flo-enough to reJoob In Me naatl at makrunance ecevltlea ana future dewbpmant typal Record
Daw,,i mnlain: Drainaild it menlldd odentgEm d IaynA Sa Opump tank kce4on,Nana armm,reserve drei ifind existag and proposed hultlhga,kcetlon Nwells,waterlines,
wells,obaervatlon port,deancNs,and other maintmanda acwss panne. Incomplete RexM Drewings may create additional delep In final installation alWmval and rNeted permits.
PPROVE
MAR 1 1 2024
MASON COUNTY ENVIRONMENTAL HEALTH
J13W
Q Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that 1 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 Geared/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.20. p4stlieor 04/24/23 *JM-0,10
'Signature of Installer Date
Bo RussellPrinted Name of SigneeMASON COUNTY PUBLIC HEALTHThe undersigned approves this Installation Report andRecord Drawing on behalf of Mason County PublicHe t� a2a
Sig to nvironmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated wnnme
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