HomeMy WebLinkAboutSWG2023-00514 - SWG As-Built - 4/30/2024 Mason County OSS Installation Repo11 rt 11 pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00514 Parcel# 22336-52-00008
Applicant Name Karl 8 Lori Fike Subdivision (Name/Div/Block/Lot)
Applicant Address 480 NE Matthews Or Lynch Cove Division:2 LOt:B
City, State, Zip Belfair,WA 98528 Installer Name Bamford Septic Repair
Site Address Same Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only Q Drainfield Only S Repair ❑Other
System Type Gravity Bed Pretreatment Type
>5 ft. from foundation? _ ❑ NIA X YES ❑ No
>50 ft,from wells? - - - - - - - - - - - - - - -- - - - - - - - -- - - - - ❑ ❑
Y >50ft. from surface water? -- - - - - - - - -- - - - - - - - - - - -- - ❑ ❑
Z
HCleanout between building and tank? - - - - - - - - - - --- ❑ 0
U Tank baffles present? - - - - - - - - - - - - - - - -- - - - - - - --- ❑ ® ❑
h 24' access risers over each compartment?- - - - - - - - - - - --- - - El ❑� El
L ®
W Effluent filter installed?- -- - - - - - - - - - - - - - — - - - - - - - -
❑ El
N
Septic tank capacity(working) 1200 gal Manufacturer Existing Concrete
G D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ® YES ❑ NO
OJ
LL Manifold/D-box accessible from surface?- - - - - - - --- - - - -- -- ❑
mZ Check valves installed? - - -- - - - - - - - - - - - - - - - - - - -- - - ❑ ❑ 0
oQ Transport Line Size 4" Schedule/Class 3034
f
Bedrooms installed (check one) ❑ 2 Q 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - - - - - - - - - - - - -- — - - - - - - ❑ N/A AYES (((��❑111 No
0 >100ft. from wells?-- - - - - - - - - - -- - - - - - - - - - ❑ o
W >100ft. from surfacewater? - - - - - - - - -- -- - - - - - - - - - - - ❑ 0 pA�1
a >10ft.from potable water lines?- - - --- - - - - - -- - - - - - -- - ❑
Z >5ft. from property lines and easements?- - - - - - - - -- - - - - - ❑ M
- - - - - - - - - -
o > 30 ft. from downgradient curtain/foundation drains? ❑ b
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ® Q
❑ Greveless chambers or 0 Clean gravel used? (check one) 1 I
Proper cover installed over drainfield?-- - - - - - - -- - - - - -- - - ❑ ® 0
tank setbacks Consistent with septic tank?-- -- -- - - -- - - - ❑ NIA ❑ YES NO
Y Pump tank ca flood) gal Manufacturer
R
24"access riser(a)antl ad ❑
Is from surface?- - - -- - - - - - - - - ❑
~ Alarm or Control Panel Installed? --- - -- - - - - - - - - - - ❑ El IDC - ❑ El ❑
2 Control Panel equipped with Timer/ET- /Court - - - - - - -
tl Pump installed in ❑ Bucket or ock or ❑ O
Pump Make/Model ❑ Floa r ❑ Transducer
a
Tank draw in/min Pump capacity gpm Squirt Height ft
ump on time Pump off time Daily Flow set at
Vp9meE 6R V00'B
52 F1�[7oPi
Mason County OSS Installation ReportP9. 2 Parcel a223zb ENT RECORD
NO
Were existing septic components abandoned as part of this project
If yes, please describe: YEs ❑ NO
tl per WAC246-92A-03604
Were all components pumped out and properly abandana
-- - - --'-
RECORD DRAWING
t T cal RecoM
This Is a permanrcn rewN and muss be accurate end descnptve enough to re-looms in ele reeve ha 6Nh-"sting "M pmpouatl buidNgs Isue Jowtlon otv2lb as"n"e1
Dmwmgs noun Dnesin 0 6 maniblo onmtatiao d layom.5eptirlpump unk l iplue i NOM snow.re
µells.Wseeve4nn pon,,tleahisas and sons'nminnounm.Use ou Inwmple@RecMd 02vnnga mry veatt addllonal ddaya i^final�nst➢Ilation apprmal end eNaled pert"a.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
DESIGNER/ENGINEER
INSTALLER
I certify that I installed the system in accordance with 1 certify that the system has been installed in OVER
by
the septic design stamped"APPROVED"by Mason Masondance NCtout County Publ septiche c He deslt h end that any de i tions
County Public Health and that any deviations shownby
here have been cleared/approved by both the designer m son here have been clea,radlapproved
and Mason County Public Health and meetall
and Mason County Public Health and meet all State State and Mason County Codes
and Mason County Codes. I further certify that all information contained on this
1 further certify that all information contained on this form and attached Record Drawing is accurate.
form and attached cord Drawing is accurate.
Signature of Install-(�
Date
o �a.
IM
of Signee •j
UNTY PUBLIC HEALTH \ '.tiAr
ned approves this Installation Report and st6baap �'.
PAULA JUY JOHNEON' .`f
ing On behalf of Mason County Public .Lti�iCNE_IC*
Health:
�'TL mn�'7 � ��o�zs7 �f - Zs-2`�'(stamp, signature and date)Environments Health Spectalst Date
uwat,a erztrzme
THIS FORM MAY BE SCANNED AND AVARABLE FOR PU6LIC VIEW ON THE MASON COUNTY WEB SITE
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r J�O r O 1,200 Gallon Septic Tank
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5-Hregp O3 D-Box with speed-levelers
and cover to surface
APPROVED
APR 3 0 2021 1
MASON CCUNTY EN"RC ME ' .0
REi MENTAL
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