HomeMy WebLinkAboutSWG2022-00258 - SWG As-Built - 4/30/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00258 Parcel# 123215100017
Applicant Name Jennifer Crabb Subdivision (Name/Div/Block/Lot)
Applicant Address 120 NE Riverhill Lane Riverhill
City, State, Zip Better,WA 98528 Installer Name Jennifer(owner)and Steve Hupper
Site Address Same Designer Name Lawrence Purdum-Apex Septic DE
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tari Only ® Drainfield Only ❑Repair ❑Other
System Type Gravity drainfied replacement Pretreatment Type
>5 ft.from foundation? -- ---- --- --- - - ------ W NIA ❑Yes NO
>50 ft.from wells? -- - - - - ---- - - - -- ------ ❑ ❑
Z >50 ft.from surface water? - - -- - - - -- - --- --- ❑ ❑
rCleanout between building and tank? - ---- ---- - e ❑ ❑
O Tank baffles present? - - - -- - --- - ❑ ❑
a24"access risers over each compartment?-- - - - --- - -- ----- ❑ e El
W Effluent filter installed?----- --- --- - - ----- ❑ ❑
to
Septic tank capacity(working) 1200 oat Manufacturer Fred Hill 2-Compartment Tank
C1 D-box water level and speed levelers used? ------- - -- --- - - ❑ NIA ■Yes ❑ NO
QJ
O Manifold/D-box accessible from surface?-- ------- -- - - - - -- El El
°PZ Check valves installed? -- -- -- - - - --- - - -- -- --- -- --- e ❑ ❑
oa
f Transport Line Size 4" Schedule/Class ASTM D 3034
Bedrooms installed (check one) ❑ 2 K 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- - - -- - - --- - - - - - - -- ❑ NIA ® YES El NO
0 >100 ft.from wells?--- - ------- --------- - -------- ❑ e ❑
W >100 ft. from surface water?- - - --- ---- ------ ❑ e ❑
ri >10ft.from potable water lines?- --- ---- ------ ❑ ® ❑
ZZ > 5 ft.from property lines and easements9- iy� ❑ ® ❑
9 >30 ft.from downgradient curtain/lourdati [seam
I{ R #b V-[D e ❑
13 Drainfield level and observation ports prat -- - -- - 0 ❑
0 Graveless chambers or ❑ Clean )j4j
Proper cover installed over dminfield?--U460N000NryENV ® ❑
Pump tank setbacks consistent with septic tank?----./OW---- NIA ❑ YES ❑ NO
`1 Pump tank capacity(flood) at Manufacturer
Z 24"access riser(s)and accessible from surfacer - ❑ ❑
aAlarm or Control Panel Installed? ----- - - - - - - -- ❑ ❑
f Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
4' Pump Make/Model ❑ Floats or ❑ Transducer
f
a
Tank draw down in/min Pump capacity Opm Squirt Height ft
Pump on time Pump off time Daily flow set at Opd
np]Wwaa12018
Mason County OSS Installation Report pg. 2 Parcel# 123215100017
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ---- -- K YES NO
If yes, please describe:Existing ravel and perforated pipes abandoned in place.
Were all components pumped out and property abandoned per WAC246-272A-0300? -- --- -- - ❑ YEs D/B NO
RECORD DRAWING
This la a permanent remN and must be around and do-alptive enough to re-locate In the need or malMananca av egias and future avelepmenL 1 dal FaTN
Dlmringscontod Palnrieltlamandold wlenletion alayout.seporlwnq lanF bu4cn.NwN arrox.rune anmfieW.ealsnngend pmweoe bulWln9e lotand of—ft,.eum.eeIL 1A
weue,observe4on pone,aeanome,ma omar malnenvice access pom6. Incmnged aemm Omdnge mey cmedadtligonal dela/s InflnY dsd�dg0u eopmrw em reI Jed petmga.
o q,
PQR ��aoN"�Evz"
MPSONUpUNj�F.J��
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with 1 certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Masan 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 cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Masan County Public Health and meet all
and Masan 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
farm and attached Record Drawing is accurate, form and attached Record Drawing is accurate.
8/22/202
Signature oflnstaller Date
Steve HUpper
Printed Name of Signes ea
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report andRecord Drawing on behalfof Mason County Publicborsaxca
Health:
Signal�ie o/ nmenugl Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upmde erztrzota
2-p dam
Rip.-gig= = e D NE RIVERHILL LN
p i s F?11a151Y€
9 m F� z
INHU5
"
382R J n-'
}' //
4. gg Mm s
c �p 4S
1 m n
$ o
A
r<
<
U
x
pp Ay m pN
4 I N2 V
An
X � X
1 O n
m p
m n
A m
m
m
0
m
30N3J
q0'W l
Z m m ti mti00 DmAAADN000 NO
Z
OmDDDrm
n �n
D ~ T` ZZZ<�yj -
L r Z T2mm�1MMM it
D f1ZO Zm A z A ��OOODO
� m K ti O
DNfTI mil. D 4�DOmZr1p y
Z �W 7J M.. m m y ArZZ'�m<
O 'Tm .Z) m N O o�yyy rOK Z
Zn�-1W
N m U r OtiOmm
m m
\ OSI� O]J A O 1ZmCm
xi Ar o
N Z 2
ON .�V r m O m
A ..
Z O O
m
x
m 8 A o
� >
r z u O
m r u r rn m
Q m Z m ~
z x
O m w i
o m m
m
f O N
m Zm z
® F
O O ,
0 m M
o m � g � - N m
D TO
r N
0 0 C T 4Yr N N n 9 Q _I-y
f m
a to S o cm9 a
N ? 2
� O
r � �
$ n
O