HomeMy WebLinkAboutSWG2024-00130 - SWG As-Built - 4/25/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024- 0 0 I Parcel# 12331-23-90146
Applicant Name Katie Laframbois Subdivision (Name/Div/Block/Lot)
Applicant Address 20 NE Quail Tread
City, State, Zip Belfair WA 98528 Installer Name Shae Oien
Site Address 20 NE Quail Trail 98528 Designer Name Tom Weaver
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑Dminfieid Only ®Repair ❑Other
System Type Gravity Pretreatment Type
>5ft.from foundation? -- - ---- ------ ---- - -- - - -- --- ❑WA KIYES ❑ NO
>50ft.from wells? __ _ ___ __ _ _ _ ___ __ ____ __ _ __ __ __ ❑ iK] ❑
Z >50ft.from surface water7 - - -- - ------ - - - - . ❑ ❑
HCleanout between building and tank? -------- - - --- -- -- - - ❑ M ❑
U Tank baffles present? -- - - - - - - - - - - -- - - - - - - - - - - - -- ❑ 91 ❑
6~. 24"access users over each compartment?.___ __ ___ _ _ _ _ _ _ . ❑ ❑
m Effluent fitter installed?---- - ---__ - _ - - - - - . ❑ ® ❑
Septic tank sae 1,500 gal Manufacturer Infiltrator Poly
R0 D-box water level and speedlevelersused? -- - - - - --- - -- -- ❑WA $]YES NO
QO Manifold/D-box accessible from surface7 - -- - - - - - - ---- --- ❑ R3 ❑
CQCheck valves installed7 - -- -- -- - - - --- - -- - - - - - - - - - . ❑ ❑
f Transport Line Sae 4 Schedule/Class 3034
Bedrooms installed(check one) ❑ 2 iC4 3 ❑4 ❑ 5 ❑6 ❑CommerciaVOther
>10ft.from foundation?- 3'PPEW41yeS--- ------ -- -- - -- - ❑ N/A ❑Yes QJ No
G >100 ft.from wells?--- - - - -- - - -- -- --- --- -- --- - - - - ❑ IN ❑
W >100 ft.from surface water? -- ------ --- - - - ❑ ® ❑
LL >10ft.from potable water lines?----- - - - - - - - - - - - -- - - - . ❑ ® ❑
Z >5 ft.from property lines and easements?
>30 ft. from downgradienl curtain/foundation drains?- - -- --- -- - ® ❑ ❑
Drainfeld level and observation ports present - -- - - -- - --- - - - ❑
❑ Graveless chambers or R) Clean gravel used? (check one)
Proper cover installed over drainfield?---- --- -- - - -- --- -- ❑ ® ❑
Pump tank setbacks consistent with septic tank?--- - - - --- - - -- WA ❑ YES ❑ No
ZPump tank size gal Manufacturer
F 24"access riser(s)and accessible from surface?-- - --- - - - - -- - ® ❑ El
C Alarm or Control Panel Installed? -- ----- -- - - - -- --- - - - - ® ❑ ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ® ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
Pump Make/Model ❑Floats or ❑ Transducer
A. Tank draw down in/min Pump capacity opm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
umuw eavme
Mason County OSS Installation Report pg. 2 Parcel# 1 23 31-23-90146
ABANDONMENTRECORD
Were existing septic components abandoned SS pan of this project? ------ --- -- --- - YES NO
If yes,please descrice:
Were all components pumped out and pmpedy abandoned Per WAC246-272A-03007 - -- ----- Qtf YES ❑ NO
RECORD DRAWING
ilrb b a I...I b<oN and..in W aeeunb.W G..Apn..—..T.nJo[ala F q.nw!of maNbnane.aelbWu.M Nbn.ay.IRmnX. T p RKYO
aF.Fw mm.F: oiYmwe A mevaN a+.mAbra broil,sRAunFR unt Faison.Rbu mram.ns.M wFAYe..Y.mq and pnoand NYd.e.Fbbw yv.b,.Fx9n.s.
aNb,ols.miimyW,tl.mas..m aAF mNnbw[.✓nu polMs ImrRYb Rwad erwlrgs m.y waY WdtivN ENRs In AMlosb.aron RVrovY.M rMFd pmNs.
Old tank removed to allow room for new lank
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that l 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'APPRO VED"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 cleareiPappmved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. Stale and Mason County Codes
I further certify that all inlormation contained on this I further certify that all intormation contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
IL A4-- 4/19/2024
Signature oflnstaller Data
Shae Oien
Printed Name of Signee ua. `
e Y
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and rHoM51 E WEAVER`.
Record Drawing on behalf of Mason County Public N #
Health:
Signature of Envlmnme far Health Specialist Date (stamp, signature anddate)
THIS FORM MAY BE SCANNED ANDAVAII.ABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE voa.w azrm+e
SLi1 o ee^ 072`Mod Sand
r R°D°d l «#LLc
Sl N2 O-W Lowly Mod Sand
/ Power line lies NW of the D-Box and close to
the corner of the bed by the home. F
/ Water line is greater than 10'from septic tank & DF b
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'APPROVED
TI<iiA "M APR 25 N24
ASONCOUNT EN NMENiALHFALiH
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