HomeMy WebLinkAboutSWG2023-0472 - SWG As-Built - 4/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00472 Parcel# 32232-50-10201
Applicant Name Diane Krogh Subdivision (Name/Div/Block/Lot)
Applicant Address 371 E Orre Nobles Rd Union Hood Canal Land B Imp Co Block:102 Lot:1-3
City, State, Zip Union WA 98592 Installer Name Bamford Septic Repair
Site Address Same Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
Q Full system Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Shallow Pressure Pretreatment Type
>5 ft.from foundation? ------ - -- - - - -- - ----- --- - - -- El NIA ® YES NO
>50ft.from wells7 - - - - - --- --- - - - - -- - --- --- -- -- ❑ ® ❑
Y >50ft.from surface water? -- - - --- - - - - - -- ❑ ❑
2
F Cleanout between building and tank? - - - - - - - - -- - --- - - - -- ❑ ❑
O Tank baffles present? -- ---- - -- - - - - - - -- - ❑ ❑
F- 24'access risers over each compartment?-- - - - - ❑ ❑
a — ❑ ❑w Effluent filter installed?-- - --- - - - - - -`--- - - -- --- - - - -
N
Septic tank capacity (working) 1250 gal Manufacturer Snyder
Q D-box water level and speed levelers used? -- ---- - - - - - ---- ❑ NIA ❑ YES ® NO
RO Manifold/D-box accessible from surface?- - - - - - - --- ❑ ❑
Ou-
inZ Check valves installed? - - -- -�� !`---- - - - - ❑ ® ❑
oa
E Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) rIE1 2� N 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - - v`•';'—- -- -- - -- - - - --- - ❑ NI ❑ YES NO
`p >100 ft.from wells?---- - - -- - --- ---- - - -- --- - --- -- ❑ ® ❑
IiJ >100 ft.from surface water? - - - -- - - - -- - - ----- - -- -- -- ❑ ® ❑
rL >10 ft.from potable water lines?- -- - - ❑ ® ❑
Q2 >5ft. from property lines and easements?-- -- - - - - --- ❑ ® ❑
K >-30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑
O Drainfield level and observation ports present -- - -- - - - - ----- ❑ ❑
M Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- -- - - - --- - - - - -- -- -- ❑ ® ❑
Pump tank setbacks consistent with septic tank?-- --- -- ---- -- ❑ wA YES ❑ No
Yz Pump tank capacity(Flood) 1287 gat Manufacturer Infiltrator
Q 24"access risers)and accessible from surface?-- -- --- -- - - -- ❑ ❑
~ Ala"or Control Panel Installed? - - - - — - - - - - - - ❑ ® ❑
a
Control Panel equipped with"rimer/ETM/Counter- - - - - - - -- -- ❑ ® ❑
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
a- Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer
� Tank draw down 2" in/min Pump capacity 50 gpm Squirt Height 318. ft
a
Pump on time 1.8 Minutes Pump off time 6 Hours Daily flow set at 360 gpd
llplei.wian.
Mason County OSS Installation Report pg. 2
Parcel
ABANDONMENT RECORD YES ❑
. _ _ _ _ _.
NO
Were existing septic components abandoned as part or this project? _ _ _ _ __ _ _
If yes, please describe: �$ ld No
Were all components pumped out and propedy abandoned per WAC246-272A-0300? --" - - -'
RECORD DRAWING
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wglp ppaervalwn WhO,cleanouis,antl oNar maimerance ecce*a po ms. Inmmplele Fcrok Draw n
. pry well For old kijrlaen dernoli sb+ed baokLitled.
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• Ota .�a1rJc abandone-d urde No
Record Drawing Attached
L—��CE�RTIFICATIDNOF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 certify that I 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 cleared/approved by both the designer shown here have been clearedlapproved by both
and Mason County Public Health and meet all State myseStatelf and Mason County Pubc and Mason County Codes Health and meet all
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.
:> _ y l.a 42N
Signal of In Date
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
51443d8 �ra
The undersigned approves this Installation Report and ' EAuLA Gov Joxxsox`�
Record Drawing on behalf of Mason County Public ' 'IC b
Health: �
Signature of Environmental Health SPeclaOst Date (stanp. signature and date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNT'WEB SITE uc°i•'°N"s°'a
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3'1 1 E o RRE t,�0 B LE.s R D _ Q 1200 Gallon Septic Tank
2-Compartment with
Effluent Filter
O4 1000 Gallon Pump Chamber
OS Valve Control Box
O Old s tank-abanda1ed undtr
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PAOLA JOY JONNSON.;
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