HomeMy WebLinkAboutSWG2023-00243 - SWG As-Built - 5/28/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SM 2023-00243 Parcel# 321343100090
Applicant Name aaa4e rocnnoN 4Nosn nas rc. Subdivision (Name/Div/Block/Lot)
Applicant Address 113 E TERRACE DR. act r OF eur2 10 AR 21911017a of NE sw s a or.s sins
City, State,Zip BELFAIR WA 08528 Installer Name Rich Moore
Site Address 1141 E Mason Lake Rd, Shek0 n Designer Name Jm zimny
INSTALLATION CHECKLIST
■ Full System Installation ❑Tank(s) ly ❑Drainfield Only ❑Repair ❑Other
System Type Pressu MIstn 'on Pretreatment Type
>5 ft.from foundation? --------------- ------------ ❑WA Ewa ❑ No
>50ft.from wells? ----- ---- - ------------------- ❑ ❑
Z >50 ft.from surface water? --- - --r--- -------------- ❑ ❑
FCleanout between twilling and tank? - - -------------- ❑ El(.1 Tank baffles present? ------- -- -- -------------- ❑ ❑
IL 24"access risers over each compartment?- --------------- ❑ E ❑
W Effluent fifter installed?- ---- - -- ---- -------------- ❑ IN ❑
N I" ___gat Manufacturer Y1Hlrabr
Septic tank capacity(working)
a D-box water level and speed levelers UIsed? -------------- 0N/A ❑yes NO
�O Manifold/D-box accessible from surface?-- -------------- ❑ e ElOW
mZ Check valves installed? --------F-- -------------- ❑ ❑
Qa E Transport Line Size 2" Sonedule/Class 3Ch 40
Bedrooms installed(check one) ®2 Q 3 ❑4 ❑5 06 ❑Comme-ciauother
>10 ft.from foundation?----------- -------------- ❑NA . yes ❑ NO
>100 ft.from wells?----------a--- ______________ ❑ ® ❑
W >100 fl from surface wales----- --- -------------- ❑ ® ❑
LL. >10 ft.from potable water lines?--- --- -------------- ❑ ® ❑
QZ >5 R.from property lines and easemeAts?- ❑ ® ❑
K >30ft.from downgradient curtairutoul(datio drains? --------- [I ® ❑
Dminfield level and observation ports p ------------- ❑ e El
e Graceless chambers Of [ICleen g used? (check one)
Proper cover installed over drainfield? ----------- ----- — ❑ ® ❑
Pump tank setbacks consistent with seliptic -- ------- ❑ N/A Nws ❑ NO
Y Pump tank capacity(flood) 1� anufacturer Infiltrator
Q24'access dser(s)and accessible( ---- ----- ❑ ® ❑
~ Alarm or Control Panel Installed? -- -- - ------ ❑ ❑
a ❑ ® ❑
f Control Panel equipped with Timer -- -- - -- --
a Pump installed in ❑ Bucket or ❑ Other
iL Pump Make/Model li .Floats or ❑Transducer
f
y Tank draw down 1.5" in/min Pump capacity 30 Opm Squirt Height ?' ft
Pump on time i min Pump off time 4 has Deily flow set at 1aO gpd
' Up]aM Mt/At0
Mason County OSS Installation Repo pg. 2 pal a 'Z $I y— 0 Q C R O
' AB NDONMENT RECORD
VJereesisking septic components rearxlona�l as part of this Promq? ----------- ❑ Yes ❑ NO
r ae It yes,please desc
Were all components pumped out and abe red per WAC246-272"3007-------- ❑YES NO
R CORD DRAWING
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CIE TIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in aoeordanae with I bond,that the system has been installed in 0.
the septic design stamped'APPRO VEO'by Mason dance with the septic design stamped'APPROVED'by
County Public Health and that any deviations shown Mason County Pudic Health and that any deviations
here have been cleereWappmved by both the designer shown here have been clean?Wappmved 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 cerlily tl)al all in/ alan contarmum on this I further camly that a information contained on this
to n alla M Re vmg is accurate. form end etteche f Record Drawing is accumfe,
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T Iula dln rUC(/slaller /Z Daae
rx7/e.
meted Name ols9mrs
MASON COUNTY PUBLIC HEALTH v m
The undersigned approves this Installation Report and
Record Crewing on behalf of Mason County Public t u e {Lsn
Health'
signaNred Envawmrenml aahspecessul Data (sfer signature and date)
THIS FoNA IMY eE SCANNEDM myutA E FOR PUBLIC NEW ON THE MASON COI1NfY NEB SITE iNvan'rore
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MAY 2 8 2024
a MASON CCUNTv-YARON4ENTAL HEALTH
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