HomeMy WebLinkAboutSWG2022-00087 - SWG As-Built - 3/11/2024 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00087 Parcel# 22302-41-0
Applicant Name Anthony Raymond&Lisa Grice Subdivision (Name/DivirW
Applicant Address 1301 Marage LN Ft 01
City, State, Zip Silverdale,WA 98383 Installer Name Bo Rt I�uss Comsbuctien
Site Address 321 NE Toonerville Dr, Belfair Designer Name Frank Marcinko
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑other
System Type Gravity Pretreatment Type
>5ft.from foundation? ------------- --- -- -- -- -- --- ❑ NIA ■YES NO
>50ft.from wells? ----------.------------------'- ❑ e ❑
Y >50ft.from surface wateR -------------- - - -- ------ ❑ ❑
Z
Cleanout between building and tank7 ----- -- - -- -- ------- ❑ e ❑
V Tank baffles present? - - - - - - --- - - -- - - - --- --- ----- ❑ ® ❑
IL 24"access risers over each compartment?- - - - - - - -------- - ❑ ® ❑
W Effluent filter installed?-- - ---- - -- - - -- -- --- -- ----- - ❑ ® ❑
Cn
Septic tank capacity(working) 1250 gal Manufacturer Sound Placement
O D-box water level and speed levelers used? -- - --- --- - - --- - ❑ NIA M YES ❑ No
OJ
LL Manifold/0-box accessible from urtace?-- -- -- - ---- ----- - ❑ � ❑
oQZ Check valves installed? -- - - - -- - - - -------- --- ❑ ❑
0
Transport Line Size Schedule/Class 3034
Bedrooms installed(ch 5 ❑6 ❑Commeroial/Other
>10 ft.from C foundation?
_____. ❑❑ ruA �vtes ❑❑ No
>100ft from we
W >100 ft.from surface water? - - -Je�V MFt`TR(y -- -- -- - ❑ ® ❑
LL >10ft.from potable water lines?-----------4H;--- -- -- - ❑ 0 ❑
Z >5ft.from property lines and easements?- - - - - -------- - -- ❑ ® El9 >30 ft.from downgradienl curtain/foundation drains?- - - - - - - - - - ❑ 0 ❑
G Dreinfield level and observation ports present --- - - - - - - - - - -- ❑ ❑
❑ Greveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfield?-- - -- -- - -- -- -- -- --- ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - ® NIA ❑ YES ❑ No
Y Pump tank capacity(flood) gal Manufacturer
Q24"access riser(s)and accessible from Surface?-- --- ----- --- ❑ ❑ ❑
F
Alarm or Control Panel Installed? -- --- --- -- ------- --- - ❑ ❑
Control Panel equipped with Timer/ETM/Counter- - --- - -- - - - ❑ ❑ ❑
7
0. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
Pump Make/Model ❑ Floats or ❑ Transducer
:3 Tank draw down in/min Pump capacity gpm Squirt Height ft
a
Pump on time Pump off flme Daily flow set at gpd
upaeme earrmre
Mason County OSS Installation Report pg. 2 Panel# 2230241-00010
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - -- - - - - - - -- -- -- ❑ YES No
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? -- -- - - -- ❑ YES ❑ NO
RECORD DRAWING
The Ic a pannamM.,d and..at ho aaurake and tluctlptlw enough to Mcosto In Me head or maintenance activHW enJ Inton development Typlcel Rewind!
DmWngs.1n: Drained&mengald orunbtlan8layoN,SepWpump tank koli North dime,nerve dminflek,ending and propomd buildings,lotaton of web.waw,hus,
wells.Woervarknport,tlamuta,dndo1Mrmaint nceaccecawinb. Irwmpkre RemN D2wkgamaycleare additional delete in final Inatdblbl appnval and Mated pdrmils.
PPROVE
MAR 1 1 2024
U4SON COUNTY ENVIRONMENTAL HEALTH
Jaw
E Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 certify that 1 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 cleared/approved 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
1 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 Record Drawing is accurate.
Icyg go- 8se 04/24/23 Ouj, o w
Signature of Installer Date
Bo Russell ,(ee
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and ,(� ! din
Record Drawing on behalf of Mason County Public `� 20100609 ;
He � Flank A.Mercinko
' lJ, 1 LICENSED DESIGNER
t�A <�—� I-a Lisd ,tt4
Sig to nvimnriental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updew a2trzma
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Row ji& Septic Site Plan"ROC Detail" Name: Raymond Tax Parcel: 22302Is 41-00010
Scale = 1" = 40' Address: 1701 NE Toonerville Or, Belfair
This b note surnzx all property Gnes/bounderies Fore been demonsusted by the&nsr(e)and/or have booths)NqW .
On-Site Septic Design i Mlled Septic Design and Excavating