Loading...
HomeMy WebLinkAboutSWG2022-00217 - SWG As-Built - 5/16/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG'jOZ2 0C)-Z- Parcel # 22336-51-00024 Applicant Name Dean and Karna Peck Subdivision (Name/Div/Block/Lot) Applicant Address 171 NE Bryan Lane City, State, Zip Beltair WA Installer Name Tony Robinson Site Address Designer Name Apex Septic Design LLC INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Distribution Pretreatment Type >5ft. from foundation? -- --- - -- - ------ ---- ------- - ®NIA ❑YES ❑ No >50ft.from wells? ----- - - - --- --- --- - - -- - -- -- - -- ® ❑ ❑ Y >5oft. from surface water? - -- - -- - - - - - - - - -- - -- - --- - ❑ ❑ Z F Cleanout between building and tank? ----- - --- - --- - -- - - - ❑ ❑ U Tank baffles present? - - -- - - - --- - - - - -- - - - - - - - - - - - ❑ ® ❑ a2C access risers over each compartment?-- - - -- -- - -- ---- - ❑ ® ❑ NEffluent filler installed?--- -- ---- -- -- - --- -- -- --- -- - ❑ ® El Septic tank capacity (working) 1250 gal Manufacturer Hagerman Precast 0 D-box water level and speed levelers used? - --- - - - - - - -- - - - NrA ❑ YES NO p0 Manifold/D-box accessible from surface?-- ----- - - - ---- - - - ❑ ® ❑ mZ Check valves installed? ------ - ------ - --- ---- -- - -- ❑ ❑ 04 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed (check one) © 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft,from foundation?-- ---- --- - -- - - -- - -- -- -- --- ❑ NIA ® YES NO 0 >100 ft, from wells?- - - ----- - - -- - --------- - - - - - - - ❑ ® ❑ W >to0 ft.from surface water? -- - -- - - ------ -- - - ------ - ❑ ® ❑ LL >10 ft.from potable water lines?-- - -- -- --- --- - -- ---- - - ❑ ® ❑ 4 > 5 ft. from property lines and easements?-- -- - - -- - - - - -- - - ❑ ® ❑ C > 30 ft.from downgradient curtain/foundation drains?-- -- - -- -- - ❑ ® ❑ 0 Drainfield level and observation ports present - - - -- - -- - - -- -- ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- ------ ----- -- - - - ❑ ❑ Pump tank setbacks ccrosl$tent with septic tank?----- - -- -- -- - ❑ wA M YES ❑ No te Pump tank capacity(flood) 1250 at Manufacturer Hagerman Precast F2C access hsef(s)and accessible from surface?- - --- - - - - -- - - ❑ E ❑ IL Alarm or Control Panel installed? -- -- --- -- - - -- - - --- --- ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter- - - - -- - --- - ❑ 0 ❑ EL Pump installed in ® Bucket or ❑ On Block or ❑ Other 11 Pump Make/Model Liberty LP-280, 1/2HP, 115V ® Floats or ❑ Transducer 2 M Tank draw down 1.25 in/min Pump capacity 25 gpm Squirt Height 51 fl Pump on time 72 Seconds pump o8 time 3 Hours Daily flow set at 239.61 gpd UP:a!e)B2'!F'A Mason County OSS Installation Report pg. 2 Parcel#22336-51-00024 ABANDONMENTRECORD Were existing septic components abandoned es part of this project? - - - --- ----- ---- ❑ YES © NO If yes, please describe: Were all components pumped out and popery abandoned per WAC246-272A-03009 -- -----• ❑ YES ® N/A RECORD DRAWING mie is a urni record and must W eccund and aesctlgroe an.wh le rtlpmb In me reed M maLttanann acavelec and I..tlevaleprn•m. Racem L`eew¢ps wn:a,n Dented 8 manddd d+amwn a ayw! Sep:4kuTa tern lrsaon 1,1"a",lae l If—,,red exrtmp ea p ,.n 1or31m o!weue v+atelmea. we.K6Bn,at.,.1 ceanc.N and p!-e-ma:n;-'all atteas-lid In9mp a.Rno•aDian:Bs may creel' deiays.n rnal ns!allehop approal and mama p,:mes ® 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 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 I further certify that all information Contained on this �forrmfan(/d)�attached Record Drawing is accurate. form and attached Record Drawing is accurate. V\ri/ii/I-/ r/W22 Signature of installer Date lony Hobinson Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and •• Record Drawing on behalf of Mason County Public ::.L4� nP..^.aM:Py r4ym}• Health: �gw Sl�b/�y � � lli�k Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY ME SITE ocre:-e enrn;e qR�ya� A g aid RN 0 a =ag5 �a ;@@ mCSI p V"-p _ yye8 m 9 \ y \ \ S \ \ 0 0 O 8 0 O y 1 N p0 C� IC Ny [Dy h1'0 >m� S SA��a ; 51�64 O\UAWN� r �a 'o ;1y m m DCmr > m o ZKVmZ z 0 C�z 0 =oZC T`Zti 91/ ti QA x D m000000.L.9V 0 �ODOry �m0RH0F0O00 ON s TOOOA22Z;� Z N jl ZD O �mzmA�lrnp F2m Z r2VI V19 rrrim O� m Ix Z mOD2ND NZyO ypy ; �Dmm�00Z�A D >. ~ +1(O�nO1TNr< yrZf NO4l rlAm O .lmlm Z ODt IN/IN Zy9NjV z 0,A-,,,AMC .Z. .IK. m OsL\mN ma. SD N 0, Erg Z _nW�l��l0 vz m �o o Za. m o\n .\ul y .Z. Cpll A �2A mr m [y�(m� '_I Zi x i AFm n m.. Q Dm < yD 9 m O� k' D DNy TWA mZ N NN o N � w A s0.i O Tl (� z ou In > �v z mm{ x o N ,A, u (T VI(T Z U go q O m u r \ i880 a ZO O SOD 4 Z Z at N Z N O o A O R A Z u N m { z V Z m Z 0 m O m A o D\0 r 7) 1 . m a m Uz N� u r � 8 n m 0 N N i