HomeMy WebLinkAboutSWG2022-00631 - SWG As-Built - 6/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00631 Parcel# 22230-23-90032
Applicant Name ALDERBRINK LLC Subdivision (Name/Div/Block/Lot)
Applicant Address 6721 CASCADE AVE
City, State, Zip GIG HARBOR, WA. 98335 Installer Name KATTRAX
Site Address 11511 ESTATE ROUTE 106 Designer Name CINDY WAITE
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type i" t - Orr f Pretreatment Type i'" , ; / n-
>5ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A [ YES NO
>50ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ 9 ❑
Z >50ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - El El
F Cleanou[between building and tank? - - - - - - - - - - - - - - - - - - El ❑
U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
24" access risers over each compartment? - - - - - - - - ❑ ® ❑
WEfFluent ilter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - P El / El
A M�
Septic tank capacity (working) ,)( IAA gal Manufacturer
O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES �9 No
0J r ❑ ❑
O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - -
I?�Z Check valves installed? -)e- - - - - - - - - - - - - - - - - - - - - - - ❑ ❑
GQ
Z Transport Line Size J ' Schedule/Class _
Bedrooms installed (check one) ❑ 2 X 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft from foundation? - - - - - - - - - - - - - - - - - - ❑ NIA .❑AYES NO
0 >100 ft from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- ❑ ❑ ❑
W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ d ❑
LL >In ft frnm notable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ F
Z > 5ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ d ❑
> 30 ft from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑
O ❑
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ Q
❑ Graveless chambers or [� Clean gravel used? (check one)
Proper cover installed over dramfield?- - - - - - - - - - - - - - - - - — ❑ IJd ❑
Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ NIA Ea'YES ❑ No
`L Pump tank capacity (flood))( tom.._gal Manufacturer k IBC.!r ii "'ter'
Q24" access riser(s) and accessible from surface?-- - - - - - - - - - - - ❑ [a ❑
~ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - ❑ Ly Ela p
f Control Panel equipped with Timer I ETM (Counter- - - - - - - - - - - El El 001
axPump installed in ZBucket or ❑ On Block or ❑ Othery\
0-'(Pump Make/Model Lf g 617-V &Floats or ❑ Transducer l
a kTank draw down 2 it min Pump capacity yy gpm Squirt Height 1 ft
XPump on time Pump off time 3 C Daily Flow set at 3&V god
upda,rl W2R010
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? -- - - - - - - - - - - - -- ❑ YES - NO
Ir yes, please describe.
Were all components pumped out and property abandoned per WAC246-272A-03009 - - - - - - -- ❑ YES ❑ NO
RECORD DRAWING
This is a permanent record and must he accunU and aescrigiw drool to reawm In he read or memtemnw adll and future development Typical Record
isl' l
prawings tbnlein: nrainfl0ld fl manifold onanlalion d layout,Saplklpump lank bcelion.NanalerMw,reserve drainfNd,axing and prop0sad bee kings.Iwation of wels,wabflines,
wells,odaervarnn pads daanouls,and olM1er mainlerancs acceu poima. Incordoele Record Drawings may create addlfional delays in rural instellatwn apWoval and related permits.
❑ 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
I further certify that all information contained on this I further certify that all information contained on this
form and attach tl Record Drawing is accurate. form and attached Record Drawing is accurate.
A
Sign u oflnstaller Date
ue+` Pam✓ i ll �)
Tinted Name o/Signed
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
Mtrr`'�1"1 � II�IZvi
Signature of Environmental He Ith Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ol>ael.d e�zvgo+e
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