HomeMy WebLinkAboutSWG2022-00258 - SWG As-Built - 4/30/2024 (2) Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2022-00258 Parcel# 123215100017
Applicant Name Jennifer Crabb Subdivision (Name/Div/Block/Lot)
Applicant Address 120 NE Riverhill Lane Riverhill
City, State, Zip Belfair,WA 98528 Installer Name Jennifer(owner)and Steve Hupper
Site Address Same Designer Name Lawrence Purdum-Apex Septic De
INSTALLATION CHECKLIST
❑ Full System Installabon ❑Tank(s)Only N Drainfeld Only ❑Repair ❑Other
System Type Gravity drainfled replacement Pretreatment Type
>5ft. from foundation? --------------------------- QM/A El YES ❑ NO
>50ft.from wells? ------------------- - --------- ❑ ❑
Z >50ft.from surface water? ------ ------- --------- - - ® ❑ ❑
F Cleanout between building and tank? -------- ----------- ® ❑ ❑
U Tank baffles present? -- -- -- - --- - -- - ---- -- -- - ---- 0 ❑ ❑
a24'access risers over each compartment?--------- ------- ❑ e ❑
W Effluent filter installed?------ ------------ -------- - ® ❑ ❑
N
Septic tank capacity(working) 1200 gal Manufacturer Fred Hill 2-Compartment Tank
❑ D-box water level and speed levelers used? ---------- ----- ❑ NIA eyEs NO
OJ
LL Manifold/D-box accessible from surface?----------------- ❑ a El
InZ Check valves installed? - -------------------- ----- ® ❑ ❑
❑Q
f Transport Line Size 4" Schedule/Class ASTM D 3034
Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- ---- ----- -- ----- -- -- - --- ❑ MIA ® YES NO
❑ >100 ft.from wells?-------- - ---- --- - --- -- ❑ a ❑
W >100 ft.from surface water?- ------------ - - - - - - ----- ❑ ® ❑
LL >10 ft.from potable water lines?--------- -------- -- --- ❑ o ❑
ZZ > 5 ft.from property lines and easements?AseA
---- - -- ❑ o ❑
K >30 ft.from downgmdient curtain/foundaI �-R =E/-C ❑
❑ Drainfeld level and observation ports r -- - -- - r G D am ❑
® Graveless chambers or ❑ Clean �(�h�Lg
Proper cover installed over dreinfield?--0.4ASON000N1Y'ENVI ® ❑
Pump tank setbacks consistent with septic tank?----. $(III/----- NIA El YES ❑ NO
Y Pump tank capacity(flood) cal Manufacturer
Z 24°access riser(s)and accessible from surface?------------- N ❑ ❑
F- Alarm or Control Panel Installed? ---- -- ------- --- ---- 0 ❑ ❑
IL
f Control Panel equipped with Timer/ETM/Counter--- -- ----- - N ❑ ❑
7
0- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
d Pump Make/Model ❑ Floats or ❑ Transducer
a
Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump oft time Daily flow set at Opd
tw
Mason County OSS Installation Report pg. 2 Parcel# 123215100017
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ---- ---- -----— Q YES ❑ NO
If yes,please describe:Existin ravel and perforated pipes abandoned in lace.
Were all components pumped out and property abandoned per WAC246-272A-0300? -------- ❑ YES n/a ❑ NO
RECORD DRAWING
Thb Is a pemeneM ncoN mtl must Ee e¢unb antl WenlpHve snou9h to re'lacab In the need or mal"o none aglWtlo end rWure tlewlopmmt Typlal Remtl
Dm smnWin: Dnlnheld8menilW Manlatlun 8byoN,aeprtr mp Wki ltor.N.Munaw,reserve dmrIldd,mblinp aM xosed CWlengs.Issso-of wets,wtledlnes,
wells,oEsemewoors deamu6,eMot,W MWM,snws¢ sspoint. Imm�plebR dDm pm mMsddIMb del:cInfinel4wleaoneppmvlaNrelabelpemib.
peg ��P�NME
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I 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 bath 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 an this 1 further certify that all information contained on this
torn and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
6/22/202
Signature of Installer Date
AL
Steve Hopper -
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH .
The undersigned approves this Installation Report and
Record Dousing on behalf of Mason County Public S2€2sF6ocsicdca-
Health" o—ssoso-
(�
Sign, &of ' nmental Health Specialist Data (stamp, signature and date)
THIS FORM MAYBE SCANNEDANDAVNLABLE FOR PUSUC VIEW ON THE MASON COUNTY WEBSITE updaredemnata
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