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HomeMy WebLinkAboutSWG2024-00285 - SWG As-Built - 7/18/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SVVG 2024-00285 Parcel# 123162390000 Applicant Name I Adams Dark B BKarem E Subdivision (Name/Div/Block/Lot) Applicant Address) 2402 Ne Old Belfair HWY City, State, Zip Belfair We 98528 Installer Name Shumaker Construction Site Address 12402 NE Old Belfair HWY Designer Name INSTALLATION CHECKLIST ❑ Full System Installation Tanks)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pump to Gravity Pretreatment Type >5 ft.from foundation? ---------------------------- ❑IllA ■YES ❑ NO >SOft.from wells? ---------------------------- - ❑ ■ El>son.tromsurtacewate(l - __ __ __ _________________ ❑ 0 El F Cleanout between building and tank? ------------------ - ❑ N ❑ O Tank baffles present? - -- ---- ------ -------------- ❑ ■ ❑ a24'access risers over each compartment?-- _____________. ❑ ❑ LILI H Effluent filter installed?-_____________ ___ ___ _ _ _ _ __ - ❑ ® ❑ Septic tank capacity(working) 1250 gal Manufacturer Norwesoo �o D-box water level and speed levelers used? -- ------ --- - - - . eNtA ❑YES ❑ NO OLL Manifold/D-box accessible from surface?-- - ------------- - ® ❑ ❑ GQ Check valves installed? - - - -- - --- - -- - ------------ - ❑ ❑ ❑ 2 Transport Line Size 2- Schedule/Clasa 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑5 ❑S ❑Commeroial/Other >10ft.from foundation?------------------------- - � WA ❑ YES NO G >100 ft from wells?-___________________________- ❑ ❑ W >100 ft.from surface water?---------------- -------- S ❑ Elfy >10ft.from potable water lines?-------------- -------- ❑ ❑ Z >5ft.from property lines and easements?---------- ----- - ❑ >30ft.from downgradient curtain/foundation drains?---------- ® ❑ ❑ O Drainfield level and observation ports present ---- - e ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dreinneld?------------------ . 0 ❑ ❑ Pump tank setbacks consistent with septic tank?--------- ___ . ❑ NIA YES ❑ NO Y Pump tank capacity(flood) 1060 gal Manufacturer Roth 2 r24-access nser(s)and accessible from surface?--------- --- - ❑ ❑ C Alarm or Control Panel Installed? -- ----------- -------- ❑ ❑ Control Panel equipped with Timer)ETM/Counter--- -------- ❑ ❑ a Pump installed in M Bucket or ❑ On Block or ❑ Other IL Pump Make/Model Liberty 2800 Floats or ❑Transducer d Tank draw down 1.5 in/min Pumpcapacity. 50 gpm Squirt Height N!A n Pump on time demand Pump off time Daily flow set al 360 gpd Mason County OSS Installation Report pg. 2 Parcel tt 123162390000 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? ----- -- Q YES No If yes, please describe; Were all components pumped out and Properly abandoned per WAC24ti-272A-0300? -- - ---- - Q YES ❑ NO RECORD DRAWING Tha Is a prmanant ncaid a"must to a.m.and ancrlpllw enough to rHocats In me mad m malmumans.cuald.s,ad lulus E,wbpmam. Typwl Rewnl orewings wnbm: Drama a mamrad pkmabon a layer septiupmip unk gwpon,rvoM mm inane dRlnkid,simian,and x aaa,lluM;ys.kntlan M Werq µs's,m . wails,ebsr fion ppb,cbanwls.and manor malmenaMaxcesapovYs. Inwmplam Rewm Dnwirys may amain,eMNwldNM a final mNallalen approval and nomad pemdk. N Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI 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 Meson 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 /oral and site ecord cawing is accurate, form and attached Record Drawing is accurate. Signafulre[/of lnso,ler`/�/ Date / rJ7YUl1 l K� G Lr+&— Printed Name of Sigmas MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behaMof Mason County Public Health: W(bjZ.,K Signature of Environment l Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uam-WIlnu, • 990' p Q N ° uJ �I1 < V YI i s RO AFp VED m $ MASO JUL 03 2024 NCOUH1yERV�ROHMEWAL HEALTH' A z$ aTN AYa '. .[i pd . 4'Sv1,f1 a 00 fx c rt. a 2 m 1 4 � ly 0 • �� APPROVED f0oli JUL 18 2024 tiY MASON COUNTVENVIRONMENiALHEAU<< ,a• RET ,o"