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HomeMy WebLinkAboutSWG2023-00353 - SWG As-Built - 7/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024- Parcel# 12109-22-00012 Applicant Name J'Anna Frisby Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 833 City, State,Zip Belfair, WA 98528 Installer Name Tom Weaver Site Address 780 E Eckert Rd;GraOeview98546Designer Name Tom Weaver INSTALLATION CHECKLIST ❑ Full System Installation KI Tank(.)Only ❑Drainfield Only [:1 Repair ❑Other System Type Gravity Pretreatment Type >5 ft from foundation? - - ---------.--------- ❑WA K]YES ❑ NO >50ft.from wells? --- - - - - - - --- ----------------- ❑ KI ❑ Z >50ft.from surface water? - - --- - - - ---------------- ❑ 91 ❑ HCleanout between building and tank? -- ----------------- ❑ 91 ❑ O Tankbafespresent? - - - - --- --- - ---------------- ❑ K) ❑ 1 24'access risers over each compartment?---------------- ❑ K] El Lu N Effluent fitter installed? - -- ❑ ® ❑ Septic tank sae 1,250 gal Manufacturer Hagerman O D-box water level and speed levelers used? -Existing lMmcdified- - ❑WA ❑YES ] NO DO Manifold/D-box accessible from surface?-- -- - - - - ----- --- - ❑ DO ❑ R'Z Check valves installed? ------------- ------------- ® ❑ ❑ 0C f Transport Line Size 4" Sµ 3034 Bedrooms Installed(check one) ❑2 W 3 ❑4 ❑5 ❑6 ❑CommerpWADther >Wft.from foundation?-- --------------------- --- 4WA ❑yn ❑ No G >100 ft.from wells?--- - -- ----------------------- ❑ ❑ W >100 ft.from surface water?------------------------ ❑ ❑ M >10 ft.from potable water lines?---------------------- ® ❑ ❑ Q? >5ft.from property lines and easements?----- ----------- ® ❑ ❑ C > 30 ft. from downgradient curtain/foundation drains?---------- ® ❑ ❑ Drainfield level and observation ports present - - - -- ® ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?---- ------ --------- ® ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ® WA ❑ YES El NO ZPump tank sae at AMnufaeWrer f 24'access dser(s)and accessible from surface?------------- ❑ ❑ ❑ a Alarm or Control Panel Installed? -- - - - -- ---- - -- - ----- - ❑ ❑ ❑ Control Panel equipped with Timer!ETM/Counter-- --- - - - - -- ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other IL Pump Make/Model ❑F)oets or ❑Transducer 4 Tank draw down in/min Pump capacity kmm Squirt Height ft Pump on time Pump off time Daily flow set at gpd JPdaud W 11Qs Mason County OSS Installation Report pg. 2 Parcel u 1 21 09-22-0001 2 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? -- - -- - YES NO If yes, please describe: Were all components pumped out and property abandoned per WAC246272A-0300? --- - - - - - ® YES NO RECORD DRAWING Tnu b.p.rmmmr nc.ana row+M.ccunn ana an.n ..no 0 b nAac.n In M.n.M of m.mnn....<WHNs uM Nan an.lo . Tlk awve oc « unman'. p.xYwldammrtda wnuew I nwN d-ft +r.An... wee..m»nmm.on.,aauau.,.m om.r m.nNv�.w»pme.. InwmpMs a«dre omdrq.my Dees aesnon.l e.oys N nrel.uw.onn ypiow.na,.Nue o.nnlu. EX Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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/appioved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet ell Stale 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. Pone and attached Record Drawing is accurate. July 11, 2024 Signatrne o/Instauer ogre Tom Weaver Pnnlad Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health. 21gAU" - 701tZ l Signature of Environmental Heahh Specialist Date (Stamp,Signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY ME SITE u.dn<d u¢�rzd+a U E vV g 'mil - 0 m s � a a \ 5 �R ac z m s A: ' 1 1" = 20' 780 E Eckert Rd Gr 12109-22-00012 T