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Home My WebLink AboutSWG2024-00077 - SWG As-Built - 7/3/2024 -.Masora County OSS Installation Report pg. 1 MASON COUNTY PUB EALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2L DDC'5-77 Parcel# 122061490010 Applicant Name ,DONALD CLARK Subdivision(Name/Div/BlocklLOt W Applicant Address 21010 E STATE ROUTE 3 �� 4 City, State, Zip BELFAIR WA 9a528 Installer Name Site Address 21810 ESTATE ROUTE 3 Designer Name dim Zmn INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑Dralnfield Only ❑Repair ❑Other System Type Pressure Distribution Pretreatment Type >5ft.from foundation? ------------ --- ----------- - [I WA ®YES ❑ No >50ft. from wells? ----- ----- ---- --------------- ❑ ® ❑ Z >50ft. from surface water? ---- -- - -- - ------- -- - ---- ❑ ® ❑ Q� Cleanout between building and tank? ------ --- ---------- ❑ ® El Tank baffles present? --- -- ---- ------ ---- ❑ ® ❑ 1 24"access risers over each compartment?-- ------ -------- ❑ ® ❑ � Effluent filler installed?- ------------ - --- -- -------- ❑ ® ❑ Septic tank capacity(working) 1250 gal Manufacturer Hagerman o D-box water level and speed levelers used? -- ----- --- ----- ® NIA ❑YES NO �O Manifokf/D-box accessible from surface?- - -- ----- -------- ❑ ❑ oQ Check valves installed? ----------- -------------- - ❑ ® ❑ Z Transport Line Size 2" Schedule/Class Such 40 Bedrooms installed (check one) ❑ 2 ❑3 Q 4 ❑5 ❑6 ❑Commercial/Other >10 ft. from foundation?---- -- ---- -- ❑ NIA ® YES NO 0 >100 ft. from wells?-------------- --------------- ❑ ® ❑ W >100 ft. from surface water? ---------------- -------- ❑ ® ❑ LL >10ft.from potable water lines?-------------- -------- ❑ ® ❑ Z > 5ft. from property lines and easements?---- - ----------- ❑ ® ❑ > 30 ft.from downgradient cudainlfoundalion drains?---- ----- - ❑ ❑ Drainfield level and observation ports present - -- -- ❑ ❑ E Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------ -------- ---- - ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NIA ® YES ❑ No Y Pump tank capacity(flood) 1250 at Manufacturer Hagemian Z F24"access riser(s)and accessible from surface?. - --- --- --- -- ❑ ❑ a Alarm or Control Panel Installed? --------------- ------ ❑ ❑ Control Panel equipped with Timer/ETM/Counter- - --------- ❑ ❑ IL Pump Installed in ® Bucket or ❑ On Block or ❑ Other IL Pump Make/Model Liberty 290 ®Floats or ❑Transducer jL Tank draw down 3 In/min Pump capacity 60 gpm Squid Height 5 ry Pump on tlme 1 min Pump off!line 4 hrs Daily(low set at 360 gpd eIUM NJVxna Mason County OSS Installation Report pg- 2 Parcel lk l27_O� Iuq D�\ � ABANDONMENTRECORD Were existing septic components abandoned as part of this pro*cv ------- U'YEa NO If yes, please describe: Were all components pumped ouland property abandoned per WAC246-272A-03009-------- ` YES ❑ NO RECORD DRAWING This Is a pert arms,rewril and must fie aaunOv and descriptive tumults to rea«are In the fixed a rrre ssmance actteales and rubrn damai meat Typtwl RemN Orevnnea mntaln: GNneeke manifold aienmtion aleymut,eeplitlyumplaNmFean,Nmtb mmw,meervedmae addxl,aldaina gnpoal berabon,m®Wn awemaxistninee, wells,oMervation purls,ahaimuk,entl oNer malntanMm emeea pNnd. Inmmplelm Remtl Dra+Arps niaycraaln addAimreltlNays In foal Installation approval entl reWtetl permlle. J 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 Mason County Public Health and that any deviations here have been clearedrapproved by both the design, 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 ;form7arry etache e o tl Dr i -rurete. form end attached Record Drawing Is accurate. fure n �Iter /�/eCe 1�.O la rlL , Primed Neme of Signee ' i; MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public ucds rie�p'",rs Health:C) I' Signature ofEnvlronmanta/061th Specialist Data (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE emhRd Nalnola M F 2 N w o Q owm - - p a _—___—__ r 710' 1••� H2O Li e APP ,O\JE 10 o ;--�- 1Ul 0 � u 1 UN o 0 0 1 NRONMENTAINEf N [EEw o M ; M , rl ; ilin DF 1 = ,£91 &w F \ a h - o Q I y c 1 � 1 r I 1 � 1 1 L-ja x- '--1 I � ._ L�___-- Z4�tA �3