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HomeMy WebLinkAboutSWG2022-00526 - SWG As-Built - 8/2/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY P B HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00526 Parcel# 420224490033 Uri Applicant Name Morgan Davidson Subdivision (Name/Div/Block/Lot) RFCFy� �1G Applicant Address 1422 Milbanke Or SE FO City, State, Zip Lacey, WA 98513 Installer Name So Russell Site Address 111 Fairwind Lane Designer Name Adam Hunter INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Dreinfield Only ❑Repair ❑Other System Type Pressure Trench Pretreatment Type N/A >5 ft.from foundation? - - - - -- - - - - - - ❑ NIA x❑ YES NO >50 ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ © ❑ 2 >50 Q.from surface water? - - - - El0 El FCleanout between building and tank? - - - - - - - - - - - - - - - - - -- ❑ ® ❑ U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ x❑ ❑ t- 24"access risers over each compartment?- - - - - - - - - - - - - - - - El ❑x El 0. LLl Effluent filter installed?- - - - - - - - - - - - -- - - - - - -- - - - - - - ❑ x❑ ❑ in Septic tank capacity(working) 1200 gal Manufacturer Existing 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - © NIA ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - - - - - - - ❑ ® ❑ r?Z Check valves installed? ❑ ❑ �Q t Transport Line Size 2 Schedule/Class Sch.40 Bedrooms installed (check one) ❑ 2 x❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - ❑ NIA ❑x YES ❑ NO >100 ft. from wells?- -- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑x ❑ W >100 ft. from surface water? - - - - - - - - - - - - - - ❑ El El LL >10ft. from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ El0 Z > 5ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑ © ❑ K > 30 ft.from downgradient curtain/foundation drains? - - - ❑ x❑ ❑ Drainficld level and observation ports present - - - - - - - - - - - - - - ❑ Q ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfeld? - ❑ ❑x ❑ Pump tank setbacks consistent with septic tank?- - - - - - - - - - - - - ❑ NIA ❑x YES ❑ No Y Pump tank capacity(Flood) 1200 at Manufacturer Sound Placement Q 24' access risers)and accessible from surface?- - - - - - - - - - - -- El ID El~ Alarm or Control Panel Installed? - - - ❑ ® ❑ a � Control Panel equipped with Timer I ETM /Counter- - - - - - - - - - - ❑ ❑ ❑ a Pump installed in ❑ Bucket or FA] On Block or ❑ Other 1 Pump Make/Model Zoeller N152 ❑x Floats or ❑ Transducer a Tank draw down 3 in/min Pump capacity 72 gpm Squirt Height 8 ft Pump on time l min 10 sec Pump off time 4hours Daily flow set at 480 glad 11,1n1eJ 11192rl3 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - - -- ❑ YES Q NO If yes, please describe. Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- ❑ YES © NO RECORD DRAWING TMs Is a pmmarrain record and must be accurate and desculdive enough to re-meow In the need of malnlenanee acurmes and furore deve ent.lopm Typical Record [)—,os center,, Droned&Mentionodena 81v ssuo, rmcut bran- Noi .clericssocon,andpmpo doley mcad I rUhr-. we ld.observation cnre aea mule,and other maintenance .nss orbits. 1—ouNare RPL d Drewing,me,runeeUni d too n! i II -n nuowi noruIcied rent © 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 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. o. FlsSSJ 5/31/2024 Signature or Installer Data Ba Russell Printed Name of Signed N 8/1/24 MASON COUNTY PUBLIC HEALTH 400s The undersigned approves this Installation d Record Drawing on behalf of/4pson Cmmy Pu,511 v Healer �C v , 6��Q1G L„0 26 Signature of Environmental Health Specielisf O114 F, (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILAB 4,PR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uodewd9 off a RECORD DRAWING continued IN S 4�1 ® „ coy o✓Q�J , �o� � '� - � - ,, �- :, a N I mo N � � u , � u � Z 3 '� p w � _ p _ ' _ �� l C'a� _ � _. __.. i jjj)4 3 � ti m �� to o�' �. �� 3' _ �'" � ° ° ,. w w _ _ � E a - � e m a — �, :. ., -. '� I � �e. � �� �;..� �I g � i Z uti N N W 6 K � i W Z I � � d I —S IL