HomeMy WebLinkAboutSWG2024-00193 - SWG As-Built - 7/29/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024- 00113 Parcel# 12305-21-00010
Applicant Name Timothy Whetsel Subdivision (Name/Div/Block/Lot)
Applicant Address 400 NE Ti Lake Rd
City, State, Zip Belfair. WA 98528 Installer Name Shae Olen
Site Address 382 NE Tiger Lake Rd Designer Nam Torn Weaver
INSTALLATION CHECKLIST
®Full System Installation ❑Tank($)Only ❑Draiofleld Only ❑Repair ❑pryer
System Type Pressure INetrea went Type Sepbc tank
>5 ft. from foundation? - ❑WA Myn ❑ 00
>50fl. from wells? -- - ------ - ------------------- ❑ 91 ❑
Z >50ft.from surface water? -- -- - - ----------------- - ❑ 91 ❑
fCleanout between building and tank? ___________________ ❑ ❑
V Tank baffles present? -- - - -- ----------- ---------- ❑ � ❑
4 24'access users over each compartment?--____________ _. ❑ El
Wy Effluent fitter installed'-___ _ ____ __ _ _ _____________- ❑ ® ❑
Septic tank size1,000 + 1,000gal Manufacturer Existing+One new tank Hagerman
0 D-box water level and speed levelers used? -________ _____. G1 WA ❑YES ❑ uo
OLL Manifold/D-box accessible from surface?-- -- ---_ __ ______ - Y❑F' ❑
O< Check valves installetl? -- - - - - - -- ---------------- -
f Transport Line Size 2 Schedule/CMss SCh 40 ❑
Bedrooms insisted(check one) (4 2 ❑33- ❑c4 ❑5 ❑6 ❑CommercieYOlher
>10 ft.from foundation?- ------2+'Zfof r-ouf uCYrOOm-- - ❑WA ®YES ❑ No
>100ft.from wells?--- - - -------------""---- -- - ❑ IN ❑
W >100kfrom surface wateO ----------------------- - ❑ ® ❑
M >10 ft.from potable water lines?----------- ❑ ® El
i >5ft from property lines and Easements?----- -- -------- . ❑ ® I]
a > 30 ft.from downgradient curtain/foundation drains?--_______- ❑ ® ❑
Drainfield level and observation ❑ ® El
Present -- - - ------ -- -
$7 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfieltl?- ------ - - - - - ----- - - ❑ ® ❑
Pump tank setbacks consistant with Septic tank?-- - - - - — - --_. ❑ WA ] Yes ❑ No
Z Pumptanks¢e 1,250 at Manufacturer Hagerman
f24'access nser(s)and accessible from surface?- - - - - - - - --_ _ . ❑ ❑
R Alarm or Control Panel Installed? - - - - - - - - - - - - -- - - -- - - . ❑ ❑ ❑
jControl Panel equipped with Timer/ETM/Counter-- ---- ----- ❑ ® ❑
G Pump installed in ❑ Bucket or ® On Block or ❑ Other
IL
Pump Make/Model OrenCo PF5010 Floats or ❑Transducer
a Tank draw down 2 in/min Pump capacity 40 opm Squirt Height 4 fl
Pump on time 2 Min Pump off time 4 Hours Daily flow set at 480 apd
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Mason County OSS Installation Report pg. 2 Parcel N
31904-56-00001
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 WAC246-272A-0300? - - - - - - - - ❑ YES ® No
RECORD DRAWING
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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 both the designer shown here have been cleamd/appfoved 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
form aached Record Drawing is accurate form and attached Record Drawing is accurate
., July 25, 2024
Signature of Installer Date
Shae Den
Pnnted Name of Signes
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and i'HOMtiSw�Ei,vEa,
Record Drawing on behalf of Mason County Public N N R'
Health
R77,
Signature of Envimnmental ealth Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upa.wd dn!nd.
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