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HomeMy WebLinkAboutSWG2023-00181 - SWG As-Built - 8/6/2024 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00181 WW_ I# 12332-52-00003 Applicant Name Ste hen Harr ivision(Name/Div/Block/Lot) Applicant Address 945 Ea Is Cm ni"t City, State,Zip Port Orchard, 8366 Instal r Name Tony Robinson Site Address 61 NE Da rea D Belfai signer Name Rod Left -- INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Standard Pressure Pretreatment Type >5ft.from foundation? --------------------------- ❑ WA QVES ❑ NO >50ft.from wells? ----------------------------- ❑ 0 ❑ Y ; >50ft.from surface water? ------------------------ ❑ ❑ z QCleanout between building and tank? ------------------- ❑ ❑ U Tank baffles present? --------------------------- ❑ ❑f• ❑ r- 24"access risers over each compartment?---------------- ❑ ❑� ❑ W Effluent filter installed?--------------------------- ❑ ❑� ❑ N Septic tank size 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? --------------- MNIA ❑vas ❑ NO 0J , OO.. Manifold/D-box accessible from surface?----------------- ❑ ❑ 095E Check valves installed? -------------------------- ❑ ❑ ❑� o¢ � Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ❑2 ❑N 3 ❑4 ❑5 ❑6 ❑Commercial/Other >10ft.from foundation?-------- -- - --------------- ❑ WA ryas NO >100 ft.from wells?---------------- ------------- ❑ W >100 ft.from surface water?----------- ------------- El a >10ft.from potable water lines?---------------------- ❑ IN ❑ Z >5 ft.from property lines and easements?---------------- El K > 30 ft.from downgredient curtain/foundation drains?---------- ❑ ® ❑ 0 Draintield level and observation ports present-------------- ❑ © ❑ OR GGraveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ N ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NrA EYES ❑ No Pump tank size 1250 at Manufacturer Hagerman Z Q 24"access risers)and accessible from surface?------------- ❑ ~ Alarm or Control Panel Installed? --------------------- ❑ ❑ a Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ a Pump installed in e Bucket or ❑ On Block or ❑ Other a Pump Make/Model Uberty 280 8 Floats or ❑Transducer a Tank draw down 1.5" in/min Pump capacity 39 gpm Squirt Height 61+ ft Pump on time 1 min 9see Pump off fime ahirs Daily flow set at 3511 gpd v .flaw... Mason County OSS Installation Report pg. 2 Parcel# 12332-52-00003 ABANDONMENTRECORD ' Were existing septic components abandoned as part of this project? --------- --- -— ❑ YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ------- - YES NO RECORD DRAWING Tab Is a manent recow and mud ae accurate and descriptive enough to rvt de in the need of maintenance actiNdes and allure development. Typical Record DMWWS wouh: ominfeld&maolbN oaentetion&IayoN,sepwpumpunk Wv ion,Noaa anmv,remrve doinfiek,evdiy aM pmp uad oufdhgs,loa4on ofools xetadioea, vrelW,ataervation ports,ckenoulq aM omen mainkmna ears points. Incompkte Record Onnno s may ueate eddlaonel delays In final Ir atamoo appmnl and mated pen ft Ly Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 cfearediapproved 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 RecordDrawing is accurate. form and attached Record Drawing is accurate. e` 07--/.le/rv�--- 7-30-2024 Sign Aura of Installer Date AA Tony Robinson Printed Name of Signee MASON COUNTY PUBLIC HEALTH r_� The undersigned approves this Installation Report and uceuego sldsR `k, Record Drawing on beha/fofMason County Public szwnec rent Health: Signature of Envintintrafritill Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE upa,Wa vttrmta ( m � M. § k � 0 mm 2 ) < ] K2 q ( � �F *# )22\9 M .2 eaAm > m§ ! $ 9 $/ m cmn mo p® O m -> Oz «> - - } ) �o ) T \� O m 0 / o2Ek ) %$ cn ) ( � ) \ § /jcn % m m § \� ) m § § §\ \ § � m \\ ` Q � M \( Z § % a* � 0 _\ �a } co� . ease 63 § / 0oA0 '09 c zj 0 § ' \ \ 0 ; b / ^ . z � � m , \ w + z c § ) \\ Mo § f ` @ 7 § e « \ � § \ E . -. .3 . _ . . . . . . . co ( = c _ ( § / j . ,........... .. \ > R ) ( � � { ) ■ cn § k , f � § \ G) m . \ \( ` � ` ^ Ti § � & . c )\ ®Gm ° 2 (%