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HomeMy WebLinkAboutSWG2023-00181 - SWG As-Built - 8/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SwG 2023-00181 Parcel# 12332-52-00003 Applicant Name Stephen Harris Subdivision(Name/Div/Block/Lot) Applicant Address 945 Ea le Crest PI yy City, State,Zip Port Orchard WA kS366 �'I sta ame Tony Robinson Site Address 61 NE Daybreak D Belfair,WA • (04ig Name Rod Left I STALLATION CHEC '1ST-' 0 Full System Installation ❑Tank(s) Tlrzmfeld Only ❑Repair ❑Other System Type Standard Pressure Pretreatment Type >5 ft.from foundation? --------------------------- ❑ NIA AYES NO >50 R.from wells? ----------------------------- ❑ ® ❑ Y >50R.from surface water? -----------"------------- El ❑ Z FCleanout between building and tank? ------------------- ❑ x ❑ O Tank baffles present? --------------------------- ❑ W ❑ d 24"access risers over each compartment?---- ---- ❑ ❑� El w. '. Effluent filter installed?-- --------------- ❑ inI' Septic tank size 1250 gal Manufacturer Hagerman ❑ D-box water level and speed levelers used? --------------- BWA ❑YES ❑ NO 0J 00: Man''rfold/D-box accessible from surface?--- ------- ❑ e ❑ mz Check valves installed? -------------------------- ❑ ❑ M ❑¢ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other 110ft.from foundation?-------------------------- ❑ WA ®YES ❑ No ❑ „1100 ft.from wells?--------------------- ❑ ® ❑ J ` >100 ft.from surface water?------------------------ ❑ ® ❑ W a ' >10ft.from potable water lines?---------------------- ❑ 0 ❑ Z >5 ft.from property lines and easements?----------- ----- of >30 ft.from downgredient curtain/foundation drain?---------- ❑ © ❑ ❑_ Drainfield level and observation ports present -------------- ❑ ® ❑ - ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ❑ Pump tank setbacks consistent with septictank?------------- ❑ WA © YES ❑ No Y Pump tank size 1250 at Manufacturer Hagerman QC.24"access risers)and accessible from surface?----- ❑ ® ❑ H aJ3.Alarm or Control Panel Installed? --------------------- ❑ � ❑ "Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ 7 p.. . Pump installed in N Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty 280 ® Floats or ❑Transducer a Tank draw down 1.5" in/min Pump capacity 39 gpm Squirt Height 6'+ ft Pump on time !min 9sec Pump oR6me 3hm Daily flow set at 358 gpd u'a eamao'e Mason County OSS Installation Report pg. 2 Parcel u 12332-52-00003 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 property abandoned per WAC246-272A-0300? ------- - ❑ YES ❑ NO RECORD DRAWING This is a pam anent record and must be accurate and cascrigim enough to reaaente in the need of maitdmunce acthnfies and Mues deMa anent T,W.l Recant Drea9ga.rah: IXa1nMW 8manlfoW odentatlon SIay.W,SepWWmptankioWn,NOMan ,,reservedminfieW,existingaMpmpwdbWldii ,,bmlbnofwIN,wterllnes, tells,of tbnpodsc anoutaaMordermalnknanmave pWN. l�lele Re dpa Msmayanteadditlonaldelays In Pastln utionapmo laMrelatedp MI&. ty 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 Geafed/approved by both the designer shown here have been c/eamd/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 1 further certify that all information contained on this I further certify that all information contained on this form and attached RecordDrawing is accurate. form and attached Record Drawing is accurate. �-` M'-Z9i( 7-30-2024 Sign ture of Installer Date Tony Robinson Printed Name of Signee MASON COUNTY PUBLIC HEALTH *EUXPIRE01 Tire undersi ned a roves this Installation Re rt and 9 PP Pd Record Drawing on behaHofMason CountyPublicHealth: R Sig�re of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VVES SITE uptlMtl Mlotdit ; a : § ; ; - x > cZ > q 0 > § \ ) ) ) | o § ! § ; 9m \ M j \ > \/ 0 e« § cmdwa > ® f 71 7 $ $ 0 (51 cm > z Do > ) �p } \ / { kk ml p \ 2 \ / § § \\ , § ! ! m ; m% % § K \/ G) ; 22 C: . §2 §> 0 Uf\( I § d \; 2 Oz co ; f{� @0 /\ a/ / C/)m , eeae & & io t j \ $ ( i ! § Z { § § o / \ § \©\ ( 0 v \ / k � � � . ( M ® 4 2 = § m § $ ) co : m � \ { % CO _ « . . . . . . ca co ( § \ } AS > � mK G / -0 _ D . C/) m 2 � Cl) a J@ \ / G) 3 \ \ / {\ / / \ , � 90rn / D \ § $ _ 2 % ,