Loading...
HomeMy WebLinkAboutSWG2023-00089 - SWG As-Built - 8/20/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00089 Parcel # 32232-50-88016 Applicant Name Gene Roberts Subdivision (Name/Div/Block/Lot) Applicant Address 193E Ore Nobles Rd UNION HOOD CANAL LAND&IMP CO BLK:88 LOT116 City, State, Zip Union WA 98592 _ Installer Name Union City Enterprises Site Address same Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfieltl Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? -- -- �-- tC - - ---- ❑ NrA ■Yes ❑ NO >50ft.from wells? - - - - - - - - - -- - -- - - - - - - - - - - - ---- ❑ ❑ Y >50ft.from surface water? - - --- - - - - - - - - - --- -.- --- -- ❑ ® ❑ z NCleanout between building and tank? --- - - - - - -- - --- - - --- ❑ ® ❑ U Tank baffles present? - - - - - - - --- - - -— - --- - --- - - --- ❑ ® ❑ 1 24'access risers over each compartment?- - - - - ---- - - ----- ❑ ® ❑ W Effluent filter installed?- - -- - - - - ---- - - - - --- - - - ----' ❑ ® ❑ N Septic tank capacity(working) 1000 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? --------------- ❑ NIA ❑ YES NO �J ❑ ❑ O Manifold/D-box accessible from surface? - - ---- mz Check valves installed? - - -- - - - - ---- - ---- - - - - - -- -- ❑ 0 ❑ oa f Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑CommerciallOther >10 ft. from foundation?- - - - --- -- ❑ NIA ® Yes ❑ NO ,��act � >100 ft.from wells?- ---- - -- -�-- - ❑ � ❑ J >100 ft.from surface water?- - - - - - --------------- - - - ❑ © ❑ a >70ft.from potable water lines?- -- --- - --- --------- - - - ❑ 0 ❑ > 5ft.from property lines and easements?- - - -- - - - - ----- - - ❑ © ❑ K > 30 ft.from downgradient cultainifoundation drains?- --- - --- - - ❑ ® ❑ Drainfieltl level and observation ports present --- -- ❑ 0 ❑ ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?--- - -- - --- - --- -- -- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- ---- - --- --- ❑ NIA ® Yes ❑ NO `.L Pump tank capacity(flood) 1000 gal Manufacturer Hagerman Q24-access risers)and accessible from surface?---- --- ------ ❑ ❑ ~ ❑ El or Control Panel Instilled? - ---- --- ----------- 2 Control Panel equipped with Timer/ETM/Counter--- - - - - ---- ❑ ❑ 7 a Pump installed in ❑ Bucket or 0 On Block or ❑ Other a Pump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 6 ft Pump on time 1.5min Pump off time 6hr. Daily flow set at 240 gpd ure.roa ea�ao+e Mason County OSS Installation Report pg. 2 Parcel# 3ZZ3 - 50- 880ib ABANDONMENT RECORD 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 WAC246272A-0300? ------ - - ❑ YES ❑ NO RECORD DRAWING This is a pt,manent r c and must as accurate and dw ipJve en-a,b ra-IeckY in Me naeE el mainbnNnca ac],111-and Noun davalopmem. Typical RewN IXaNnya mMain: Dnlnfidd&mandold onenudon a layout 5epW ump dank bmtian.Nwtn anc ,,roaeM daunhNd.sananq and proWaeG dawn's,Indaudd awalla.walaelinaa, wells.odwrvadon pens.deenaW,and oNxmaintanance e.Wae Wi^b. ln<ompleie RemM Oms+npe mayaule Mdidmal de"in rnal initiation,approval and is.pa—ft. See a } ached 0 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I car*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 clearedrapproved 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. - nature of Installer Date illta S � nlmonC �_.W vv` ` Printed Name of Signse MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and PAULASJpI JpHNSON'. Record Drawing on behallof Mason CountyPublic ' 'ICY316E I Hearth:r �. �^, 1IZ-D�V p -I I Z� Signature of Environmental Health Specialist Dam (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTYWEB SITE �pi1p°�12010 . (��lh O Audio-V�suel Alnxa. © Cieanou: © 1000 0u=Septic Tank WeD 2-Computam<vrzN s"P. ad Al,-iian.,l PraioeS� E9tumt Flra 1000 GaU=Pump Chamber 1 OS Valw Control Heat o 28 X40' f—k J F l lam • r e{•ect .� . f ovn JetiLcle+rc�f;c �.� y' „oo s iG EYtN" PAUTA JOV JOM.. qq,.�� s� n N - 3223Z-56-401� E"cem biped —� 32232-So -fl9G1to t ; -� zs j/ �J �rJp �Y` NO ✓• E. TY.e �eS@ E3J o.C . w ;) {+1 rese�de bs1Du Zo� I-F ^A s buJI t Sleeve VA econe _�anv��`� 322�Z-60-88Ci(o when with n 10 �f t4� E orr� Nobles Rd op Qnj Sepi c Component 11 n o 1�A 98S9Z NOFOU ,MO,„ APPROVED ►R AVY1f 024 RYE AUGOF 20 2 MASON COUNTY ENVIRONYBIAL REAM RET