HomeMy WebLinkAboutSWG2023-00078 - SWG As-Built - 9/9/2024 Mason County OSS Installation Report pg. 7 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00078 Parcel# 123205000004
Applicant Name MJ SCOTT ENTERPRISES LLC, Subdivision (Name/Div/Block/Lot)
Applicant Address P 0 BOX 1 ?N
City, State, Zip BELFAIR WA 98528 Installer Name Franklin Clark-A+Onsite,LLC
Site Address 642 Old Belfair Hwy, BELFAIR WA 98528 Designer Name Franklin Clark-A+Onsite,LLC
INSTALLATION CHECKLIST
■ Full System Installation Tank Only El Drainfield Only ❑ Repair ❑Other
Low Ri�TschnddNles Pfetreafinent
System Type ascnR- 0 Type_
>5 ft.from foundation? -- - - ------ - - - ---- - - - -- - - QN/A ■YES ❑ NO
>50 ft. from wells? - - - -fff—E El 11
Y >50 ft.from surface water? -- - - - - - ❑
FZ uu
Cleanout between building and tank? 3- - - -pUG ❑ ■ ❑
U Tank baffles present? -- -- - - - - -- - - - - - 2j&- El ■ ❑
F 24"access risers over each compartment -- - - - - -- -- - - ❑ ■ El
W EHluentfilterinstalled?----- - --- - - By -.- - ❑ ❑ ■
to
Septic tank size 1,200 gal Manufacturer Infiltrator System
G D-box water level and speed levelers used? --- - - -- - ---- - - - ■ NA ❑ YES ❑ NO
QJ
0 ManifoldlD-box accessible from surface? - - - - --- ❑ ■ ❑
m= Check valves installed? - -- - - - -- -- - - -- - - - -- - -- - — - ❑ ❑ ■
OQ
f Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ■3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft, from foundation?-- - - - -- - -- - -- -- - -- -- - - - - -- ❑ NIA ■ YES NO
>100 ft. from wells?----- - - - --- --- - - - - - - - - - - - - -- ❑ ■ ❑
W >100 ft.from surface water?- - - - - - - ----- --- - -- - -- - - - ❑ ■ El
a >10 ft.from potable water lines?- - ----- - - - -- - --- ------
Z > 5ft. from property lines and easements?-- - - - -- - - - -- - -- - ❑ ■ ❑
G: > 30 ft.from downgradient curtain/foundation drains?- -- -- - - - - - ❑ ■ ❑
Drainfield level and observation ports present - -- - -- - - -- -- - - ❑ ■ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?--- - - - - ------ - -- - -- ❑ ■ ❑
Pump tank setbacks consistent with septic tank?- -- - --- - --- -- ❑ WA ■ YES ❑ No
Y Pump tank size 1,200 gal Manufacturer Infiltrator Sy9plD
Z 24"access risers)and accessible from surface?- - ---- - ------ ❑ ■ ❑
HEl
a Alarm or Control Panel lnsWlled? - - ---- - ---- --- - --- - - ❑ ■
Control Panel equipped with Timer/ETM/Counter- - - - - - - -- -- ❑ ■ ❑
Il Pump installed in ❑ Bucket or ❑ Bottom of tank re design specifications On Block or ■ Other P 9
0. Pump Make/Model LomidgeTechnologies,lRHp,110V,Model LOT-30 ■ Floats or El Transducer
a Tank draw down 2.1 gpm in/min Pump capacity 30GPM opm Squirt Height N/A ft
Pump on time 22 secs Pump off time 3 mins 38 secs Daily flow Set at 360 apd
Vpb,eE W imis
Mason County OSS Installation Report pg. 2 Parcel It 123205000004
ABANDONMENT RECORD
Were any existing septic components abadoned as part of this project? --- -- -- ❑ YES NO
If yes, please describe:
Were all components pumped out and propedy abandoned per WAC246272A-0300? -- -- ---- ❑ YES NO
RECORD DRAWING
TLi.Is a u nnamnt asand and must W aaunb add descaptire enough to in Innate In Me neM of mainRnanca.oved&s and Ntum di nlWassi Typ®I reemN
Drawings careen. DmnFew 6 manifold adenb4m 6lrycuk segk/pmry lank Icmdon,North anew,maeree dlanaea,ewAy and pcyxd[unangs k' onn of wens,watemnes,
wtlls,observation pals,deswub,and other mnshenands avxa ptinb. Inananane Reand Dmnings my urvale addl4mal de Ws in final insulalon.ypovdl and related dermas.
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 clearad(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 earthy,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.
C QWA , 02Auq 2024
Signature of Installer Date
Franklin Clark-A+Onsite,LUC .:
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH ;.
The undersigned approves this Installation Report and rnwax�wnx ..
Record Drawing on behalf of Mason County Public
gemv2omn
Health: rat(11 L.i,vt
shgnaN Spe
cialist [Dal to (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE urmlee dmrzple
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