HomeMy WebLinkAboutSWG2023-00491 - SWG As-Built - 9/23/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLI ALTH
APPLICxANT/ PERMIT INFORMATION
Permit Number SwG 1,07-S- )Parcel# 22310-79-90661 S
Applicant Name BONNIE MILLER Subdivision (Name/Div/Block/Lot) R �J
Applicant Address 7198 WINTERBERRY Pl.NW FCF� 10
City, State, Zip SEABECK,WA 98380 Installer Name BCS DEVELOPMENT LLC
Site Address 791 NE BLACKSMITH DR Designer Name BRANDON JONES
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type PRESSURE Pretreatment Type
>5 ft.from foundation? ------------------ --------- ❑N/A ®YES ❑ NO
>50ft.from wells? ----- ----------- ------ - ------- ❑ Q ❑
Z >50 ft.from surface water? ---- ------- --- - -- - -- ---- ❑ IN ❑
HCleanout between building and tank? ---- ---- ----------- ❑ 0 ❑
U Tank baffles present? --- - -- - -- -- ❑ ❑
a24"access risers over each compartment?-- ------ ------- - ❑ ❑
W Effluent filter installed?---- - ----- - ---- - --- - ❑ e ❑
a)
Septic tank capacity(working) cal Manufacturer
O D-box water level and speed levelers used? -- ------ ------ - eWA [I YES ❑ NO
0J
0 Manifold/D-box accessible from surface?------- --------- - ❑ e ❑
°OZ Check valves installed? ------------- -- - ----- - - --- ❑ . ❑
CQ
M Transport Line Size 2- Schedule/Class 40
Bedrooms installed(check one) ❑ 2 M 3 ❑4 ❑5 ❑6 ❑CommerciaVOther
>10ft.from foundation?---------- --- - --- - - ❑ NIA E YES ❑ NO
C >100 ft.from wells?--- ---------- - - ----- ------- -. ❑ M ❑
W >100 ft.from surface water!---------- ------------- - ❑ IN ❑
u. >10ft.from potable water lines?--------------------- - ❑ e ❑
QZ >5ft.from property lines and easemenis?------- ------- -- ❑ e ❑
LL' >30ft.from downgradient curtain/foundation drains?--------- - e ❑ ❑
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
Z Pump tank capacity(flood) 1250 at Manufacturer HAGERMAN PRECAST
Q 24"access riser(s)and accessible from surface?-------- ----- ❑ E ❑
F
C Alarm or Control Panel Installed? ---- ------ - ------ --- - ❑ ® ❑
Control Panel equipped with Timer I ETM/Counter---------- - ❑ e ❑
7
a Pump installed in ❑ Bucket or ❑ On Bock or ® Other FLOW INDUCER
a Pump Make/Model ORENCO PF30011 ® Floats or ❑ Transducer
a
Tank draw down 1.375 in/min Pump capacity 33 opm Squirt Height 5 ft
Pumpontime 55sec Pumpofltime 2hrs Daily flow set at 360 opd
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Mason County OSS Installation Report pg. 2 Parcel li 22310-79-90661
ABANDONMENT RECORD
Were erusbng septic components abandoned as part of this project? ❑ YES 8 NO
If yes, please describe: N/A
Were all components pumped out and property abandoned per WAC246-272A-03009 -------- ❑ YES ® NO
RECORD DRAWING
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0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with l certify,that fie system has been installed in accor-
the septic design stamped'APPRO VED'by Mason dance with fhe septic design stamped'APPROVED'by
County Pudic Health and that any deviations shown Mason County Public Health and that any deviations
hem have been clearerUappnxved by both the designer shown here have been cleare&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 Meson County Codes
l fudhercerbi that all information contain on this I further certify that all information contained on this
form and attached Record Drawin = accurate. Imm and attached Record Drawing is accurate.
7/12/2024
Signature oflnstaller Date
Bill Bumbabuch 1` 'f
Printed Name of Sign"
MASON COUNTY PUBLIC HEALTH
14 ' :•A
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public Sy
d
Health:,(�� r, ����/� (� h-7 ;;••�CpD4pn, R;,Janes.,}.
KJ.1Vlry' W° vT t " "J� 9/16/2024
Signature ofEnvirOdran I Health Specialist Dab (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Dpd+admumle
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