HomeMy WebLinkAboutSWG2023-00456 - SWG As-Built - 9/19/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00456 Parcel# 12317-43-00090
Applicant Name TUESDEE MESSER Subdivision(Name/DivBlocklLot)
Applicant Address 1670 OLD BELFAIR HWY
City, State,Zip BELFAIR,WA 98528 Installer Name ABBA EXCAVATING LLC
Site Address 1670 OLD BELFAIR HWY Designer Name APDESIGNS
INSTALLATION CHECKLIST
Full Syetem Installation ❑Tank(s)ONy ❑ Dramnelil Only ❑Repeir ❑Omer
System Type GRAVITY BED Pretreatment Type r% f
>5 ft.from foundation? --------------------------- ❑WA YES [I NON
>50ftfrom wells? ---------------------------- - ❑ M ❑
Z >50ft.from surface wateR ------------------------ ❑ ❑
r Cleanout between building andtank? ------------------. ❑ ❑
U Tank baffles present? ------------------ ❑ ❑
6~. 24'access risers over each comparbnem?--------------- -
❑ ❑
LU N Effluent filter installed? ---------------.- ❑ ❑
Septic tank capacity(working) 1250 ml Manufacturer HAGERMAN PRECAST
0 D-box water level and speed levelers used? -------------- - ❑N/A ■YES No
00 Man4. ifold/D-box accessible from surface?----------------
- ❑ e ❑
QQCheck valves installed? ------------------ ❑ ❑
f Transport Line Size 4- Schedule/Class 3034
Bedrooms installed(check one) ❑2 ®3 ❑4 ❑5 ❑6 000mmercia6Other
>10 R from foundation?-________________________- ❑ N/A EYES No
l] >100111.from wells?--___________________________ ❑ 0 ❑
W >100ft.from surface"iteR-_______________________ ❑ ❑
ti >10ft.from potable water lines?---------------------- ❑ ❑
QZ >5ft from property lines and easements?---------------- ❑ IN ❑
K >30 ft.from downgmdient curtaiNfoundation drains?---------- ® ❑ ❑
0 D2lnfield level and observation ports present -------------- ❑ IN ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?-- ----------------- ❑ ® ❑
Pump tank setbacks consistent with septic tank? ---- - NIA ❑ Yes ❑ NO
ZPump tank capacity(flood) at Manufacturer
Q 24'access nser(s)and accessible from surface? -- ❑ ❑
~a Alarm or Control Panel Installed? - --------- -- - ® ❑ ❑
jControl Panel equipped with Timer/ETM/Counter------- --- - e ❑ ❑
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
4' Pump Make/Model S Floats or ❑Transducer
S
IL Tank draw down in/min Pump capacity opm Squirt Height ft
Pump on time Pump off time Daily flow set at qpd
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7Mason County OSS Installation Report pg. 2 Parcei a 12317-43-00090
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? --------------- ® YES El No
It yes, please describe:PUMPED 8 ABANDONED EXISTING SEPTIC TANK
Were all components pumped out and properly abandoned per WAC24/-272A�0300? �------- ® YES NO
RECORD DRAWING
T s b x Wrmerwit rM'M4 and msl M wou W"Mcrlptlee emuO to ro utx In Me need of mBNmM°ecWltla eM rubn der.1ap^aM1 Trolwi Rpsd
WwxgHmwb' peNMd°neNbr].00e LYfso.Sptioturry.Io-rlon.Noun ar .reserve WevilFM.®Yrq atl l8^wed Euiargs.lacelio�WweuH.walerllnae
NEYr,ppeerv¢K p+.h,tlednyh.aMaVw sal'o daev sss4 l—ice.Rerm,buwege miy veab addi dea,M fiulme.....ion epprwelBM rNe4N permits.
}Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in actor-
. 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 dearedlapproteed by both the designer shown here have been cleared/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
I further certify that all information contained on this I further certify that all information contained on this
Kn and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
7129/24
Sig,hetureoflnsteller Dare
PAM M BUSEK
Prinfad Name of Slynee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and A
Record Drawing on behaMofMason County PublicHealth:y-.� �,., ,,.
kL 1 �g y 8-1-2y
Signature of-EEm i�mrenembil HHealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED MD AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SME "p°i1Y°Qia01B
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