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HomeMy WebLinkAboutSWG2024-00346 - SWG As-Built - 12/15/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH -- -. APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00346 Parcel# 22336-54-00020 Applicant Name Chad Sperber Subdivision (Name/Div/Block/Lot) Applicant Address 61 NE Wanda CI City, State,Zip Belfair,WA 98528 Installer Name Bill Bumbalough Site Address 61 NE Wanda Ct, Belfair,WA 98521 Designer Name Rod Left INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only X Urainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? --------------------------- QN/A ❑YES ❑ NO >50 ft.from wells? ------------------- ---------- 0 ❑ ❑ Z >50ft.from surface water! ------------------------ ® �✓ ❑ ❑ rCleanout between building and tank? ------------------- ❑ ® ❑ f.1 Tank baffles present? --------------------------- ❑ Q ❑ l- 24"access risers over each compartment?- ----- ❑ ® ❑ WC- Effluent filter installed?---- ------------ ❑ ❑ to ` Septic tank size 1150 gal Manufacturer Existing G D-box water level and speed levelers used? ------ -- ❑ wA Q YES ❑ NO �J 00 Manifold/D-box accessible from surface?----------------- ❑ ® ❑ O?Zi.Check valves installed? ------------------------- ❑ ❑ ❑QI Transport Line Size 4' Schedule/Class SDR35 Bedrooms installed (check one) ❑2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-------------------------- ❑ WA NYES ❑ NO "J1100 ft.from wells?----------------------------- ❑ X ❑ -�. >100 ft.from surface water?--- -------------- ❑ It ❑ W LL " >10 ft.from potable waterlines?---------------------- ❑ X ❑ Z >5ft.from property lines and easements?---------------- ❑ X ❑ K >30ft.from downgmdient curtain/foundation Brains?---------- ® ❑ ❑ O Dreinfield level and observation ports present -------------- ❑ 0 ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dreinfield?------------------- ❑ ❑ Pump tank setbacks consistent with Septictank?------------- QwA El YES ❑ NO Y Pump tank size gal Manufacturer Q --.24"access riser(s)and accessible from surface?------------- ❑ ❑ ❑ Alarm or Control Panel Installed? --------------------- ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ ❑ p.; Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑Floats or ❑Transducer D Tank draw down INmin Pump capacity gpm Squirt Height ft a Pump on time Pump off time Daily flow set at gpd upama cmgoie Mason County OSS Installation Report pg. 2 Parcel# 22336-54-00020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ----------- ---- ❑ YES E NO If yes, please describe:Tank being reused Were all components pumped out and properly abandoned per WAC246-272A-0300? -- ------ ❑ YES ❑ NO RECORD DRAWING Into Is a pemamnl record and must be accurate and descriptive amounts to notocale In Ne need or malnlenance ectivllles and future development. Typical Record Dmsee.contain: Dramflem d mandeN aMntatiM 8leyam,eeplwWmpwnkbcetien,NOMsnow,rewrve dreinrieW.ealslm9 end pmWaetl bvtltlh8a,kraibn ofvrells,vroledine; cells.observalbppads,GemouU,mm oNea nuinlenan¢saris pbNb..Irtcanplele RemN DmvMga meyaealeaddNoneltleleys h fnel Instatletion appravel arA mlaled permAi. 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 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 hero have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet at/ 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 D wing is accurate. form and attached Record Drawfug is accurate. GtrCli/ J � r 11/6/24 Signatu)uVinstaller - Data Bill Bumbalough Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public wsns rsidel:p+ Health: 1` III EXPIRES 12/161 iz (vvI' Signature ofEnvironmenfal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UCblM ntrsote ` D � m \ / k « � < Ln / - \ � } < /) COA ? � : f & § d2 \ 2\�z , g : © « zz �z a \22 //\ W � © # ee (D Q § § ( 2 ; § R § ) ( d ! & r ° / » 002 § > ` 0c ; T o x ® ) | ( ) � § ; ( \ \ En 2 \ - � § § : § Q § :E M Z m §— z ; . 22 § \ cna /o G - , , w 0 m 0 m | \& 2 > ) \ K 222C3 ) ) /� m $ $ q # m 2 ff / ) & z G K - $ § § ) 0 0 2« f q § m > > / \ ®b 0 m gym ) » \ } ( 2 ) T �. §\ 0 k � � � � M0 mz \$ 2 £ % $ § e § z ; � � mz = ® 2sg2 o § § $ § | // ) 4 [ Q � ) ) ( � j\ \ - 22 � § 9m § k | 2 / m i\ k S . m ) } /{ C- $ \ / / ) {\ ■ | coI � 'o $® k ) ] 29 z ] \/ / | , § $ § 2 § fA \ � 74 . « �