HomeMy WebLinkAboutSWG2024-00364 - SWG As-Built - 12/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00364 Parcel# 12330-52-00015
Applicant Name Renee Healy Subdivision (Name/Div/Block/Lot) Fir
Applicant Address 4229 W.Arsenal Way S�kO
City,State, Zip Bremerton,WA 96312 Installer Name Keith Chamberlin F�1
Site Address 40 NE Schooner PI, Belfair Designer Name Rod Left
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only N Repair ❑Other
System Type Gravity Pretreatment Type
>5 ft.from foundation? -------- n (�'(� FED
❑ NIA WYES ❑ NO
>50 ft.from wells? ----------- V EC�}f-�J-E ❑ x ❑
_ >50 ft.from surface wateR ------ ❑ ® ❑
QCleanout between building and tank? - -QE� - -- ❑ 0 ❑
U Tank baffles present? --------- -- --- - .---. -- ❑ ❑N ❑
F 24°access risers over each compartm - - -------- ❑ N ❑
a
ul Effluent filter installed?--------------------------- ❑ ❑
N
Septic tank size 1000 gal Manufacturer Infiltrator
0 D-box water level and speed levelers used? --------------- ❑ NIA ®YES NO
-J
00 Manifold/D-box accessible from surface?----------------- ❑ IN ❑
o?z Check valves installed? -------------------------- 0 ❑ ❑
0<
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed(check one) 92 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?--- -------------- ❑ NIA AYES NO
0 >100 ft.from wells?----------------------------- ❑ § ❑
d >100 ft.from surface water?------------------------ ❑ ® ElLL7
' ME >10ft.from potable water lines?---------------------- ❑ 8 ❑
Z . >5ft.from property lines and easements?---------------- ❑ ® ❑
W >30 ft.from downgradientcurain/foundation drains?---------- ❑ a ❑
� '.. Drainfield level and observation ports present -------------- ❑ 0 ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over dreinfield?------------------- ❑ 0 ❑
Pump tank setbacks consistant with septic tank?------------- W NIA ❑ YES ❑ No
Y Pump tank size gal Manufacturer
Q24"access riser(s)and accessible from surface?------------- ❑ ❑
dAlann or Control Panel Installed? --------------------- ❑ ❑
�- Control Panel equipped with Timer/ETM/Counter----------- e ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or ❑Transducer
a
Tank draw down iNmin Pump capacity gpm Squirt Height ft
Pump on time Pump off lime Daily flow set at gpd
uw.�m amrzaie
Mason County OSS Installation Report pg, 2 Pe ssl# 1233G-52-MO15
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Wera asbting septic components abandoned® part of this Proiact't ______ ____ ®.YEa ❑.No
Ir m,please desclb :Tank and Purh n Y uR - —.—
W� all componanfsw pad cal ico pMp"aeee ..d M WAC245slu-0300? ------ -- ® `' `E.fic, .
TW Y�Aa'�a KaE era coal b�at b�ofrtln^a9R b nJoub N IM netl✓�6aM�cLMW R4 MVr MvibW<�t '.)9h1 aY39
M1M4+wsic tAW[W 6vrbtlabMw6bg45M+fyrT tmkbs�rii NmNvmma mtmuAmYCawYq rtl POAM16AStga,btlbn NxM4 MML®,
Hp.aErwOn WXtlevwh.MNsmii4e �v vme Pia b+rrM^�^P.vmdlhnM'P°W creed NR�.d05M�„WYma,6tr.WF^'b WIakBpmii
�BCUd Drawing Abached
.�CERTIFICATION:OEINSTAIIATION .,.w.
. INSTALLER - DESIGNER/ENGINEER
I certify that I mstatted the system in accordance wdh I certify that the system has been instolled in acox'-
the septic design stamped'APPROVED'by Mason dance with the septic dosgn stamped"APPROVED"by k
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been tieamdlappmved by both the designer shown here haw been eteare"plemmil by both
.it Mason Comfy Public Health and meet off State myseff and Mason County Public Health and meet ail
and Masan County Codes. Slate and Mason County Codes
I Bather ombly that ali infonnabbn contained on this i fmiber certify that ell iMonnation contained on M/s
form and attache}Record Drawing is accuralu- `ore and alteched Record Drawing Is accurate.
ty
Signahna Minsthlllor Data. '
Printed Neme of Sgree
W
MASON COUNTY PUBLIC HEALTH
The undersigned approves Nis Installation Report and s
6 Y _
Record Drowing on behafrdbmwo,County Public �ros.= ot=.aven
Health: EXP^Yg <01ii1
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