HomeMy WebLinkAboutSWG2022-00617 - SWG As-Built - 1/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPI JCANTI PERMIT INFORMATION
Permit Number Sit 2022-00617 Parcel# 321343100010
Applicant Name PRIME LO ATICN AND SIT .Taro LLC, Subdivision (Name/Div/Block/Lot)
Applicant Address 113 E TERRACE DR
City, State, Zip BELFAIR WA98528 Installer Name Jim Zlmny
Site Address 1pENA5c..A "D.L "'ABBSB' Designer Name Rich Moore
STALLATION CHECKLIST
Full System Installation ❑Tank(s) Dnly ❑Drainfield Only ❑Repair ❑Other
System Type Sandli ressure Bed Pretreatment Type
>5 ft.from foundation? _______ ____ _______ ______ __ ❑WA fives NO
>50ft.from wells? -___________________________- ❑ 0 ❑
Z >50 fl from surface water? --- -- ------- ----------- 0 ❑
FCleanout between building and tank It ------ ------------- 0 ❑
(� Tank baffles present? ------- - --- --- --- - ------- - ❑ 0 ❑
d24"access risers over each COmpa m?-______________- ❑ ■ ❑
HEffluent fitterinstalled?---------------------- ----- ❑ ❑
Septic tank capacity(working) 1250 al Manufacturer Irdikrator
O D-tax water level and speed levele used? ------- --- --- - - 0WA ❑ Me NO
�8 Manifokl/0.box accessible from surface,---------------- - ❑ ❑
da Check valves installed? -- - -- - - - ------- --------- - ❑ 0 ❑
2 Transport Line Size 2" Schedule/Class SCH 40
Bedrooms installed (check one) 2 ®3 ❑4 ❑5 ❑6 ❑Commercialf0ther
>10 ft.from foundation------ - ------------------ ❑ NIA dyes NO
>100 ft. from wells?-- ------- -- --- ❑ M ❑
W >100 ft. from surface wateR ---- ------------------. ❑ ® ❑
T 110 ft.from potable waterlines?-- ------------ ------- ❑ ❑
QZ >5 ft. from property lines and ease nts? - ❑
K >30 ft from downgradlent curtairift indation drains?-- -- ---- -- ❑ ❑
Drainfiekt level and observation o ❑ ❑
p present
❑ Graveless chambers or 0 Cluin gravel used? (check one)
Proper cover installed over drainfield -------------- --- -- ❑ N ❑
Pump tank setbacks oonslstenlwfth eptic tank?- - ---- ------- ❑ NIA Dyes ❑ No
ZPump tank capacity(Flood) tgoo gal Manufacturer Intiftrator
H 24"access nser(s)and accessible In msurface?------------ - ❑ ® ❑
1 Alarm or Control Panel Installed? -- ------ -------- --- - ❑ ® ❑
Control Panel equipped with Timer/ /Counter---- - -- ---- ❑ e ❑
a. Pump installed in e Bucket Or On Block or ❑ Other
IL Pump Make/Model L�WFloats or ❑Transducer
a Tank draw down 1" in/mli Pumpcapacity 25 gpm apin Squirt Height 5' fl
Pump on time t Min 4e secs Pump off time 4 his Daily flow set at 270 gpd
uPe.ueemrmie
Mason County OSS Installation Report pg. 2 Parcel a
ABANDONMENTRECORD
Were ezrshng sepllc comporents abandoned as pan of this pr,.nt, - --------- ❑ we No
II yes,please descr-0e
Were all components pumped out and properly abandoned per WAC24&222A-00002 ------- ❑ Yes ❑ No
RECORD DRAWING
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❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I Cedi/y that I installed the system in accordance with I certify that the system has been selalled in accon
the sepla,design stamped'APPROb D-by Mason dance with the sect.design stamped'APPROVED'by
County Public Health and that any deviations shown Mason County Pubtk Health add that any deviations
here have been Neered/appmved by both the designer shown here have been clearad/approved by both
and Mason County Public Health and meet all State myself add Mason County Public Health and meet all
and Mason County Codes. State and Mason Counly Codes
I fudhereaddy t In in ration cc tamed on this I further codify that ae iMormalion contained on this
/ atta erl Re rirg l accurate form and attached Record Drawing is accurate.
l2- /s y
Sure of entt 00,Wp Dale
13Nwe Nwaewsgn..
MASON COUNTY PUBLIC HEALTH
The undersigned approves this hadfas abon Report and
Record Drawing on beheld o/Meson aunty Public
Health:
Sgnature of Enalonmera I Health Specal W Dab (stamp,signature and date)
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