HomeMy WebLinkAboutSWG2022-00622 - SWG As-Built - 1/10/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00622 Parcel# 123305000066
Applicant Name Barbara J Evans Subdivision (Name/Div/Block/Lot)
Applicant Address 110 NE Anchor Way
City, State, Zip Belfalr,WA 98528 Installer Name Deno's Septic
Site Address Same as applicant address Designer Name Caliber Septic Design-R.Bazzell
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Standard Gravity Pretreatment Type
0
>5 ft. from foundation? -- - - - -- --------------- - - - - -- ❑ NIA ®yes ❑�O x�o
lyC�
>SORfrom wells? - - - -- - - - - - - - - - - - - -- - ------- -- ❑ e ❑I
Z >50ft.from surface water? - - -- - ----- - - - - - - - - - - - - -- ❑ ❑
rCleanout between building and tank? ----------- - --- -- --- ❑ ❑I b
V Tank baffles present? - - -- - ----- - -- - - - - - - - - - - - - -- ❑ � ❑i
a24"access risers over each compartment?- - - - - - - - -------- ❑ ® ❑�
W Effluent filter installed?- ---- - -- - -- - -- - - - - - - - -- - --- ❑ ❑I
Septic tank capacity(working) 1150 gal Manufacturer Unknown Existinq Concrete
C D-box water level and speed levelers used? - - -- - ----- - - - -- ❑ WA ®yes ❑ NO
OJ
0 Manifold/D-box accessible from surface?- - -- ------ - - - - - -- ® ❑ ❑
0°Z Check valves installed? - - - - - - - - - - - - - ----- -- - - - - -- ❑ ❑
oa
f Transport Line Size 4" Schedule/Class SCH40/3034
Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - - - ----- --- -- - -- - - - - - - -- ❑ NIA ■ YES NO
>100 ft.from wells?---- - - - - - -- ------------------- ❑ ❑
W >too ft.from surface water?- - - - - - -- - --- -- -- - - - - - - -- ❑ ❑
M >10ft.from potable water lines?- - - --- ----- --- - - - - - - -- ❑ ❑
QZ >5ft. from property lines and easements?-- - - - - - - - - --- - -- ❑ S ❑
K >30 ft.from downgradient curtaintfoundation drains?- - - - - - - - - - ❑ ® ❑
Drainfield level and observation ports present - - - - - - - - - - - - -- ❑ ® ❑
e Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- -- -- - - - - - -- --- - -- - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank? - --- -------- - NIA ❑ YES ❑ NO
X Pump tank capacity(flood) at Manufacturer
Q24"access riser(s)and accessible from surface?------------ - ❑ ❑ ❑
aAlarm or Control Panel Installed? - ---- ------- -- - - - - --- ❑ ❑ ❑
f Control Panel equipped with Timer/ETM/Counter----- - - -- - - ❑ ❑ ❑
7
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
0. Pump Make/Model ❑ Floats or ❑ Transducer
2
M Tank draw down in/min Pump capacity gpin Squirt Height ft
a
Pump on time Pump off time Daily flow set at gpd
upea,m arzrrzaia
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- ------- ------ YES No
If yes, please describe: I i
Were all components pumped out arld properly abandoned per WAC246-272A-0300? -- ------ 13 YES WNO
RECORD DRAWING
hea b a pelmwM rewN and musk M acvreN and dnWptive enough to nMaato In Me need M noilntenanw activates and future develepmeM. Typkul Record
onnd'.mntal0. CneirrfieW 8 manddd oMnntim 81ayc.:.Ap&lpump lank bta0pn,NOdh armw.nswa dreb(gld eais6ng eM proWaeO MrilJings,Iw(n of walla,walaFwe,
wrens.paservwon lallu.ckanpuls.and purer mamanance aa»sa p0inls Inconpeta Ramp Odnalps May more add tonal deWa in fvra,.insulation doordnl and Modsd tannin.
Ir Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certdy 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 here have been dearedappmved by both
and Mason County Public Health an t all State myself and Mason County Public Health and meet all
and Maso unty Codes. State and Mason County Codes
I Furth tify th hformation contained n this /further certify that all information contained on this
to a atta ed R co Orawi cc is. (omr and attached Record Drawing is accurate.
Sig ture of Insta er Date
P
-Tor✓efYWAN 4ln6L[
rented Name of Signed 0 '*..
MASON COUNTY PUBLIC HEALTH I
The undersigned approves this Installation Report and 1037126 F;
Record Drawing on behalf of Mason County Public (CHARD L BAIZELL
Health: LICENS DDESIGNIl
l (o�ZS
Signature of Environment I Health Specialist Date (stamp, signature and date)
THIS FORM MAV BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updwd vnndn
FT
§ �)
| ]2
) }k
Fa _ �
,�- -—-- ---- - \�
\
\ /
r\ �� \
\ i Cl)
q$k `
y
\
j) 7; §2
` § k\ )\
\ }§ )\
kt �
m
� §/ \ rn
k C)
\»\k ) 0\ ) )
§,z |)\ !
$§(; /2|
m§fA m!§
k7± |
® « \ ¥
! -
| � ■ ; \ ( _
( ■