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HomeMy WebLinkAboutSWG2024-00428 - SWG As-Built - 2/14/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number swG 2024-00428 Parcel# 22221-53-00107 Applicant Name Brian Williams Subdivision(Name/Div/Block/Lot) Applicant Address PO Box 741 City, State, Zip Beftair,WA 98528 Installer Name Josh Peterson Site Address 261 E. Forest Dr, Belfair,WA 9852E Designer Name Rod Left INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only Q Drainfield Only ❑Repair ❑Other System Type Glendon—Off" rrrrrr��n,,,...Preretreatment Type >5 ft.from foundation? ---------- B ff" ❑ WA AYES ❑ NO >50 ft.from wells? ------------ u ---- L V - H{I ❑ 0 ❑ Z >50 ft.from surface water? ------- FEB YQ ll��l l ❑ O ❑ rCleanout between building and tank? - ZQ2� ❑ ❑ O Tank baffles present? ---------- ❑ 0 ❑ Q. 24"access risers over each compartm - - ---- El El W EiBuentfilter installed?------------- --- -- -- ------- ❑ 0 ❑ to Septic tank size gal Manufacturer Existing O D-box water level and Speed levelers used? ----- ■ WA ❑YES ❑ NO DO: Manifold/D-box accessible from surface?----------------- ❑ ® ❑ g?Z Check valves installed? --------------- ----------- ❑ ® ❑ 02 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?---A 'y)}w -- ❑ WA ®YES ❑ NO >100 ft.from wells?------ �tilJ ■ r ❑ ® ❑ >100 ft.from surface water?- ----�—r� --1,- -rramt-�-- --- -- ❑ ❑■ ❑ W -- LG�Tfi1L8-- - ■ LL >70 ft.from potable water tin - ❑ ❑ ❑ Z >5 ft.from property lines anQ (y 1177 tOMUWAL HEALTH-- ❑ ElQ K >30 ft.from downgredient curtain/foundation rna2 -------- ❑ ® El O Dminfield level and observation ports present -y ----------- -- ❑ 0 ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ❑■ ❑ Pump tank setbacks conslstant with septic tank?------------- ❑ NIA 0 YES ❑ NO Y Pump tank size 1000 at Manufacturer Existing Q24"access riser(s)and accessible from sudace?------------- ❑ ❑ h a -Alarm or Control Panel Instarred? -------- ------------- ❑ � ❑ Control Panel equipped with Timer/ETM/Counter----------- ❑ ❑ a -Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model Existing ® Floats or ❑ Transducer a Tank draw down .48" in/min Pump capacity 10 gpm Squirt Height NA ft Pump on time 9sec Pump oft time 10min Daily flow set at 240 gpot uiE ...1. 27_7Z-z Rt - " - on/o-f Mason County OSS Installation Reportpg. 2 Parcel# NDONMENT RECORD ❑ YEb NO Were existing septic components abandoned as part of this project? "-- '" " -"- lease describe: YEB ❑ NO N If Yes,P abandoned Der WAC246272A-D300? --'"""- W ere all components WmP�out end property RECORD DRAWING wb 1 IM nwd d"J"t0"a"".cWN1e..M i OfvMlw wab a. TNs b•Parmenaat t M OM a t ba acwrRa and xaawlPiNa.Iwu9nKK artow.inervv Nall�. I� la >IBIIeEcn ePPa'9 aN IdaleC GamN. aaw:n%mlala: 02iMIaN8manaola o1a &bYw+,Seplw% Ikcmdats RawN DrnnMa mays w.w.asawauw wm.a.wma.a+M tins.mp1MeNwa awac Pan APPROVE FEB 14 263 D MASON COUNTYENt"PONMENTAL HEALTH JB W Record Drewing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER I certtly that the system has been installed in eccor- I certity that I Installed the system in accordance with dance with the septic design stamped'APPROVED"by Mason County Public Health and that by both any deviations the septic design stamped°APPROVED"by Mason shown here have been cle&mdlaPP County Public Health and that any deviations shown here have been cleared/approved by both the designer myself and Mason County Public Health and meet a ll and Mason County Public Health and meet all State State and Masan County Codesl further cenfy that all Information contained on this and Mason County Codes. is accurate. I further certify that all information contained on this Porm and attached Record Drawing form and attach d Record Drawing is accurate T� Date Sig of Installer ft �E-'fErc tinted Name of Signee MASON COUNTY PUBLIC HErALTM The undersigned approves this Installation Report end re Record Drawng on behalf of Mason County Public Exawee till u Heart ' W U J (stamp, signature and date) SIB rrvaonrnan}al Health SPecfallat Date cPa.ue n+aa+e to SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE THIS FORM MAY BE Q - co » j § \ § ` ` | Z > c K § q ¢ § ■ > > x 27 0 \ } K \ rn � � \ . m 0 m ® ` z 2 3cn � o0 G 2 z - ° § 9 > \ 2 $ \ a m m m k } 2 > § % o a z g z q , D k > / k § 2 ' 0M > 2 # -n ( m ) ) \ % M £ 3 \ % m272ma 2m Zk)�/ . . o , z ; \ , m 2 » @ > R ` § ~ oQ/ � ® - _ 22 w % � m \ ° km » > ` ) ? \ �y f m <+> m / / > 6 $ ) $cn / k ) ? \ \ \ ) \ / 2 C/3 % d \ / @See k § ) § �, ' © � , m § | } | ] § | | — § �m / . zm ; . . C ; oz ; 5 ; A Z me ; Rv q ® § § . § q M \ § § > w , ¥ � _ § 0 m \ § f \ Z ; § r = § § \ § _ & m 7 a 2 m _ � o � \ \ � �_ m k \ ( \/ ® C) � \ \ CM § ) k ° * k03 | . k\ [ "|| | g m 7(