HomeMy WebLinkAboutSWG2024-00349 - SWG As-Built - 2/20/2025 ason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00349 Parcel# 422055101008
Applicant Name Phillip Tucker Subdivision (Name/Div/Block/Lot)
Applicant Address 10260 Ramble Or NW
City, Stale, Zip Bremerton,WA 98311 Installer Name Royal Flush-Dann Ogg
Site Address 101 N Gadwall PI N, Hoodsport Designer Name Caliber Design-Richard Bazzell
INSTALLATION CHECKLIST
❑ Full System Installation N Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type RV Holding Tank Pretreatment Type
>5 ft.from foundation? -------------------------- - ®run ❑Yes El No
>50ft.from wells? --- ------------------------- - ❑ e ❑
Z >50R.from surface wateR -- --- -- ---- -- ----------- ❑ ❑
F Cleanout between building and tank? ------------------ - ❑ ❑
V Tank baffles present? -- - - - -- -- ---- ----- ---- -- --- ❑ � ❑
1 24"access risers over each compartment?---- -- - - - - - -- --- ❑ ❑
W Effluent filter installed?----------- - --- -- - - - - - - --- - 0 ❑ " 1
N ;
Septic tank capacity(working) 1500 gal Manufacturer Hagerman Precast-Concretes
r
I
0 D-box water level and speed levelers used? ---- --- -------- N/A ❑yes No !y' �
00 Manifold/D-box accessible from surface?-------------- -- - ❑
tn= Check valves installed? ---- - - - - - ---- --- --- ------ - ❑
o2 Transport Line Size We Schedule/Claw n/a LL i
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑5 ❑6 ®Commercial/Other L m
>10R.from foundation?------------------- --- - -- - ® NIA ❑ ves ❑ NO
C >too R.from wells?-------------------- - - - - -- - -- ❑ ❑
W >100 ft.from surface wateR- ---- --- e ❑ ❑
LL >10 ft.from potable water lines?-- -P -ft-}�� ■ ❑ ❑
aZa > 5R.from property lines and ease ?-------�-- e ❑ ❑
K CCpp
> 30 R.from downgradient curtain ggn tionFlalas3 ® ❑ ❑
Drainfield level and observation po pre�dl6YJTY[ lR - e ❑ ❑
E���n�
❑ Graveless chambers or ❑ Clean gravel ��velu�4Jc�NMhedNlSrlkyU I,
Proper cover installed over drainfield?-- -------- --------- - 0 ❑ ❑
Pump tank setbacks consistent with septic tank?----- -- -- -- - - 0 NIA ❑ ves ❑ NO
Y Pump tank capacity(flood) n/a oat Manufacturer n/a
Q 24"access riser(s)and accessible from surface?---------- -- -
0 ❑ ❑
~ Alarm or Control Panel Installed. ❑
Control Panel equipped with Timer/ETM/Counter-- -- -- -- --- ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n/a
4 Pump Make/Model n/a ❑ Floats or ❑Transducer
f
yTank draw down n/a in/min Pump capacity n/a gpm Squirt Height n/a ft
Pump on time n/a Pump off time We Daily flow set at n/a gpd
Updale W21i2018
Mason County OSS Installation Report pg. 2 Parcei# 422055101008
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? --- - -- - ❑ YES NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-272A-0300? - -- -- -- - ® YES ❑ NO
RECORD DRAWING
This Is a parmanent record and must ad hourafe and diddedWao anaueh m Mhase In W nand or melMenenw eMviaae and Nlun sandalwood. Typical Rewrd
unseen,coMn¢ Dona ld d manM[M odentaton&laws.ss,sweamp fork adds,North anva,reurve NeinfreN,exlsling and proposed load inga kodean of wale,weletllnee,
wells,observelian pa,b,dmnouts,eM oMermtlnlerence xusa osiN. I,rt'anoess Record DmMnge any mate additional delays in final installmim el9mval and islands pdrais
AppROVE
FEB 2 0 2025
MASON COUNTYp4B H
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E Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER]ENGINEER
1 certify that 1 installed the system in accordance with 1 certify that the system has been installed in Sol
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 cleareci approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I furthe a fly that Informal contained on this I further certify that all information contained on this
form d a a ]a d Drawing is accurate. born and adachod Record Drawing is accurate.
.2 -/,Z Z
Sig um of nstaller Date
Darin Ogg
Printed Name of Signs
MASON COUNTY PUBLIC HEALTH ♦ p
The undersigned approves this Installation Report and tWl Lt t�tt
Record Drawing on behalf of Mason County Public LIGENSEDOFStGNER
Be
10/15/2024
S' t o Environmental Hea ecialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updwxentrmfe
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