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HomeMy WebLinkAboutSWG2023-00476 - SWG As-Built - 4/16/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00476 Parcel# 32232-50-79013 Applicant Name Kristina Monk Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 61 Union Hood Canal Land&Imp/Lots 13-15 City, State, Zip Union WA 98592 Installer Name TJ's Excavating Site Address 13 E Sprague Ave Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drain f my ❑Repair ❑Other System Type Shallow Pressure etreatment Type >5 ft,from foundation? -- - --- - ----- -- -- ❑ NIA YES ❑ NO >50 ft.from wells? Q Or�h_ .-_ ❑ Z >50 ft.from surface water? -- - - -- -- - ❑ ❑ Cleanout between building and tank? - -- _'t._ _. ❑ U Tank baffles present? -- - --- - -- - - R _ _ _ _. ❑ El a 24'access risers over each compartme - --`--__ -__- ❑ IN El W Effluent filter installed?----- - - - - -- - - --- - - _ _- ❑ Septic tank capacity(working) 1.250 oa nufacturer Hagerman o D-box water level and speed levelers used? --------------- ❑ NIA YES NO 00 Man'(fold/D-box accessible from surface?-- --------------- ❑ ❑ 192 Check valves installed? -- - - -- ----- - ---- - -- - - - ---- ❑ OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑2 ®3 �Fr"I'4 ❑5 ❑6 ❑Commercial/Other >10ft.from foundation?-- -- -L�R.4�.DwSi S5-' --___ _ _. ❑ wA ® YES NO >100 ft.from wells?- ------- - --- __ ❑ ® ❑ >100 ft.from surface water?- - - ---- W - =Rp�_f�Y ❑ Z >10 ft.from potable water lines?-- - - - - - --- Zi : ❑ . ❑ Q > 5 ft. from property lines and easemen - ,�"{'�j'}' } ® ❑ m > 30 ft.from downgre dient curtain/foun -gar ?ySN- -—— - 'F' ❑. ® ❑ Drainfield level and observation ports present - - -- -RR-RC�'9E:1;fit EEE� 0 ❑ ® Graveless chambers or El Clean gravel used4va one) Proper cover installed over drainfeld?--- - - - - --- ------- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- ---- - ------ ❑ NIA ® YES ❑ No Y Pump tank capacity(flood) 1,000 at Manufacturer Hagerman Z Q 24"access risers)and accessible from surface?--- --- -- --- -- ElLI a Alarn or Control Panel Installed? --- - - - - - - - -- --- --- - - - ❑ El Control Panel equipped with Timer/ETM/Counter-- - -- --- - - - ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump MakelModel Liberty 280� P ❑ Floats or Transducer a Tank draw down 225 in/min Pump capacity 43 ppm Squirt Height 5 ft Pump on time 2 min. Pump off time 6 hr. Daily flow set at 360 gpd umerea envm+e Mason County DES Installation Report pg. Z Parcel# 3�-zb2- 5O - -1R013 ABANDONMENT RECORD YES NO Were existing septic components abandoned as part of this project? ---- If yes, please dascdbe: xo Were all components pumped out and properly abandoned per WAC24E-272A-0300? -"-"-""' YES RECORD DRAWING rw a+w^".�•Nr n.wa.m mew a.a�.s.na e. ea .meusry u,..a m n....e a..xwn•�c rrym Rewa ofawvla•mmeN: oiWRNaamWda anemaoen elrywn.5epouh.�p cone wreom.Nu ert>+.reserev 00d.aaysw�sm�va w�eawa++^^ �eO p^^� wau.m.e�+=uio�.m.nwe,a.a.nvmem�en.nam wmu. mmmde�e Rewa orminse^er PPROVE APR 16 2025 ICI"SON CCUNTY ENVIRONMENTAL VRwrd vdng Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 cerdty that I installed the system in accordance with 1 certify 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 clears"ppnoved 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 furthercer ify that all information contained on this I further certify that all information contained on this form and attached Re brd Drawing is accurate. form and attached RecordfiVwmg is accurate. Signature lost Ikr Data s Printed Name of Signee v' MASON COUNTY PUBLIC HEALTH ned approves this Installation Report and ; _PAuu uor JONry WN The undersigned 9 PP C'IS' , E 16N Si+i}b. Record Drawing on behalf of Mason County Public wMea t a : y—/(a '� S u .f nmental Health Specialist Date (stamp, signature and date) THIS FORNI MAY BE SCANNEO ANO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uwue.nirzo+e So' o` SALE: 10-30 As-buhl- 0' EA S EM'lE i �� 1� R\StlNk N`aN� scaacyu6 hvs — a 3zZ3a 50 74 n 43 30 y3 a S?apclug Avg . - lEA EMtN'L WAT W FINy t . Aug i PPRO VE z—: �, APR 161015 i MASON COUNTY ENVIRONME J13W NTAL HEALTH _ - itckAt� 00 i 13-14 IS ' i 7-.81 9 fy t C4--I:A 2C.cLS 12 -IS�a v�ai�IgD OAudio-Vsual Ala-m t !. © Cleanout 1 y � © 1200 Gallon Septic Tank ( .. 2-Compartment with Effiumt Filter 3 1000 Gallon Pump Chamber OValve Control Box l PAULA JOY JOHNaON ; 'llC i Nly SNP :4? 86 '