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HomeMy WebLinkAboutSWG2022-00096 - SWG As-Built - 6/9/2025 ( s Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH ✓ APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00096 Parcel # 22211-51-01025/ Applicant Name Jacob Kappert Subdivision (Name/Div/Block/Lot) Applicant Address 3139 Donnelly Dr. SE City, State, Zip Olympia, WA 98501 Installer Name House Brothers Site Address 4881 NE North Shore Rd. Designer Name Jim Hunter INSTALLATION CHECKLIST WI Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other System Type pressure "retreatment Type >5 ft.from foundation? - ❑ N/A E YES ❑ NO >50 ft.from wells? - - - , - - ❑ 0 ❑ Y >50 ft.from surface water? - - - - 41 - 1 -- ❑ ® ❑ 95 - - HCleanout between building and tank? ` - 0, - - - - ❑ ® ❑ V Tank baffles present? - - - - - - - 0 If ❑ F- 24" access risers over each compartm:nt?- - - - - - ---- ❑ ® ❑ a W Effluent filter installed?- .4 - ❑ ® ❑ N Septic tank capacity(working) fS O 0 gal Manufacturer HB Precast (42. D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO pJ 0 Manifold/D-box accessible from surface?-m - ❑ ❑ 0 Z Check valves installed? - - ❑ ❑ ❑ CIQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ill 2 ❑3 ❑4 ❑ 5 ❑6 Commercial/Other >10 ft.from foundation?- - N/A ❑ YES ❑ NO CI >100 ft.from wells?- - It ❑ ❑ W >100 ft. from surface water? - - it El IT >10 ft. from potable water lines?- - ® 0 ❑ 5 > 5 ft. from property lines and easements?- - It 0 0 > 30 ft.from downgradient curtain/foundation drains? U ❑ 0 Drainfield level and observation ports present - - U ❑ 0 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A No YES ❑ NO Pump tank capacity(flood) 11-00 gal Manufacturer HB Precast 1.-k n Q24"access riser(s)and accessible from surface?- - 0 MI 0 t` a Alarm or Control Panel Installed? - - ElRI ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ 11 ❑ M 4. Pump installed in ❑ Bucket or • On Block or ❑ Other Pump Make/Model 20c,„lolr Vc�j © Floats or ❑ Transducer a. Tank draw down 2 u a in/min Pump capacity ,3-0) gpm Squirt Height S ft 1 Pump on time *fib 2 rne•1 Pump off time 12®bojfs Daily flow set at 2 0 U gpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# 22211-51-01025 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Q YES D NO , If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Ei YES 0 NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development Typical Record Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow.reserve drainfield.existing and proposed buildings,local.on of wells,waterlines wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 5—C.:-.11::::: 9(Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /certify that 1 installed the system in accordance with I 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 cleared/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 further certify that all information contained on this I further certify that all information contained on this form an attached Record Drawing is accurate. form and attached Record Drawing is accurate. —eill- `--)7311.4-1.-1, tYL2o6/7/1— 1 I r / / Sig ure of Installer ate s �� JNe 14-t . .. .0, -.;.. .. ...,.0,•„,,„ ...\ • Printed Name of Signee i 4: gloi 1i., , MASON COUNTY PUBLIC HEALTH ay 4, <el .► 510)273 ram�. The undersigned approves this Installation Report and ,! o ' LAMES R.►um-ER t Record Drawing on behalf of Mason County Public ����►1CNvsfD`s`K-:tvc=""f7' Health: EXPWS: 03/22/Z,6 R.r \JIA/V\C),(tW) ( i 1Zc- Signature of Environments)Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated&21/2018 . . r iiii,e_ ner 1011 . ‘S'L, , . ,• ,,,•• ,_ - - . - 6- --- 1.-- •-I I .1 _I_ .1____ 4_ _ __._I_ _ _f___ _ _l_ 1 I_ it_ x.. . 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