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HomeMy WebLinkAboutSWG2025-00218 - SWG As-Built - 7/11/2025 t Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00218 Parcel # 12330-32-00110 Applicant Name Fred & Linda Gold Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 263 TR 11 OF GOVT LOT 3 City, State, Zip Belfair, WA 98528 Installer Name Workman Contracting Site Address 200 NE Chinook Dr. Belfair, WA Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST • Full System Installation El Tank(s)Only ❑ Drainfield Only 0 Repar ❑Other System Type_ Shallow Pressure Pretreatment Type >5 ft. from foundation? - •;;,`-1 ❑ NIA Q YES ❑ NO 1.13 >50 ft. from wells? - ❑ • ❑ • >50 ft. from surface water? - R - 2825- - - Li El ❑ Z 8 ❑ ❑■ CI • Cleanout between building and tank? - - - F- U Tank baffles present? - - 0 ❑ !— 24" access risers over each compartment?- - - ---—— - - - - ❑ X d El 0 ❑ W Effluent filter installed?- - u) Infiltrator Septic tank capacity (working) 1,250 gal Manufacturer ❑ D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO —IDO Manifold/D-box accessible from surface?- - ❑ ❑ CI i Check valves installed? - - ❑ ❑� ❑ ❑Q 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 II 3 1114 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO O >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - 0 0 ❑ ti >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ I ❑ Q cc > 30 ft. from downgradient curtain/foundation drains?- - ❑ © ❑ io Drainfield level and observation ports present ❑ MI ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - El NIA Q YES ❑ NO • Pump tank capacity (flood) 1060 gal Manufacturer Infiltrator Z < 24" access riser(s) and accessible from surface? El El El F- Alarm or Control Panel Installed? - - ❑ • ❑ a 2 Control Panel equipped with Timer/ ETM/Counter- - CI I CID d Pump installed in 0 Bucket or ❑ On Block or El Other * Pump Make/Model Zoeller N152 ❑ Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 10 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd Upta ed Et2'.•20'8 Mason County OSS Installation Report pg. 2 Parcel# V212= ABANDONMENT RECORD ® YES � NO Were existing septic components�aband n� as Part this- pro-S- , - �� b, 0. A If yes, please describe: NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - YES 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 conain: Drainfeld&manifold orientation&layout,Septa/pump tank location,Nora,arrow.reserve drainfield,existing and proposed buildings.location of wells,waterlines. wells,observation ports,cleanouts,and otter maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. II Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER! ENGINEER I certify that I 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate. --jtA. h Signature of Installer Date ... 11, INA Printed Name of Signee f: r'' It •1,^! h MASON COUNTY PUBLIC HEALTH „'';•r , ]., •.t: The undersigned approves this Installation Report and t St L340 ,r -• PAULA JOY.IOrHNSON *'t'` Record Drawing on behalf of Mason County Public i LIC" .l'ti br..51GN cAi•• Health: r RIVA(11\9(441 "7 ((( (7...c -7-7_zs- Signature of Environmektal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2/2018 MIMIIIIIL co: I 3wtiE Spf .0 ode - N N5. x5b' PgimARe 3°?: to -1‘ D.�• TKE-}J C3+ 5 6 I°L5 P i , c � . 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