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HomeMy WebLinkAboutSWG2023-00255 - SWG As-Built - 7/14/2025 Mason County OSS Installation Report pg. 1 APPLICANT/ PERMIT INFORMATION MASON COUNTY PUBLIC HEALTH Permit Number SWG 2023-00255 Parcel# 12330-33-90029 Applicant Name Matthew Kni ht Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 4 City, State, Zip Wuana, WA 98395 Site Address Installer Name Jason Schauer 140 NE Seitz Dr, Belfair, WA 98528 Designer Name Rod Left INSTALLATION CHECKLIST ��ak► a Full System Installation e�� ❑Tank(s)Only ❑ Drainfield Only System Type Standard Pressure ❑Repair ❑Other &n >5 ft. from foundation? - _ _ _ _ _ _ _ Pretreatment Type �+� <I S. >50 ft. from wells? - - - - - - - -- - - - - - - - - - _ - _ _ _ _ - - ❑NSA ' Y >SO ft. from surface water? - _ _ __ _ _ - - O YES ❑� z - - - - - - - - - - 0 0 0 1.. Cleanout between building and tank? --- - - - - - - - - - - -- -- - - 0 ❑ ■ 0 _0 Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - 0 E" 24"access risers over each compartment?- - - - - - - - -- - - - - - - 0 ❑ 0EJ LU ■ ❑ Effluent filter installed?_ _ _ _ _ _ _ _ _ _ _ _ - ❑ Septic tank size 1250 0 0 gal Manufacturer 0 D-box water level and speed levelers used? - _ _ _ _ _ - - _ Ha erman _-- - >< II O Manifold/D-box accessible from surface?- - _ _ - _ - - _ _ - Nia ❑ YES 0 NO Q - _ _ _ _ _ - _ - - _z Check valves installed? - - - - - - El Q * Transport Line Size 2„ ❑ El Schedule/Class Bedrooms installed (check one) 0 2 ---- 40 ❑ >10 ft. from foundation?- _ _ _ _ _ _ _ _ _ _3 ❑4 ❑ 5 ❑6 ❑Commercial/Other 0 >100 ft. from wells?- _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - ❑ NiA OYES NO �j >100 ft. from surface water? - _ _ _ _ _ _ _ __ _ _ -- - 0 ❑ Z >10 ft. from potable water lines?- - - - - - - - - - - - - -- - - - - - - 0 El>5 ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ 0 DiEll ce 30 ft. from downgradient curtain/foundation drains?- - _ _ _ _ _ _ _ 0 El Drainfield level and observation ports present - - - _ _ - _ - - - _ ❑ ® 0 - ® Graveless chambers or - _ ❑ ® ❑ ❑ Clean gravel used? (check one)) Ell Proper cover installed over drainfield?- - - - - - - - - - - -- - Pump tank setbacks consistant with septic tank?- - _ _ _ _ __ _ _ 0 0 El ZPump tank size 1000 El N/A 0 YES ❑ NO gal Manufacturer tQ 24"access riser(s)and accessible from surface?-- _ _ _ _ Ha erman _ IZ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - ❑ a El Control Panel equipped with Timer/ETM/Counter - - _ _ _ _ _ _ _ ❑ © ❑ a ❑ Buc Pump installed in 0 MIrl ket or On Block or El Pump Make/Model ❑ Other Libe 290 a_ Tank draw down Ej Floats or 0 Transducer 3" in/min Pump capacity 66 Pump on time 40.9sec —gpm Squirt Height g+ ft Pump off time 3hr Daily flow set at 3 5�gpd Updated 8/21/2018 Mason County OSS Installation Report p pg. 2 Parcel# 23303390029 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -___________ ` ` - 0 YES ® NO If yes, please describe; Were all components pumped out and property abandoned per WAC246-272A-0300? - --____ . YES ® NO This Ia a RECORD DRAWING �'�'�record and most be accurate and descriptive enough to n- tocato This is contain. Drapermanent re o &manifold t e accu &l in the need of layout.Septrctpurro tank maintenance a rcce nand pro and future dewcioVme ll&w l Record rtmes, wells,obaervatkxt ports,Ueartputs,and ioc Avon,r�nrth a other metrnanan �"',reserve drainflaW,existing and proposed I�— �e access points. Incomplete Record Drawings m buildings,�goval of d rely ed ern it may vests adde0'�nal delays in final insta1114pn aCOroval and related permits. I DRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER /certify that l installed the system in accordance with DESIGNER/ENGINEER the septic design stamped"APPROVED" 1 certify that the system has been installed in accor- CountyPublic Health and that any deviationshown dance with the septic design stamped"APPROVED n by Mason County Public Health and that any deviations here have been cleared/approved by and Mason County Public Health and moeet the all Statener shown here have been cleared/a pproved by both myself and Mason County Public Health and meet all and Mason County Codes I further certify that all information contained on this State and Mason County Codes /further certify that all information contained on this form and attach Record Drawing is accurate. form and attached Record Drawing is accurate. Lt 01 ature of Installer Da e Oft JASON SCHAUER r L Printed Name of Signt�e <'':: IA MASON COUNTY ,PUBLIC HEALTH • �`• iti) . , The undersigned approves this Installation Report and 110 Na Cf..4310re Mk' Record Drawing on behalf of Mason �- T' Health: C44!nty Palk F tit,, Signs ore of Environmental Health Specialist Dat alist C 6 oN�F 'q e MAYBE SCANNED AND AVAILABLE FOR FOR (stamp, signature and date) PUBLIC VIEW ON THE MASON COUNTY WEB SITE up6'*'d arztnote I O N * * * D 0 0 Z D D rxCOrr D H 0 C m m C o -;Z `�ik� Z D z D D my n m m''-' ' �,11 rr- Z 0 f- C m= D a,;mm7:,''� 11k. n 0 0 H X j7 m o =\c • O dr r m 0 0 E 3 p m ilk o L ;% �� 0 m Z m m m M , �°' i cn Z m cn Z Z ► d o O Z p 0 • a m _ crn m m Z 0 cn X -n ,Zmj W D D 0 o O m D D m m �I _ a r Z z z m< m• 'i D 0 = 0M ZD � `<r- 0 mOzz r m0 D 0 mZ ° C> Dz � Z7 � z00 0 MO• XUME m Z 180.00, D m � ° m -1' o )0'{ H D 5 D D oo m --,`< T m m• Z 7) 0 �r C r X D ( Zm • ; ::: 0 m 0 ... pC� 7 � o 0 • m!;,� ::,c H : omD m m 0 Z Di mp cf) m � m C TT N)] . ma I)(/) m-< W , os ,y 910 oo Q D1 -I pG oT F :r I L� m , • • .�� 0 / .. `.. m / , �►: OOOO / "u m 2O / II II II II r cn r o r A j n I :r, r`� . o <i � ? /r o m o a a a a a m 73 rag m , C m OC m < yWr / �. —••.. r ,,r Ede N " Cr -1 C7 Y D 0 0 0 I I D.. 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