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HomeMy WebLinkAboutSWG2022-00547 - SWG As-Built - 7/6/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-0547 Parcel # 52001-75-00260 ircumnvij Applicant Name MICHAEL AGOSTINI Subdivision (Name/Div/Blockt) JUN 2 0 2023 Applicant Address 1910 G ST City, State, Zip TACOMA, WA. 98405 Installer Name SELF INSAKEB Site Address 1801W HANKS LAKE RD Designer Name CINDY WAITE INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s)Only ❑ Drainfield Only El Repair El Other System Type GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - 0 ❑ ❑ >50 ft. from surface water? - ❑ ❑■ ❑ Z HCleanout between building and tank? - - ❑ ElCI 0 Tank baffles present? - - ❑ ❑■ ❑ a24" access risers over each compartment?- - El 0 ❑ W Effluent filter installed?- ❑ UI ❑ co Septic tank size 1200 gal Manufacturer HAGERMAN 0 D-box water level and speed levelers used? - - ElN/A ❑■ YES fl NO x00 Manifoid/D-box accessible from surface?- _ 0 El El mZ Check valves installed? - - ❑ ❑ oQ E Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) 0 2 El 3 El 4 ❑ 5 El 6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO O >100 ft. from wells?- - ❑■ ❑ ❑ W >100 ft. from surface water? - ❑ 0 ❑ Li >10 ft. from potable water lines?- - ❑■ ❑ El Q > 5 ft. from property lines and easements?- - ❑ El ce > 30 ft. from down gradient curtain/foundation drains? - ❑ ❑ ❑ CI level and observation ports present - - El 0 GI❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank?- - El N/A ❑ YES ❑D NO `-� Pump tank size gal Manufacturer Z • 24" access riser(s) and accessible from surface?- - El ❑ ❑ a Alarm or Control Panel Installed? - - ❑ El ❑ 2 Control Panel equipped with Timer/ETM /Counter- ❑ ❑ ❑ n O. Pump installed in El Bucket or ❑ On Block or El Other 2 Pump Make/Model El Floats or ❑ Transducer Tank draw down in/min Pumpcap acity acit p Y gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 52001-75-00260 ABANDONMENT RECORD Were existing septic components abandoned as part of this project'? - - 0 YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES ❑ 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: Drainrield&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield.existing and proposed buildings,location 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 ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that l 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 ealth and meet all State myself and Mason County Public Health and meet all and Mason County Cod• State and Mason County Codes I further certi• tha all i . ation contained on this I further certify that all information contained on this form . di t : hr. - . Drawing is accurate. form and attached Record Drawing is accurate. // 'L APIPA ' 1 - 3 i�11 Signature of Install rate i �� 42- 11 rrI `b,aa- � �v5:iic'TI • 0v- ���li 0- • F.64:ShT„ f Printed Name of Signee `J i 104o,4,i 21i I % 709 MASON COUNTY PUBLIC HEALTH , •: The undersigned approves this Installation Report and o� INDtOE ITE ( Record Drawing on behalf of Mason County Public ,; LIc p DE IGNER �i/ Au": 1101iNAM II\ WIIIIMM211 Health: [MKS 0510, Ri kek-r\,\prn ..-Vb )-. Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 APPROVED JUL 0 6 2023 MASON COUNTY ENVIRONMENTAL HEALTH T'4t - 0-SO4- LS RET 7`44 2- a -s0"A- zs' v l v G'�.r v A T L 4' or �1 . A. a+4 G u �i Y C� i + i"ifiL / i d fr.. / LI / t L r� : '':'; ,a. C E ITEk.a' . w P. LICE D DESIGNER �1/ ExPIRE$ 05r10i 3� \)_____Lez_i_zza.,,_i. 1 ✓O J 1 ^� r//` WY. 1 liPPROtivr. c ,:a, f.7;..i \ ' ow 0 8 2022 �/ SicilIK1TY ENVIRONMENTAL HEAL r �� B TH r 1 � rsl ,N1 Cabt tol��', C, U.f,d r +4,4 CO Xl' o D �G,€11 ails ti • 1 ,16' Vwi.,,,? n - L\ -\ 3\tk 0 .. / zga \ \ -3P,1r Printed 4h+rlNa tY DMA,un Printed from Mason County DMS �'"�S /v �� `" A Q iNora,,7 •j, APPROVED 0.A° 2\ 510041 N�` rr O LICE DY Al 1'k DESI NER le JUL 0 6 2023 '"" EXPIRES o5n0, MASON COUNTY ENVIRONMENTAL HEALTH RET 0 tat"Jire /2 Lly 0(1)- (9 CI 1. Iz' ' am . . ,._......-w --- 1.0009 F 1G ' ' 7' •A - at. i ____ ...---r' t' CY 'S ,-- 7s 2 .0,