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HomeMy WebLinkAboutSWG2023-00394 - SWG As-Built - 11/20/2023 Ct Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00394 Parcel # 32134-32-90050 Applicant Name MARK OLANDER Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 1727 City, State, Zip SHELTON, WA. 98584 Installer Name TRIPLE A --- Site Address 1250 E MASON LAKE RD Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other -- System Type GRAVITY Pretreatment Type >5 ft. from foundation? - - - - - - ❑ N/A Q YES ❑ NO >50 ft. from wells? . - ❑ 11 C Z >50 ft, from surface water? - - ❑ I El f Cleanout between building and tank? - ❑ © [ , u Tank baffles present? . - - - 0 0 n a 24"access risers over each compartment?- - ❑ 0 ❑ 1.11 Effluent filter installed? - ❑ El Septic tank size 1200 gal MarS�Fa,��(cturer GRAYSTONE EXISTING ' _ R0 D-box water level and speed levelers used? - 0 NM ❑YES ❑ NO ou. O Manifold/D-box accessible from surface? 0 ® 0 Da Check valves installed? - 0 0 0 z Transport Line Size 4 Schedule/Class A5TM2729 . . ,i Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A O YES D NO G >100 ft. from wells?- ❑ 4 W >100 ft. from surface water? - ❑ 0 Z >10 ft. from potable water lines? ❑ 0 ❑ tor > 5 ft. from property lines and easements? 0 gil 0 > 30 ft. from downgradient curtain/foundation drains?- . II 0 Drainfield level and observation ports present - ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield? . 0 0 ❑ Pump tank setbacks consistent with septic tank? - ❑ N/A ❑ YES ® NO Z• Pump tank size gal Manufacturer < 24"access riser(s)and accessible from surface? - ❑ 0 0 F O. Alarm or Control Panel Installed? - 0 0 ❑ 7 Control Panel equipped with Timer/ETM/Counter- . 0 0 0 �J 0- Pump installed in 0 Bucket or ❑ On Block or ❑ Other `1-I C▪ PumpMake/Model • D Floats or ❑ Transducer Q. Tank draw down in/min Pumpcapacity Q. p ty gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd g uvnmo,1 ETGp18 Mason County OSS Installation Report pg. 2 parcel# 32134-32-90050 ' ABANDONMENT RECORD I Were existing septic components abandoned as pal of this project? ❑ YES Q I NO If yes please describe. Were all components pumped out and properly abandoned per WAC246-272A-0300? - ❑ YES ❑ NO RECORD DRAWING • This Is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Typicar Record Drawings contain: Drainbeld&manifold arlentatmn B layout,Septic/pomp tank location.North arrow,reserve dralnfield,exisling and proposed buildings.location M wells,walerllnes. wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Mexico may create addronai delays in final installation approval and relatedlpermhs CyX6n„ 7Ns141/7- i e<vrc OW e dr' ei4.4 r( rn,/,' -fad ® 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 accdr- 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 a ached Fjecord D(rrr in isis accurate., form and attached Record 0.,wing is accurate. / Sigr)�t(ire of Installer Date t • ' soici Printed Name of Signee /p W' j0 MASON COUNTY PUBLIC HEALTH #" The undersigned approves this Installation Report and g tic- ION Record Drawing on behalf of Mason County Public - axnlaes.F ta, Health' 1(77O(702? \4 Signature of Environmental Health Specialist bate -- (stamp, signature and date) • THIS FORM MAY BE SCANNED ANDAVAILABLE FOB POETIC VIEW ON THE MASON COUNTY WEB SITE °dame Aalrmla N -1 V • 1� ? • � M O • °' 4 Y E E '� �R'� 1 • UCENSEDZE@IGNER O • / "`-Y _ Oc✓3i W1` W • /O LZ '\ ` / It l %o O ,i r • • co wok w co NZw w \' gLLoCO w 4 yy N Q ~ cc >> w I • 0 coLL Q I- ZZOU) WnQcc ? wp _ � a � t o y h ¢ W QZ ce H M \18rt xx xx LIJ W Q RW WR � U � � -. si- einivvic6rao Lk~ /.?Sp rile au I ke i1, ( DCa,.AS,kr) L a'-,I4 t...1 i VS ° 2 c i j . . ...... .. t 'Of e-0 ..______? , _ 0 __], 1 ler D '',,?, XI I ' N, ...a _______. .______________. fp' a ao • 1 •-ler _..i elf0 ,_,. 4:.b.,,-e. .., / / 0) .4 pl it/ "= 1 . 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