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HomeMy WebLinkAboutSWG2009-00233 - SWG As-Built - 2/28/2018 Mason County OSS Installation Report pg. 1 MAS COONTY2F4J4EALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2009-00233 Parcel# 22233-52- i13------------- Applicant Name Tom Hargreaves Subdivision (Name/Div/Block/Lot) Applicant Address 7056 S. 220th street City, State, Zip Kent, WA 98032 Installer Name Otto Field Site Address 2151 Mason Lake Dr. E. Designer Name Robert Paysse INSTALLATION CHECKLIST UI Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Pretreatment Type >5ft. fromfoundation? - - - - - - - - - -- - - - - - - - - - - -- - - - - ❑ N/A ❑■ YES ❑ No >50 ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ Z >50ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - El ❑■ ❑ HCleanoutbetweenbuildingandtank? - - - - - - - - - - - - - - - - - -- El ❑■ ❑ U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ El a24"access risers over each compartment?-- - - - - - - - - - - -- -- ❑ ❑■ ❑ W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ■❑ ❑ Septic tank size 1200 gal Manufacturer Sound Placement O D-box water level and speed levelers used? - - - - - - - - - - - - - -- • N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ 0 El XI Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - El ❑■ ❑ GQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 El Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑■ N/A ❑ YES ❑ NO >100ft. fromwells?-- - - - - - - - - - - - - - - - - - - - - -- - - - - - ❑ ❑t ❑ W >100ft. fromsurfacewater? - - - - - - - - -- - - - - - - - - - - -- - - ❑ ❑� El u. >10ft.frompotablewaterlines?- -- - - - - - - - - - - - - - - - - - - - El ❑■ ❑ ZZ > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ ❑■ El 0C > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - 0 ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?-- - - - - - -- -- - - - - - - - - El ❑ ❑ Pump tank setbacks consistant with septic tank?- - - - - - - - - - --- ❑ N/A ❑■ YES ❑ NO Pump tank size 1200 gal Manufacturer Sound Placement Z24"access riser(s)and accessible from surface?- - - -- - - - - - - - - ❑ UI El d Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ II ❑ = Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ ® ❑ Pump installed in 0 Bucket or ❑ On Block or ❑ Other gPump Make/Model Turbin ❑ Floats or © Transducer IL Tank draw down 2 in/min Pump capacity 45 gpm Squirt Height unknown ft a Pump on time 1 min Pump off time 240 min Daily flow set at 270 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 22233-52-00013 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - -- - - - - - - ❑ YES ❑■ 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 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,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. J t,=1 ' , gu- ✓ c ❑ 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. mot- 2/26/19 Signature of Installer Date Robert H. Paysse Tank only installer Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public RoeER°H3 YssE Health: EXPIRES 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 PL�ti - /// '• I / R1OO' - EXP E8 MANIFOLD CPprrdVEDN \ \ \ \ \ - 1 O � �S i �ItYY OBSERVATION PORT EXISTING GARAGE PIONEER DIGGING 1NC. CUSTOMER: KIM MCFARLANE SCALE Pdd PARCEL#: 22233-52-00013 TEST HOLE k TEST HOLE 2 SEPTIC DESIGNS DRAWING: PLOT PLAN 3083 E.MASON BENSON RD. CRAPEV1EW,WA 98546 DESIGNER: ROBERT PAYSSE 16"45"CS IT 34" ROOTS•45" ROOTS-3•34" Q.�F10E 36Q-. 6.I$Q-.. 3¢4M 53,^° ©RA $ X PAYSSE