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HomeMy WebLinkAboutSWG2018-00034 - SWG As-Built - 5/25/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTI - APPLICANT/ PERMIT INFORMATION Permit Number SWG ZOL - O j-- I Parcel # 12217-42-90133 Applicant Name Batiack Holdings Subdivisidn (Name/Div/Block/Lot) Applicant Address PO Box 2269 Allynmore Ridge lot 3 City, State, Zip Gig Harbor WA 98335 Installer Name J&J development Site Address 19015 E SR 3 _','� ;0\l6 Designer Name Peninsula Septic Designs INSTALLATION CHECKLIST 11 Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type pressure distrubution Pretreatment Type >5 ft. from foundation? - ❑ N/A © YES ❑ NO co 7 >50 ft. from wells? - - ❑ 0 ❑ ;5 >50 ft. from surface water? - - ❑ [ ❑ n_ Cleanout between building and tank? - - ❑ IF Tank baffles present? ❑ 0 ❑ 24" access risers over each compartment? ❑ ® ❑ oN Effluent filter installed?- ❑ ® ❑ Septic tank capacity (working) 1250 0 gal Manufacturer Haggerman Precast L, r 3 CI D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO � �O Manifold/D-box accessible from surface?- - ❑ I 0 u. m- Check valves installed? - - ❑ El ❑ oa 2 Transport Line Size 2" Schedule/Class '.-40 1 Bedrooms installed (check one) ❑ 2 I] 3 ❑4 ❑ 5 Vi. 5rCommercial/Other >10 ft. from foundation? - - ❑ N/A IN YES ❑ NO 0 >100 ft. from wells? - ID in El- W >100 ft. from surface water? - - El ill ❑ Er. >10 ft. from potable water lines?- - IIIIIID? > 5 ft. from property lines and easements?- - ❑ ® ❑ alE > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ CI FTrainfield level and observation ports present - - ❑ II ❑ r n - Graveless chambers or 0 Clean gravel used? (check one) r Proper cove'-installed over drainfield?- ❑ ❑ ❑ '`z' triniPump tank setbacks consistent with septic tank? - - ❑ N/A © YES ❑ NO Few �.�1 Pump tank capacity (flood) 9000 gal Manufacturer evergreen precast r-- 24" access riser(s) and accessible from surface?- _ ❑ I ❑ ,LT.—.__ _, tlarm or Control Panel Installed? ❑ IN ❑ ontrol Panel equipped with Timer/ ETM /Counter ❑ • ❑ n a. Pump installed in ❑ Bucket or ® On Block or ❑ Other n' Pump Make/Model liberty ® Floats or ❑ Transducer d Tank draw down .375 in/min Pump capacity 45 gpm Squirt Height 4.042 ft Pump on time 8 i^''") Pump off time 1 4hrs Daily flow set at �l 1(� gpd Updated B/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 12217-42-90133 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 272Aj0300? El ❑ 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,SeptiGpump 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 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 1 further certify that all information contained on this I further certify that all information contained on this form and at ched R rd Drawing is accurate. form and attached Record Drawing is accurate. .., ,,,43, �y 12/5/21 �r Si ature of I ler Date i` Kenneth Jones Printed Name of Signee co.. ofw'1 He '1;A .4.t hCr.,) oa•,',n MASON COUNTY PUBLIC HEALTH . , � : The undersigned approves this Installation Report and 'ti' tS i, ttCz:9 Record Drawing on behalf of Mason County Public „` ^^2':'; [- 71t1tr- Health: ' 1(2--.Mil\Af LP cciTc-7 7,2_ - — 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 B/21/2018 . 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