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HomeMy WebLinkAboutSWG2021-00227 - SWG As-Built - 5/9/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-0022 1 Parcel# 62017-75-00040 Applicant Name CORY MORAN Subdivision (Name/Div/Block/Lot) Applicant Address 408-11 REINKE RD City, State, Zip CENTRALIA, WA. 98531 Installer Name SELF INSTALLED Site Address 301 W LUCAS LANE Designer Name CINDY WAITE INSTALLATION CHECKLIST II Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - - ❑■ N/A ❑ YES ❑ NO >50 ft. from wells? - ❑ 0 El Z >50 ft. fi E _ _ 7_ `4 _ _ -- - - ❑ < Cleanout between building and tank? -1# _ - - © ❑ V Tank baffles present? - _�IAY � % Z2 _' ❑ 0 El a 24"access risers over each compart ?- - ❑ Ill ❑ El 0 ❑ UJ Effluent filter installed?- By - ❑ ■❑ El co Septic tank size (� gal Manufacturer M r'/ C C1 D-box water level and speed levelers used? - 0 N/A ❑ YES 0 NO mQ 0 Manifold/D-box accessible from surface?- - El ® 0 Check valves installed? - - El El El 2 Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) 0 2 0 3 ❑■ 4 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation?- - 0 N/A ❑ YES ❑ NO 0 >100 ft. from wells?- - ❑ 0 El W >100 ft. from surface water? - 0 ® ❑ Er >10 ft.from potable water lines?- 0 ❑ ❑ z >5 ft. from property lines and easements? ® IN> 30 ft. from downgradient curtain/foundation drains?- - It El ❑ Drainfield level and observation ports present - - El El 0 0 0 Graveless chambers or pgClean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El El Pump tank setbacks consistant with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank size / 2on gal Manufacturer frn r is/ Z < 24"access riser(s)and accessible from surface?- - ❑ ® ❑ a Alarm or Control Panel Installed? - - ❑ 0 0 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ 4. Pump installed in Bucket or El On Block or ❑ Other a' Pump Make/Model 24 I1e�. 151 ! J /g1 Floats or El Transducer a. Tank draw down in/min Pumpcapacity acit p 5 _gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd updated 8/21/2018 Eleeliuca� tlU� SrI-? aso‘ 6°4--IA,s 2ea�i. ' � Mason County OSS Installation Report pg. 2 Parcel# 62017-75-00040 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. MI Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER l 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 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. /11* Signatu of Installer Date i 14 �P�F,`N.AS �- Printed ame of Signee /Py4 R/ rtly MASON COUNTY PUBLIC HEALTH N4. : �� The undersigned approves this Installation Report and o� NDVE4 AITE ��ir t11 Record Drawing on behalf of Mason County Public LrcENSED DESIGNER 1� im\am����N ..0i I. �......��, Health: EXPIRES usno/ � (13 (2Z Signature of Environmenal 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 IrorrimMEINPr APPROVED JUN 13 2022 MASON COUNTY ENVIRONMENTAL HEALTH RET A ‘3)\14 • 1. Residence :�Po< ^sy ' �1 2. Out buildings N Q---�`' °,'' yr r 3. 1200 gallon double compartment '�' `"� concrete septic tank 'or cI s o� WANE ! SE! DESIGNER ��` 4. 4. 1200 gallon one compartment d".... , ................... .`.. , pump tank Ex`''H`s "5"°- 5. Audio/visual alarm 6. Transport line 7. i/a Itie b< 8. Primary drainfield(4x50' laterals) 9. Reserve area (between primary laterals) 10. Well Jl, ideii, O Q i cbig El Ei 7 — iti „..,./ ..,,,N. CP s 69d k4imov, hatke I. ate 6SO/ '0' 30> IN L 1 cgs 1-2-,vte loot 2oo�' Soo ' [�l�_ 75_ dOp�fp Ii" —ir ®o