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HomeMy WebLinkAboutSWG2020-00479 - SWG As-Built - 8/30/2022 M 'roc ounty OSS Installation Report pg. 1 MASON COUNTY PU J/ EALTH APPLICANT/ PERMIT INFORMATION .y Permit Number SWG 2020-00479 Parcel # 319017590022 •6?f: Gi' Applicant Name Conwell Investments Subdivision (Name/Div/Block/Lot) ,• '�17 • Applicant Address 2415 Carpenter Rd SE `�`t City, State, Zip Lacey, WA, 98503 Installer Name Johnson & Maddox Const. `. Site Address Lit'0 SE Lynch RD Designer Name Jim Hunter INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Mound Pretreatment Type >5 ft. from foundation? - - ❑ N/A ©YES ❑ NO >50 ft. from wells? - •- ❑ 0 ❑ Z• >50 ft. from surface water? - - ❑ El ❑H Cleanout between building and tank? - - ❑ ❑ U Tank baffles present? - - ❑ ❑� ❑ a24"access risers over each compartment? - - El 0 ❑ W Effluent filter installed?- - ❑ El ❑ u) Septic tank capacity (working) 1200 gal Manufacturer Evergreen Precast --.0 D-box water level and speed levelers used? - - MI N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ID o0Z Check valves installed? ❑ ❑ El OQ 2 Transport Line Size 2" Schedule/Class 200 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- - ❑ ❑ W >100 ft. from surface water? - - El It El u.. >10 ft. from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - ❑ LK ❑ ce > 30 ft.from downgradient curtain/foundation drains? - - ❑ MI ❑ n Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © LI Pump tank setbacks consistent with septic tank? - - ❑ N/A 1=1 YES ❑ NO • Pump tank capacity(flood) 1000 gal Manufacturer Evergreen Precast Q24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ !` a Alarm or Control Panel Installed? - - ElPE ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ U ❑ n n- Pump installed in ❑ Bucket or gl On Block or ❑ Other o. Pump Make/Model Myers ME3F II Floats or ❑ Transducer 2 a. a Tank draw down 2" in/min Pump capacity 48 gpm Squirt Height 52" ft Pump on time 1.5Minutes Pump off time 4hours Daily flow set at 360 gpd Updated 8/21/2018 fMas yn county OSS Installation Report pg. 2 Parcel# 319017590022 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES El 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. cy,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 Reco - Dr.wig is cc ate. 4,4 iNF 8 16 2022 het*4 (gnat of 1 alter Date t+ 6 -3 -Z-2_ 4.Larry Johnson � / Printed Name of Signee .!s� z 2,// �`� ,i.„ MASON COUNTY PUBLIC HEALTH r si.�2r3 Off, LAMES R.HJMER The undersigned approves this Installation Report and LKEtVSED D'eSiGfVETt Record Drawingon behalf of Mason CountyPublic i 211. ''''mot' E�CYtitf is 03/L2/ Health: 0:1KNOTC447) 9 ( z47- 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 8r21r2018 , 1 ' s 9 o N ", j r o X 1i j1 4. ,,,1 43 i • g H_ • s • X. CO m 'w_ m -v Z N rn w 73 °• 1 2 Z N rn { 1\ UU Vm n I \� fi w rR 3 1 *IR I -17 �Y. 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