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HomeMy WebLinkAboutSWG2022-00131 - SWG As-Built - 8/8/2022 V . • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00131 Parcel# 42307-50_- 00049 Applicant Name Ron Kruger Subdivision (Name/Div/Block/Lot) Applicant Address 15689 Yokeko Dr. Lake Cushman Div. 2 Lot 49 City, State, Zip Anacortes, WA 98221 Installer Name T.J. Goos Site Address 10 N. Potlach Dr.N. Designer Name Dale L.Tahja INSTALLATION CHECKLIST 1 ❑ Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressurized Trenches Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A ®YES 0 NO >50 ft.from wells? - - ❑ 1 ❑ Z >50 ft.from surface water? - - ❑ II < Cleanout between building and tank? - - ❑ ® 0 4 V Tank baffles present? - - 0 ® ❑ a24"access risers over each compartment?- - El ® 0 WW Effluent filter installed?- - 0 D 0 4 Septic tank capacity(working) 1,200 gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - ® N/A ❑YES ❑ NO OO Manifold/D-box accessible from surface?- - 0 IN ❑ Z Check valves installed? - c).4( - ElIN ❑ Transport Line Size 2 inch Schedule/Class Sch.40 Bedrooms installed (check one) 0 2 ❑3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft from wells?- - 0 It W >100 ft.from surface water? ❑ ❑ NI t >10 ft.from potable water lines?- - 0 ® 0 > 5 ft.from property lines and easements?- - 0 ® ❑ d > 30 ft.from downgradient curtainffoundation drains?- - 0 ® 0 13 Drainfield level and observation ports present - - 0 ® 0 ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 IN 0 Pump tank setbacks consistent with septic tank?- - ❑ N/A ill YES ❑ NO `-L Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman a24"access riser(s)and accessible from surface?- - ❑ El ❑ ~ Alarm or Control Panel Installed? - - El 11 Ela 2 Control Panel equipped with Timer/ETM/Counter- - ❑ EN ❑ °- Pump installed in ❑ Bucket or © On Block or ❑ Other 2 Pump Make/Model Liberty 280 0 Floats or ® Transducer d Tank draw down 2 in/min Pump capacity 44 qpm Squirt Height 5 ft Pump on time 3 min. Pump off time 7 hrs. 57 min. Daily flow set at 180 gpd Updated 8/21/2018 time -\ 0 -----Y)-00C)/AC\ Mason County OSS installation Report pg.2 Parc # ,ADONMENt'.RE�Dp._wpm Were existing septic oo abandoned as part of this mad? - 4----- 10 YES 0 M If yes, please describe: ❑ Were all components pumped out and properly abandoned per WAC248-272A-0300?' - No RECORD DRAWING This Y a permanent mood and must be accurate sod descriptive Meow to ro4ocet5 in the need of mehrbnance atxtvldn and tutus development.of walk , d OmegaWaft1 dnteid A nianlrold odentadon d layout, pump tank location.North arro%!WNW drst�eid,exlednn and Installation> on andftalked ablet WOKobtervatiat tom, ,and other maknteet3nce access pants. IncompleteRecord Red Drawings may create additional delays in Mal I ♦ R Record Drawing Attached CfIPIATION OF INSTALLATIOl } E INSTALL ER DESIGNER!ENGINEER 1 certify that 1 installed the system in accordance with I certify that the system has been Installed in actor- 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 anyby both deviations here have been cleared/approved by both the designer shown here have been cleared/appm ved and Mason County Public Health and meet all State myself and Mason County Public Health and meet a!! 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 Xs name. form and attached Record Drawing is accurate. ,_,.- ...j.......___e_c_ ''' t\ 4',1., •:, Signature� of In leer Date �wo R P II t'oc t: is Printed Name of Slgnee / o , ` MASON COUNTY PUBLIC HEALTH ,,Aiii stivart a ,��,i�� The undersigned approves this Installation Report and '" . DAL E t.214 w, Record Drawing on behalf of Mason County Public s 0: - t.IC MSEP CESfCNER 1' Health: m asoam w. - ..,.. itievrcw-.��:1. Q'y\V`,11()ThA('I c7e.)1 tb j2-Z- sxv-;:f,:-,. - —_ob Signature of Environmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC V1ElN ON THE MASON COUNTY WEE,SITE Up,ieted 8'21t2o"9 1 ______ /.- -- _ -%\-- k,. 0•(N.. \`\‘(-\)c\e...\- . . _ ONVC.Z,\ . . , 0%1— .C)--1 60 l '° . \b, ! \9Q4� - ,'fi r,fir, t\ . \ e_c_or elk \ x-cx\ovr\,()_.\ (c- e.,,,\[\se..3, ck- ,1-` ‘'c S\gG oo n70-k SviG ,c , 03 1 • n i • 1\ \ 1 . ' ' fi (N, ' .*-01-`, . mod, _i -. yam.. ' sr I' ! . -) 1 / t� / ti • / . a y. • mot :i.i f ..3,r \ rp / ,,,. '-,, .,,-/ , J j k: �.' Y........_q_. cy/ , i ' , C. . r 1 1 /Q \ \ .."0 �� N001 .\ or : 4. , t'. v of`""mow sip% c :--z- 1 (7. 51 00 21 4 . .sr,�. i 0 '-, /4:. - ,:-:.;‘ . _ DALEL. 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