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HomeMy WebLinkAboutSWG2020-00014 - SWG As-Built - 9/16/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00014 Parcel # 222095400082/222095100023 Applicant Name Thomas Jones Subdivision (Name/Div/Block/Lot) Applicant Address 3930 Hoyt Ave CLIFTON BEACH TRACTS City, State, Zip Everett WA 98201 Installer Name Trinity Excavating Site Address 6421 N.E. North Shore RD Designer Name Mike Jerkovich INSTALLATION CHECKLIST IN Full System Installation El Tank(s)Only ❑ Drainfield Only El Repair El Other System Type Pressure Pretreatment Type >5 ft.from foundation? - - ❑ N/A • YES ❑ NO >50 ft.from wells? - - ❑ © ❑ Z >50 ft. from surface water? - - CI ❑■ CI H Cleanout between building and tank? - - CI III CI U Tank baffles present? - - ❑ 0 ❑ d24"access risers over each compartment?- - CI CI© W Effluent filter installed?- - ❑ ❑■ ❑ N Septic tank capacity(working) 1 200x3 gal Manufacturer Hagerman Precast ---o D-box water level and speed levelers used? - - ❑� N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - CI IN CI mZ Check valves installed? - - ❑ ❑ ❑ oQ 2 Transport Line Size 2.5" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 El 3 El 4 El 5 El 6 El Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft. from wells?- - ❑ LU ❑ w >100 ft. from surface water? - - CI MI CI it >10 ft. from potable water lines?- - ❑ ® ❑ Q Z > 5 ft. from property lines and easements?- - CI1. CI cc > 30 ft.from downgradient curtain/foundation drains?- - ❑ I ❑ Drainfield level and observation ports present - - ❑ I ❑ IN Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - El N/A ID YES El NO • Pump tank capacity(flood) 3500 gal Manufacturer Evergreen Precast Q 24" access riser(s)and accessible from surface?- - ❑ I ❑ 1- 0- Alarm or Control Panel Installed? - - ❑ 0 ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ I ❑ n a Pump installed in it Bucket or El On Block or El Other a• Pump Make/Model Liberty FL 200 UI Floats or ❑ Transducer EL a Tank draw down 43 in/min Pump capacity 80 gpm Squirt Height 2.5' ft Pump on time 1.86 Pump off time 3hr 58 min Daily flow set at 840 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 222095400082/222095100023 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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. 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. es Signature of Installer Date /0 ,/ 7L J G�a,)��rl;r-) , '#'%f Printed Name of Signee l. MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and ;•' ''' .-A • i^.�O' 5100385 Record Drawing on behalf of Mason County Public t°°"MICHAEL D.JERKOViCH I� Health: LICENSED DESIGNER 4/1 I t I EXPIRES 01-19-2023 nature 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 oz�z !iI m 0ppA Lf O�f r 4�7 E Z m1 c� P r z . 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N 0 ti� (31 70 `• �`"." 4 O O O ii>11 N CA) i < -o z GI) _O O 7 aF.._. :;, r , THOMAS JONES & CHRISTIE KALOPER 1,,„ " g'o ,,,, 0-, - -g - „e-e- 6421 NE NORTH SHORE RD., BELFAIR, WA 98528 - O R