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HomeMy WebLinkAboutSWG2022-00363 - SWG As-Built - 8/22/2022 MASONCOUNTY PUBLIC HEALTH glklunA` Installation Report pg. 1 APPLICANT/ PERMIT INFORMATION -1'- 2Z-Z. C0 Parcel # 22336-50 00059 PermVnber Appli“• iso`'= e Lan Wce Subdivision (Name/Div/Block/Lot) .y pplicant Address 6456 NW Redfern Ct. City, State, Zip Silverdale, WA 98383 Installer Name Shumaker Construction Site Address 391 NE Gladwin Rd. Bellair Designer Name Acme Septic Design INSTALLATION CHECKLIST Q Repair 0 Other Full System Installation ❑Tank(s)Only 0 Drainfleld Only 0 Pressure _ Pretreatment Type System Type - � N/A Q YES ❑ NO >5 ft. from foundation? - ❑ MI ❑ >50 ft.from wells? - - ❑ 0 ❑ >50 ft.from surface water? - 0 0 ❑ Z Q Cleanout between building and tank? - ❑ 0 U Tank baffles present? - - 0 0 0 a24" access risers over each compartment?- ❑ ❑ W Effluent filter installed?- Hagerman Septic tank size_______________1250 gal cn Manufacturer__ - � N/A ❑ YES ❑ NO 9 D-box water level and speed levelers used? - 0 ® 0 gJ0 O Manifold/D-box accessible from surface?- i C9 Z Check valves installed? - 40 0 Q 2 Schedule/Class Transport Line Size Ell5 ❑6 ❑Commercial/Other Bedrooms installed (check one) 0 2 0 3 4 - ❑ NIA El YES El NO i >10 ft. from foundation? - 0 0 ❑ >100 ft.from wells? ---I >100 ft. from surface water? - ❑ © 0 I❑ ❑ W a-. >10 ft. from potable water lines?- - ❑ 0 El > 5 ft.from property lines and easements? 0 0 > 30 ft. from downgradient curtain/foundation drains? - - 0 111® 0 Drainfield level and observation ports present ❑ Graveless chambers or © Clean gravel used? (check one) ❑ 0 0 Proper cover installed over drainfleld? Pump tank setbacks consistant with septic tank? El N/A Q YES 0 NO IHagerman 1250 gal — Pump tank size Manufacturer - 0 0 ❑ Z 24" access riser(s) and accessible from surface?- 0Pi 1- - ❑ I d Alarm or Control Panel Installed? ❑ 0 2 Control Panel equipped with Timer/ETM /Counter d Pump installed in ip Bucket or r] On Block or 1] Other d Liberty 280 Floats or El Transducer Pump Make/Model m Squirt Height 12' ft a Tank draw down t•5 in/min Pump capacity—3 _—gp Pump off time 2 hr Z,4t Min Daily flow set at 360_gP Pump on time 1 min Updated 8/2112078 Mason County OSS Installation Report pg. 2 Parcel# 223365000059 ABANDONMENT RECORD - D YES 0 NO Were existing septic components abandoned as part of this project? - \ If yes,please describe: existing septic tank pumped by Kurts septic pumping - NO Were all components pumped out and properly abandoned per WAC246-272A-0300? Q YES RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance nactivities and future Irindevl cation of wells,Typical waterlines,at Record Drawings contain: orainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing andproposed wells,ooservation 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 lfhere d Mason been cleared/approved Public Health and meet all th and Mason County Public Health and meet all State myState and Mason County Codes 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. Q(Oa 2L Signatur of Installer 1 Date r 7,---,1 St - — 11 ; Pr; fed Name o%Signee 11 1 • yc �, '' MASON COUNTY PUBLIC HEALTH /�/�' �`t}" . �� Ilia•- " The undersigned approves this Installation Report and 1 04 PT Record Drawing on behalf of Mason County Public ,ir [xPfP:G$ Health: U, v j2 l i //5/ Z Z Z Signature of Environmental ealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED•AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 y • ' • • • m Tram?, \a �'. ;.i' • = AIL .1 ���•. •fit.`.•. ,� � zi r .. .. rn< . • • . 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