HomeMy WebLinkAboutSWG2017-00088 - SWG As-Built - 8/7/2019 reirvIg
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Mason County OSS Installation Report pg. 1 MASON COUNTY P BLIC H 2 4!�EALTH
. APPLICANT! PERMIT INFORMATION D ------_ D4--
Permit Number SwG i9(-)` 7 -{ j 8-O Parcel# 22212-50-08032
Applicant Name JAG Construction Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 476 Lakewood Plat A Block 8 Lots 32 - 35
City, State, Zip Manchester WA 98353 Installer Name Tom Weaver
Site Address •?‘C, East Ellinor Peak PI Designer Name Tom Weaver
INSTALLATION CHECKLIST
JJ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Gravity Bed Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ®YES ❑ No
>50 ft. from wells? - - ❑ ® ❑
Z >50 ft. from surface water? • - ❑ El
< Cleanout between building and tank? - • ❑ ® ❑
U Tank baffles present? - - ❑ ® ❑
a24"access risers over each compartment?• - ❑ ® ❑
`W Effluent filter installed?- - 0 DE
Septic tank size 1,200 gal Manufacturer Infiltrator IM 1060
O D-box water level and speed levelers used? - • ❑ N/A gJ YES ❑ NO
x0O Manifold/D-box accessible from surface?- - ❑ E ❑
mZ Check valves installed? - - IN 0 0
6E Transport Line Size 4�� Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ICJ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A ] YES ❑ NO
0 >100ft. fromwells?- - ❑ n 0
W >100 ft. from surface water? - - 0 rj ID
Z >10 ft. from potable water lines?- - ❑ ] 0
Q > 5 ft. from property lines and easements?- - ❑ KJ ❑
IY > 30 ft. from downgradient curtain/foundation drains? - - ❑ xi ❑
0
Drainfield level and observation ports present - - ❑ ri ❑
❑ Graveless chambers or 20 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® 0
Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO
Pump tank size gal Manufacturer
< 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑
aAlarm or Control Panel Installed? - - 0 0 0
E Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑
a. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
d Pump Make/Model ❑ Floats or ❑ Transducer
dTank draw down in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
upd,!.d amnc,e
22212-50-08032
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES tZ NO
If yes. please describe
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES NA 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 avow.reserve drainfield,existing and proposed buildings,location of welts,waterlines.
welts observation ports,Cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits
See Attached
[a Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER! ENGINEER
I certify that 1 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.
e.
Signature of Installer Date
tJs� ?
Printed Name of Signee -4;E:
MASON COUNTY PUBLIC HEALTH ` i!'
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eft
The undersigned approves this Installation Report and � re
5?00333
Record Drawing on behalf of Mason County Public -THOLUAS E.WEAVER•. •
IC NS"cdIS,_FSI c`R.
Health. ExPlPES^i r2 Z Z
i `,h 74 41
Signat e of r nmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Liwaled 5'-1/2O 6
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