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HomeMy WebLinkAboutSWG2022-00371 - SWG As-Built - 2/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00371 Parcel # 32105-75-90051 Applicant Name Rodney Carriveau&Diana Atwood Subdivision (Name/Div/Block/Lot) Applicant Address 486 Patterson Rd City. State, Zip Port Angeles, WA 98363 Installer Name Mikkelsen Septic, LLC Site Address 641 E Hyland Dr, Union, WA Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation 0 Tank(s)Only 0 Drainfield Only 0 Repair ❑ Other System Type Gravity Trench Pretreatment Type >5 ft.from foundation? - %''Q °' `AIL{ - ❑■ N/A ❑YES ❑ NO >50 ft. from wells? - - NI 0 0 z >50 ft. from surface water? - - Q 0 0 < Cleanout between building and tank? - _ ❑ 0 ❑ 0 Tank baffles present? - - 0 © 0 a24"access risers over each compartment?- - 0 ® 0 W Effluent filter installed?- 0 II 0 co Septic tank capacity(working) 1,200 gal Manufacturer Norwesco 0 D-box water level and speed levelers used? - - 0 N/A ® YES ❑ NO J �O Manifold/D-box accessible from surface?- - 0 II El ODE Check valves installed? il- 0 0 E Transport Line Size 4 inch Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- § -g-E- N/A ❑ YES ❑ NO 0 >100 ft. from wells?- / 0 0 -I >100 ft. from surface water? - _F� a: >10 ft. from potable water lines?- 2g23 0 0 El Q > 5 ft. from property lines and easements?- 6� `-1� _ © 0 El 0 > 30 ft. from downgradient curtain/foundation drains r= ----- INI 0 El Drainfield level and observation ports present - ❑ ® ❑ 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- _ ❑ II 0 r_p tank setbacks consistent with septic tank?- - ii N/A ❑ YES No Pump tank capac (flood) gal Manufacturer Z Q 24" access riser(s)and a ible from surface? ❑ 0 d Alarm or Control Panel Installed? -- ❑ ❑ 2 Control Panel equipped with Timer/ETM /Cou - - ❑ ❑ ❑ M /. Pump installed in ❑ Bucket or ock or ❑ Q. PumpMake/Model � ❑ Flo or ❑ Transducer d Tank draw in/min Pump capacity gpm Squirt Height ft mp on time Pump off time Daily flow set at d L a'.aleC 8.2'..'201 e Mason County OSS Installation Report pg. 2 Parcel# 32 t 05`7 5-q005 1 • Were existing septic components abandoned as part of this project? - - El YES s5 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES El NO 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: Drainfieid 8 manifold onentalion 8 layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buldings,location of wells,waterlines, was,observation ports.deanouts,and other maintenance acn ss points Incomplete Record Drawings may create additional delays in final instaIation approval and related permits. 4 °ROVE,, FEs SillAO'tOUNTy a y ?023 ENV1RpNfljENTA JBW HEALTH IARecord Drawing Attached 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. �- -- OI 2 2 8� Signature of nst ler Date ... Printed Name of Signee G •,•.-u. e`h i �� �.' �� f MASON COUNTY PUBLIC HEALTH �\ The undersigned approves this Installation Report and N 51CJ349 { Record Drawingon behalf of Mason CountyPublic 4 • Pku A..or 14HNSON .'t ,� •�v C(�fS`t�'t�ESi�Nfi�.. He // // ezpl �ri�i ' w4A 2 -4 3 / - Zs''t-t Si atur v nmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821/2°18 sQ.. : 1 = 40 ' l to 41 D` 0 zo 4o (,0 So n...._._______ ci .ii- �� '` Roc ve C0.vriJeau- d x / j t p i a�v� cZ Kl} weof� t � T 50I 7 q II f , l� L _ J �,.,� G 1 . ..., t, -44.....4,0 i . 0 -z.:. ." sist.. ft 1 max.,vc:k��' y .• v J`` I may : • PAULA JOY JOHNSON •T L T / 1 , 2,5'- 23 c / / Nr M (1 az ((c)3' x 551 PY 1„►-,mn P.f. WI t T've-/t,c,_ ..e,s 6 S. ` O .G. M x M co- Y� �v.� Pb o\t2 Kev: r 0 Cleanout x 0 1,200 Gallon Septic Tank V #0 2-Compartment with Effluent Fiat( c D-Box with speed-levelers tic. v7.:' and cover to surface V,G�c4r�`-73, 40 yyl • i r —41Sr 17), l fo3.'1`1 '