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HomeMy WebLinkAboutSWG2021-00292 - SWG As-Built - 2/22/2023 CC- Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00ackA. Parcel # 22017-52-00053 Applicant Name PDQ Contracting Subdivision (Name/Div/Block/Lot) Applicant Address P. O. Box 4 City, State, Zip Wuana, WA 98395 Installer Name Final Vision Inc Site Address 371 E. Budd Dr, Shelton, 98584 Designer Name Acme Design Inc INSTALLATION CHECKLIST It Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A El YES ❑ NO >50 ft.from wells? - - ❑ Ei ❑ Y >50 ft. from surface water? - - ❑ • ❑ Z Q Cleanout between building and tank? - - El El ❑ U Tank baffles present? - - ❑ 0 ❑ F. 24" access risers over each compartment?- - ❑ 0 ❑ a. W Effluent filter installed?- - ❑ El ❑ Septic tank size 1250 gal Manufacturer Hagerman O D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO J XOO Manifold/D-box accessible from surface?- - ❑ El El OQ Check valves installed? - - ❑ ❑ El • Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑� 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO >100 ft.from wells?- - ❑ ❑■ ❑ a _1 >100 ft. from surface water? - - ❑ 0 ❑ W L.T. >10 ft.from potable water lines?- - ❑ El ❑ Z > 5 ft.from property lines and easements?- - ❑ ❑ ❑ Q CC > 30 ft. from downgradient curtain/foundation drains? - - ❑ El ❑ 0 Drainfield level and observation ports present - - ❑ ❑l ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ NIA © YES ❑ NO Y Pump tank size 1250 gal Manufacturer Hagerman Z < 24"access riser(s)and accessible from surface?- - ❑ ® ❑ n~ Alarm or Control Panel Installed? - - ❑ El ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ • ❑ D a Pump installed in ❑ Bucket or El On Block or ❑ Other a• Pump Make/Model Liberty 280 ❑E Floats or ❑ Transducer a Tank draw down 1" in/min Pump capacity 22 gpm Squirt Height 6 ft Pump on time 81 sec Pump off time 3hr Daily flow set at 237.6 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - YES NO 1f yes,please describe: • Were all components pumped out and properly abandoned.per WAC2467272A-0300? - — _- � YES El 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,Septidpump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,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 1 certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped"APPROVED-bMason 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 a ached Record Drawing inaccurate, form and attached Record Drawing is accurate. 101}l/)-02 nature of Installer Date 1 kr C�{rY1 Sty'Punted Name of Signee MASON COUNTY PUBLIC HEALTH 4�The undersigned approves this Installation Report and r �j4;, X Record Drawing on behalf of Mason County Public v. LEFT 4 UCENS is()ammo/ Health: noranuXoirosA omtur EXPIRES 12115r ,/P Z'J7 z 1z -- Signature of Environmen 1 Health Specialist Date (stamp,signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated eatnote * * * * * * D 0 O z D D rr- X m O rr- f DD z Z co z -Irn = .k TI m i i, 0 0 0 H m m z Cn h og 5<'':7� 1\° Fri) .0< mzmmn /1 cn m cn ? ? 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