HomeMy WebLinkAboutSWG2021-00538 - SWG As-Built - 2/22/2023 I 4,, i AMR TM'
Mason County OSS Installation Report p �(( 1 NJASON COUNTY PUBLIC HEALTH
APPLICANT1'PERMIt t J bRMA-:ION W�
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Permit Number SWG ZQZ(-0/953� I;: Parcel # ZZO l5c100OZU
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Applicant Name ,,e Home /�o0t-}rrv-60,Subdivlsion (Name/Dtv/Block/Lot)
Applicant Address PO E.ox Zel/ BY•_-----
City, State, Zip ?e1SO 4 i,j _<l\l`rsVT)" ill e Installer Name S 4 c..1940, - -nr 4 c
Site Address Z, £ -•<-f-Jj ` Designer Name �vwvt5 ei(L
�3 INSTALLATION CHECKLIST
CZ= 'Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
Ir.l N System Type -V2Y-e- 5 Pretreatment Type
(---.1 >5 ft from foundation? - - ❑ N/A '1=1 YES 0 No
4-=.I `— >50 ft from wells? - ❑ 0 0
2 >50 ft. from surface water? - 0 NEI El
__ ct4 Cleanout between building and tank? - ❑ �] 0
Tank baffles present? - 0 �] 0
a. 24-access risers over each compartment'- - 0 \ L] 0
W Effluent filter installed?. - 0 0
CI) Septic tank size 1 Len _gal ManufacturerS4buJ /c.r_e•,,- f' LLs'?3
0 D-box water level and speed levelers used? - - -is N/A El YES 0 NO
XO O2 Manifold/D-box accessible from surface?• - 0 - 0 0
co, Z Check valves installed? - - 0 0
<
Transport Line Size --/__t r Schedule/Class c--// ,)
Bedrooms installed(check one) ❑ 2 IS]3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft from foundation?- - 0 N/A 'fl YES ❑ NO
p >100 ft. from wells?- - 0 0
w >100 ft from surface water? • - 0 0
ti >10 ft from potable water lines?- - 0 tC ❑
Z > 5 ft. from property lines and easements?- - 0 0 0
Q
Ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0
o
Drainfield level and observation ports present - - 0 b ❑
Graveless chambers or ❑ Clean gravel used? (check one)
i Proper cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistant with septic tank?- ❑ NIA YES ❑ NO
Z• Pump tank size 1006 gal ManufacturervJ Pikrsy_.-c vs 2L33
4 24' access riser(s)and accessible from surface?- - ❑ ❑
Alarm or Control Panel Installed? - - ❑ ❑
• Control Panel equipped with Timer/ETM/Counter- - 0 O
a. Pump installed in ❑ Bucket or-NEI,On Block or 0 Other
n' Pump Make/Model L„m)Lt r S? , Floats or
0
Transducer
Tank draw down in/min Pum capacity Sc
EL P h // gpm Squirt Height 1 h
Pump on time / },.v"n Pump off time J. 1 rs Daily flow set at -' .c gpd
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Mason County OSS Installation Report pg. 2 Pa' Z201$57iXX}Z(}
ABANDONMENT RECORD
',Vete erlstino septic components abandoned as part of this protect? • ❑ YES --b] NO
It Yes please describe -
1Yere all components pumped out and properly abandoned per 1NAC246-272A•0300' ❑ YES ❑ NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re locate in the need of maintenance actrvlttes and tutore de+Nepm•nt
nTwna•.onnlam D'ant„•4&mane:d See'r.M•'T f.rl t> s -n N^'•- ^rw•ra.•rv^d•a:n'•^N rr,.Or ao7 r,.•- -.,ed p. I- ..•'' - • .,
w^^: ›biorval.D port; cl"an:N:'. and orner ma.r lenj'.ce p•.rcc pf;Yc 1•'u'rrop'^t.r''•'r 1(D'aw'-s n.Y neJrr.rid1•n'.0 d''iys.n Irf.I!f•.' ,'�a:0'^Y 1.1".1"•
El/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
1 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.
_de" � /
Signature of Installer Dale
S - 5i I i d
Pnnted Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and -`�� '•� '3—X2I
Record Drawing on behalf of Mason County Public • 'o= Tanvls c.xeucx m�
Health LICENSED DESIGNER
"corn cY�EYniacs 15.1
_7-20
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 " • -
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ri . .
v • N
• has\\ale
0' 30' 60'
0
Please note: This as-built has been
drawn for reference in assisting in locating
the septic area and is in no way intended to
be a survey. Water and utility line location
c 4111 have been estimated. This drawing is not
to be used to locate water or utility lines.
Carpo
Shed
moo.
Utilities & ,` Home Site ♦♦
Water Line \ •♦ Sound Placement
® ♦ice 4" 0 12-2633 HW
•
•
• Valve Box
/ II
♦•4.•
NO
Approximate Location of Abandoned b. ♦ \
1 Bedroom Septic System ♦♦�♦♦ 0//
♦� j
l Drain Lines
Retaining Wall ♦ \ 0 4 2 @ 3' x 48' ea.
// // I� 2@3' x52' ea.
�0 I/ /j� �Ij�/�,
,!.., c
II A: i/i /j
Reserve Area %,�' /// */
45.5' x 13.5' *��� '�� '���
c�
AppROV ���,f,
FEB ED %'
MASON COON 22 2023 Observation
11 Eh'VIRONMENlAL Ports (4)
RET HEALTH
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TRAVIS C.311CK
LCEPZSED DES'GNE.R
Permit Number: SWG2021-00538 anws 11-ff-2o ir
Installed By: Rochester Dirtworks 0
Empire Home Construction LLC. Advanced Septic Consulting Inc. Design: Date:
230 E Eastlake Dr. 3210 Westside Hwy. Castle Rock, Washington 98611 21-274 2/13/2023
Shelton, Washington 98584 Cell: 360-433-5476 E-Mail:dirtwhisperer@gmail.com As-Built Scale: 1" = 30'