HomeMy WebLinkAboutSWG2021-00537 - SWG As-Built - 2/22/2023 �� MIIVI`: CC.
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Mason County OSS Installation Report pg. Yu FEB 1 6 2023MASON COUNTY PUBLIC HEALTH
APPLICANT/ PgfpMIT INFORMATION
Permit Number SWG 2021-00537 Parr.Pl# 220245000017
Applicant Name i Empire Home Construction LLC Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 241
City, State. Zip Kelso, Washington 98626 Installer Name S 4 cr-,._ Snf d r.--
Site Address 27 i E Lc-,,.,ds1 Designer Name Travis Buck
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INSTALLATION CHECKLIST
3 Full System Installation r]Tankfs)Only n Drainfield Only 0 Repair 0 Other
System Type_ '' _55L- Pretreatment Type _
>5 ft from foundation? • , - -- - - ❑NIA YES 0 NO
>50 ft. from wells? . ❑ 1] 0
Y >50 ft. from surface water? • 0 �] 0
Z
< Cleanout between building and lank? - ❑ �] 0
V Tankbaffiespresent? - - -- -- - - - - ❑ 0
•
d 24.. access risers over each compartment?- - 0 ] 0
rw Effluent filter installed?- - 0 IC 0
Septic tank size (egg gal Manufacturer...,,,..d Plc-c4,._.---I' 1,LZ3
0 D-box water level and speed levelers used? - . '❑ N/A ❑ YEs ❑ NO
J
DO- Manifold/D-box accessible from surface?. 0 � ❑
/m Check valves installed? ❑ u Cl< ,,
2 Transport Line Size Schedule/Class^l,)
Bedrooms installed (check one) ❑ 2----0 3 0 4 0 5 ❑6 ❑Commercial/Other
>10 ft from foundation?- - • ❑ N/A '❑ YES ❑ NO
0 >100 ft from wells?- - 0 ❑
--I >100 ft from surface water?tti - ❑ N 0
u.- >10 ft. from potable water lines?- - 0 ❑ 0
� > 5 ft from property lines and easements?. - 0 ❑
Q
ix >30 ft. from downgradient curtain/foundation drains?- - 0 , , ❑
Drainfield level and observation ports present ---- - 0 d
0
-'8 Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- -. . 0 TA ❑
Pump tank setbacks consistant with septic tank?. - 0 N/A -N YES ❑ NO
X Pump tank size i 6 gal Manufacturer
Z —
24' access riser(s)and accessible from surface?- - 0 -_ ❑❑
dAlarm or Control Panel Installed? - - - ❑ IU,
2 Control Panel equipped with Timer I ETM/Counter. . ❑ IN 0
a. Pump installed in ❑ Bucket or On Block or 0 Other________
n PumpMakerModel c IL,- r,�2-_.
t__.. ___ I] Floats or 0 Transducer
Tank draw down in/min Pumpcapacity ( " U ft
a. ,..J' ' P y gpm Squirt Height Z, "5'
Pump on time_ ) 1.,,i'irk Pump oft lime---,,3—lia— Daily flow set at 4S gpd
•
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Mason County OSS Installation Report pg. 2 Parce,tt 220245000017
ABANDONMENT RECORD
Vi/c•'e eai 1inq septic components abandoned as part of this poled/ -- - - - - (� eE:. i
des. please describe ---- — — — — _ _
\Yrrr nil t nnipunrnts pumped out and properly abandoned per WAC246.272A•0300" • • C 'rE NC:
RECORD DRAWING
Sbn is a p►rmanant r.cord and mull ba arcuraln and dest/104v,enough to a Total.In the need of manttanance 3'.1:,_ts 3-1•. :-•-1 ' -• •
t,.»nv.r.ni.11 fe dntw•to b mV, -'d crv.•nbll.nn 6 hq.,a! �!'C'" Pr^m t.mb 1 r ut-n q•.•• .. a •. ...f•.0••••1 .r , .. - •wa •l,-••
•r!•. ,•t••ova'•n rrn; •Y•.ln.uts end uh'ef mani.•,erun..rre•vt pens In:menkc t7rr,vd f)r lA,p•.• •••, ., -r J•-:/s a fra r .;.. .r1<'^••• .•.. •
Record Drawing Aracrled
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
l 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
Signature of Installer Date
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Punted Neme of Stgnee et .P
of
MASON COUNTY PUBLIC HEALTH • •
e1�t
The undersigned approves this Installation Report and p �irr
Record Drawing on behalf of Mason County Public TMA IN) CK .
Health LICENSED DESIGNER
/7;741, sit-It 207r7
Signature of Environmental eanh Specialist Data VVarid��
9 A (stamp, signature date)
THIS(ORM MAY BE SCANNED AND AVAILABLE con PURL IC VIEW ON THE MASON COUNTY WEB SITE '' '"'
® AnyScanner
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 A,
utility line location have been estimated. This drawing
is not to be used to locate water or utility lines.
0' 50' 100'
Lansky Dr.
® 165'+/-
Utilities
Shared Well 100'Radius
Well [Water Line
Driveway
Home Site
Sound Placement
12-2633 HW A
r Drain Lines
Valve Box / 5 @ 3'x 40'ea.
M -- M
observation
APPROVED Reserve Area
7 Ports(5)
40'x22.5'
FEB 22 2023
MASON COUNTY ENVIRONMENTAL I1LALTh
RET
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O ..165'+- ei TRAVFS C RUCK
LICENSED DESIGNER
Permit Number:SWG2021-00537
Installed By: Rochester Dirtworks exriRes 11 r zn f
Empire Home Construction LLC Advanced Septic Consulting Inc. Design: Date:
271 E. Lansky Dr. 3210 Westside Hwy. Castle Rock.Washington 98611 21-273 2/13/2023
Shelton, Washington 98584 Cell:360-433-5476 E-Mail:dirtwhisperer@gmail.com As-Built Scale: 1" = 50'