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HomeMy WebLinkAboutSWG2022-00443 - SWG As-Built - 2/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00443 Parcel # 42209-54-00040 Applicant Name SEAN FERGUSON Subdivision (Name/Div/Block/Lot) Applicant Address POP BOX 367 City, State, Zip HOODSPORT, WA. Installer Name SHOENING SEPTIC Site Address 440 N MOUNTAIN VIEW DR Designer Name CINDY WAITE INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? III- - LI ❑ Z >50 ft. from surface water? - LE.�iE - ❑ © ❑ ft_ ivotz_i_itmz _ liti LS Cleanout between building and tank? - ❑ � Cl U Tank baffles present? - 11 - ❑ U] ❑ d24" access risers over each compartm- t?- Lu ❑ El ❑ W Effluent filter installed?- klyL4- ; _ - ❑ 0 ❑ co Septic tank size I Z3(7 gal Manufac'TQ2 Pa. yet_,,, ]It) 9 D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO oO Manifold/D-box accessible from surface?- _ CI1 CI m- Check valves installed? Ill El- ❑ �Q 2 Transport Line Size 4 Schedule/Class ASTM2729 Bedrooms installed (check one) ❑ 2 U] 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - El N/A 0 YES ❑ NO 0 >100 ft. from wells?- - 0 ❑ ❑ W >100 ft. from surface water? ❑ RI ❑ i >10 ft. from potable water lines?- ❑ CI ❑ Q > 5 ft. from property lines and easements? - ❑ 111 GI Q• > 30 ft. from downgradient curtain/foundation drains? - - it CI CI Drainfield level and observation ports present - - ❑ It ❑ © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- _ ❑ El ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES 0 NO Pump tank size gal Manufacturer Z < 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ H a. Alarm or Control Panel Installed? - - ❑ ❑ ❑ Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑ 4- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other 2 Pump Make/Model ❑ Floats or ❑ Transducer a.• Tank draw down in/min Pumpcap acity acit P y gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 42209-54-00040 ABANDONMENT RECORD Were existing septic components abandoned as part of this project'? - - 0 YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - W YES 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 arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. S ni S7 diPej 47 PLI /11 4 ` r-46: ...3—"G G �r is b-e4 w t--eti p Apcflo,vE r c fit r , . FEB 2 1 2023 MASON COUNTYENVIRONib1ENTAL (;.. JBw HEALTH , .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 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. .,,.W 11"Z"7-2 ditiSignature of Installer Date i 1IV--),{oni,k-e,ev-\ .c..:- (),-,0-ex\Art) ... • Printed Na a of Signee j ��P�1, n,d ./„ ,Nns !� MASON COUNTY PUBLIC HEALTH o,r N`4.t~ = 2,11 V\`- The undersigned approves this Installation Report and •4 sJ,,,v- Record Drawing on behalf of Mason County Public o� CINDYoE WAITE `���+1 Heal �0 LICENSED DESIGNER 11 irdi ('-,1__ \� Ilk IllelbliM IF t --.)j Lxi'rRLS OSildi Si atu Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8r2V2018 i ♦ r 13*), - - I r 40.4 '�,;�et P �4 �1fi ik, i Ga I r Cl` LICE CI -E jYDE W$t E R !1 > �, 1 LxI'iRES OS 1O' , Itle.P. C v1 2;' _ . / ...___ 1 . 0 it 3L4• r' Q Lx, s'1 Ni Per,01 � • c lei �✓G4,�" \iiii / / . • (1-sP ' CP 1 IOU q ,,e,ja,c) 54,04, i is f °b u ,t I 0.4 44 / x4NSy s<,1 1, (EAIm I ,, 0 li V cch.r..w'W. t, L�� & P1tI Iv)Q D L t,A L��, J F11� 0 R F5'Px.ve Ace. IQ'h. tc LI 2 .0 q^se!- a,ovo ® soli tot; '1 iO A/ "!60,1 Q/M/ 1/reu/ DiS/ °-caw L-J r C CO ' -/.epil, q I 2d 1 4/0- , 6ri' Z -tee : 1 1 of .. G " PPROVEnkidil l ' ?" --C FEB 21 2023 V K cthisp`' ' ;Je._ ceav rer.- cAf 0 A./ MASON COUNTYENVIRONMENTAL HEALTH JBW