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HomeMy WebLinkAboutSWG2020-00367 - SWG As-Built - 3/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00367 Parcel # 52007-14-00040 Applicant Name Jenn Pauley Jay Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 327 W 114' OF SE NE N OF RD , S 48/136 City, State, Zip Matlock,WA 98560 Installer Name Goldy Septic Service LLC Site Address 14280 W Shelton Matlock RD Designer Name Arrow Septic Designs INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Othe- System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft. from foundation? - - 0 N/A ❑ YES ❑ NO >50 ft.from wells? - - ❑ 0 ❑ Z >50 ft.from surface water? - - El El El ▪ Cleanout between building and tank? - - ❑ ❑ 0 U Tank baffles present? - - ❑ I ❑ H 24" access risers over each compartment?- - ❑ I ❑ a El ❑ u.t Effluent filter installed?- - El N Septic tank size 1200 gal Manufacturer Miles C) D-box water level and speed levelers used? - - • N/A ❑ YES ❑ NO oOJ Manifold/D-box accessible from surface?- - El 0 a?Z Check valves installed? - - ❑ ❑■ ❑ oa 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 0 5 6 _ ❑Commercial/Other >10 ft. from foundation? li- �- - N/A ❑❑ YES ❑ NO 13 >100 ft. from wells? 1 W >100 ft. from surface water? 11 el ❑ ❑ 1 >10 ft. from potable water lines?- tom---- - - - ❑ I ❑ > 5 ft. from property lines and easements?- - -- - - - - - - - ❑ 0 ❑ id > 30 ft. from downgradient curtain/foundation drain y_----_- - IF ❑ ❑ o Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank size 1200 gal Manufacturer Miles z - ❑ 0 ❑ < 24" access riser(s) and accessible from surface? H Alarm or Control Panel Installed? - - ❑ ❑ IN 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ M a- Pump installed in ❑ Bucket or © On Block or ❑ Other a-• Pump Make/Model Zoeller N152 El Floats or ❑ Transducer Cl. Tank draw down 2.1 in/min Pump capacity 45 gpm Squirt Height 5 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8212018 (40 Mason County OSS Installation Report pg. 2 Parcel# 5 ZOV7' M.-000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-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 activities and future development. Typical Record Drawings contain' Drainleld&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfleld,epsting and proposed buildings,location of wells,watertines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 5ee A-t---fackA, Ct ® 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 attache R cord D wing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date 0.5 Jo Goldse.-..* Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 1 :' " S•... ..1;h). Record Drawing on behalf of Mason County Public f`� s t ou3as N' v, L. JOY JOHNSON ; Health: 'L'tCENSE D'ESI'l;Ni: r ,..vC.,_ ...... ,,,No c.cyl S 7`' Z- -2-3 Signature of Environmental alth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated srztaota A • ?roFka �Sbvi lk writ Jenh ?ault1 jay, fiafCtl 4'SZ007-tw-000'�0 :1, , f�1280 hl 5hzlior 1Wttlock ea 3I'vr We t^ WA a ssvf All \ SCaE.e: lM: 3G' a is 30 46 .. 60 \oo 3BR t• +louse RC' • Lliq. . El G lign , 5451 © Audio-V .• . . o - © mot Tank 1200 Ga1� '� I © 2-ColliP with y. " Efface Filter LC ( Jam° Gallon Pump Caw:ober 1 .oI N x x O- � I e 0 L_ _j APPROVED MAR 0 9 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET , A. er* ,. mat wy, . ' ��� 5 •� 5100349 �"� PAULA JOY JOHNS ON ls,"triir.,-NER "/4y�oc. .. 2,Z'$'23