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SWG2021-00295 - SWG As-Built - 3/6/2023
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00295 Parcel # 22018-51-00009 Applicant Name Knight Construction Subdivision (Name/Div/Block/Lot) Applicant Address P. O. Box 4 City, State, Zip Wuana,WA 98395 Installer Name Final Vision Inc Site Address 741 E.Timberlake Dr, Shelton, WA Designer Name Acme Design Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pressure Pretreatment Type >5 ft.from foundation? - - ❑ NIA 0 YES ❑ No >50 ft.from wells? - - 0 0 0 Y >50 ft.from surface water? - - ❑ 0 0 z FQ- CI between building and tank? - - 0 0 U Tank baffles present? - - 0 ❑■ ❑ a24"access risers over each compartment?- - CI 0 CI W Effluent filter installed?- - 0 0 ❑ rn Septic tank size 1250 gal Manufacturer Hagerman `a D-box water level and speed levelers used? - - © N/A ElYES ❑ NO X0 Manifold/D-box accessible from surface?- - 0 ® ❑ 09 Z Check valves installed? - - 0 0 0 ❑Q Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑� 2 ❑3 ❑4 ❑ 5 0 6 0 Commercial/Other >10 ft.from foundation?- - El NIA al YES ❑ NO 1-1 >100 ft. from wells? - - ��- 1-i[ !1- - ❑ ❑■ ❑ w >100 ft.from surface water? � 1= - 0 © ❑ E >10 ft.from potable water lines.'- --- mAR-0-t -nr ❑ ❑ ❑ Z `> 5 ft. from property lines and easemen - ❑ 0 ❑ Q IY >30 ft.from downgradient curtain/found tion drains? - 0 0 ❑ o Drainfield level and observation ports pr Ant--- - - ❑ 0 ❑ ® Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank?- - ❑ N/A 0 YES El NO • Pump tank size 1250 gal Manufacturer Hagerman < 24"access riser(s)and accessible from surface?- - 0 ® ❑ ~ Alarm or Control Panel Installed? - - 0 1.1 ❑ d 2 Control Panel equipped with Timer/ETM/Counter- - 0 0 ❑ 0 a. Pump installed in El Bucket or © On Block or ❑ Other d• Pump Make/Model Liberty 280 t Floats or 0 Transducer a Tank draw down 1.5" in/min Pump capacity 33 gpm Squirt Height 6 ft Pump on time 54sec Pump off time 3hr Daily flow set at 239.8 gpd Updated 8/2112018 Mason County OSS Installation Report pg. 2 Parcel# 22018-51-00009 • 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 7 r. RECORD DRAWING '. ... 1i;' . '� This Ls a permanent record and must be aequrate and descriptive enough to re-locale In the need of maintenance activities and future development. Typical`Record- Drawings contain:OraInfield E manifold Methadon&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed bull:lags,location cf wen,waterlines, +j welts,observation pads,deanouts,and other maintenance access points. Incomplete Record Drawings may create add.bonai delays in final Instailatlon approval and reeled permits. I i E] Record Drawing Attached • CERTIFICATION OFINSTALLAMION 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"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 rld attached cord Drawing is accurate. form and attached Record Drawing is accurate. !l Si tore of Installer Da a CO i AI 1� l Printed Name of Signee fki_ MASON COUNTY PUBLIC HEALTH T''4 The undersigned approves this Installation Report and J �" L MIL Record Drawing on behalf of Mason County Public " UCENS•r DESIGNER . Health: i7i0001000i00/0/iiiiiiiPS EXPIRES 121151 (tlik.Q.AkpLA/1 >/197L, Signature of 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 812112o1e 1 * * * Z D D Dz —I O D D r� I D Cocn m r- 35cz =c�D- p _ m Cn = cmn Cn z z z I C)cn v rn o CCD U' O z --i 0 0 n m � � 70 CT) C m 0 � -I 70 C ! rn W -1 D rnD ➢ 73mz rn � i Cis n co z z m 23 U) rn m z p � Ci m m Cn 0 -�C � = 0 o > o D —_ rr- 1 TI D %� z 0 /.' 80, o z -0 C) s 0T. v z rO / / z < mz CD �SFM� T _ 0 > o m z z fTl / o > > r CD rnZ7 / D < . 70 o 1---- 0 i C / / Fri T M 0 z zm I - / / m m v �-1 r 70 Cn 70 Cr) v D D O O O $ / Os, / 70 c D m � CD M 70I-0 CI / CDD cp M °JG I CD rzn Z7 0 / / a'��"o / 23 .-C�J en 7 z = / / rn / /o / fy° /z ./ N o if / / : 2eRy00s AAT 0 / p000 0- : / (1) -' 7,j" 0 .6.t\ill 1 v frit- . . .0/iiI, . . • . • -•arf, / 1'1' Ut n • / kJ) ° o�0 r 0 A 0 _ m m � � m � Z FTCeF 8 v V �" � o 0 `. kFFgST a . 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