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HomeMy WebLinkAboutSWG2021-00199 - SWG As-Built - 3/6/2023 C.C. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00199 Parcel # 22007-50-00004 Applicant Name James Stewart Subdivision (Name/Div/Block/Lot) Applicant Address 20 E Skookum Dr Timberlake#7 TRS 4-5 City, State, Zip Shelton Wa 98584 Installer Name Jamie Workman Site Address .&fo E S11--ow Lt4'V \ 0 vc-- Designer Name Micah Halverson INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Bottomless Sand Filter Pretreatment Type Septic Tank- Sand Filter >5 ft. from foundation? - -� ❑ N/A ■❑ YES ❑ NO 1+! >50 ft. from wells? ' - ,--�-a 1`fl- 7\ ❑ ® ❑ Z >50 ft. from surface water? - '-` ❑ ■❑ ❑ FQ- Cleanout between building and tank? - - - - -� _FEB-2 7 Z0' �. [] 0 ❑ U Tank baffles present? - 1 - - -SW - - - - U ❑ F- 24" access risers over each compartment?- - � =-_-- 0 ❑ a. W Effluent filter installed?- - ❑ 0 ❑ cn Septic tank capacity (working) 1250 gal Manufacturer _ Sound Placement 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES El NO DO Manifold/D-box accessible from surface?- - CI 0 ❑ co, Z Check valves installed? - - ❑ ❑■ ❑ 0Q E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 El 5 ❑6 El Commercial/Other >10 ft. from foundation?- - ❑ N/A I YES ❑ NO CI >100 ft. from wells?- - ❑ ■❑ ❑ W >100 ft. from surface water? - - CI0 CI ti >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - CI ❑ Q Q > 30 ft. from downgradient curtain/foundation drains? - - El 0 CI Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A IS YES ❑ NO `.r Pump tank capacity (flood) 1275 gal Manufacturer Sound Placement < 24" access riser(s) and accessible from surface?- - ❑ © ❑ H a Alarm or Control Panel Installed? - - CI NU ❑ 2 Control Panel equipped with Timer/ ETM / Counter- - ❑ 0 ❑ m a Pump installed in El Bucket or ❑ On Block or ® Other Orenco EasyPak 2 Pump Make/Model Orenco 5005 0 Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 35 gpm Squirt Height 6' ft Pump on time 1.5 min Pump off time 4hrs Daily flow set at 310 gpd Updated 8/212018 - Mason County OSS Installation Report pg. 2 Parcel# Z2003- �� C000 �( ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES VI NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES Li 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 Record Drawing Attached CERTIFICATION OF INSTALLATION 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate./ Sig re of Installer Date t r ih Panted Name of Signee /1 MASON COUNTY PUBLIC HEALTH wI� The undersigned approves this Installation Report and \ f i' t0ja,• 11 Record Drawing on behalf of Mason County Public 5100409 1\Cr Health: ! UCENSED DESIGNER Grt\katryL6111 C /z MIRES:M18/ 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 8/21/2018 • i 4. t�?,.i .,. 'di,,i' ,J.,Aft ' ... A. - k‘ Li ....." .., , .4zy: 43:14'., , ,iisit1 , Atarr.V) s.• ,,,rf ,i ,,,•.,,,,• , .• 144-1; . '• I.,. P-•• 11 n j . r` l J f r .7f '� 4 •�•f� :j' u. ..""77 L` it 0 . C.... / '1 ''., �!'9 .i '.(� . ,,,� >45a x.,,ii� Y ,7 i�44,, 't 4` ff fi// �,.' .'y '' r i).4 C 4 J a f _ ` Z Nr IV 4 Z Ill w * S • il / z ', � ��� .•` MM Vi A, 4/ �I� y:ran (o (o Ort 3,O (o �NN N'(o < Q (n • ()1 J a 'F' a) t (o S7�i13.� rt -nC z QE.3.N. • N O (D 1 N Q TS slcoo .= mvcozo (o o m �. Gov _—co N 3 5 N (D a B 3Z Sie 0 O* U,'1 v 1:)...68, .h0 6 +A. v , , 1 , y , x , i 2 8ed,.Drh n i B�D?p21-0,4'ed10 Ho 01 eikio r a, ;T ---I '• W 00 �, 8ofto,,,,,eSs �DG � � �40. -'-"-"" Sdhdrwter d< s63eo „ E���n,r L...,.. ....,.„,„.„.. ttc't77/ss S Cu /+,9� �F"t : v Nit R� &dll�r CO PGeleM1"019 /111111111111pr• 2- Sere,61 4R 3 G, CO Reserve 13,R*Iter 72 g 17' N (D i+ ,gL try` _ 7 ��Y,q���\fit '-'6 a —T a rn tii 4'p.A� t 4 V H a e‘, il „x,,,--6:,...7.-- , 3 O _nA (-- ie)= - o rn oq • co A i w O. a rn rn T 0 • rn • A C II i Abbreviated Description: TIMBERLAKE WI TR5 4-5 DPG #21-02 AF #2153516