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HomeMy WebLinkAboutSWG2022-00219 - SWG As-Built - 3/27/2023 Mason County OSS Installation Report pg. 1 0 . rrb , MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00219 Parcel # 22012-23-90090 Applicant Name Robert& Marty Barrows-Dexter Subdivision (Name/Div/BlocklLot) Applicant Address 180 E Country Bumpkin Ln City, State, ZipShelton Wa 98584 y Installer Name Jerry Upson Site Address Same Designer Name Micah Halverson INSTALLATION CHECKLIST © Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair p ❑Other System Type Glendon Pretreatment Type >5 ft. from foundation? - - ❑ N/A [] YES ❑ NO >50 ft. from wells? - 11 F Z 1❑ © IDZ >50 ft. from surface water? - (; ❑ ❑ 4k < Cleanout between building and tank? - - - - - - ❑ 0 ❑ ,_ it o Tank baffles present? - - MAR 2 0 r'0-' O El d 24" access risers over each compartment?- - NCO-re- - - - - El ❑ LJ Effluent filter installed?- By ■❑ ❑ co Septic tank capacity (working) 1200 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO ><O Manifold/D-box accessible from surface?- - El It CI QQ Check valves installed? - - CI • El 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ❑■ YES El NO Cl >100 ft. from wells? - - El 0 ❑ —1 >100 ft. from surface water? - ❑ 0 ❑ W it >10 ft. from potable water lines?- ❑ 0 ❑ z > 5 ft. from property lines and easements? > 30 ft. from downgradient curtain/foundation drains? CI ❑ CI o Drainfield level and observation ports present - - ❑ • ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - El ■❑ El Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1275 gal Manufacturer Sound Placement Z < 24" access riser(s) and accessible from surface?- - Cl UJ ❑ H a Alarm or Control Panel Installed? - - ❑ UI ❑ Control Panel equipped with Timer/ ETM / Counter- - ❑ 0 ❑ d Pump installed in El Bucket or El On Block or 0 Other Orenco PVU 2 Pump Make/Model Orenco PF 100511 ❑ Floats or it Transducer a. Tank draw down N/A in/min Pumpcapacity N/A 0- P tY gpm Squirt Height N/A ft Pump on time N/A Pump off time N/A Daily flow set at 270 gpd Updated 8/21/2018 90 Mason County OSS Installation Report pg. 2 Parcel # ZZ0 Z — Z-3 ,c!©0 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? - - 11 YES Ei NO RECORD DRAWING This is a permanent record and must he 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 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. 1J�z.� 3--/�-23 ignatur nstal r Date z i-1 Z S 1� Jr1 r/ tJS[�� �f Printed N me of ignee rr�. % I a wn4,,. 'a. MASON COUNTY PUBLIC HEALTH -'/_ .4`'V The undersigned approves this Installation Report and tp. Record Drawing on behalf of Mason County Public ,i f AVANT AME l.�r �, Health: t A LICENSED DESISfiER _ ,,, '3(a7/> EXPRES.09/181 Signature of Environ ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2112 01 8 N HUH. z • / \ C. ' Q N 2 N EC Z-n d / . 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