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HomeMy WebLinkAboutSWG2020-00538 - SWG As-Built - 2/23/2023 (2) Mason County OSS Installation Report pg. 1 .C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00538 Parcel # 32005-42-00030 Applicant Name Nolberto Chavez-Martinez Subdivision (Name/Div/Block/Lot) Applicant Address 2253 E Johns Prairie Rd. City, State, Zip Shelton, WA 98584 Installer Name Mason County Excavating Site Address 2191 E Johns Prairie Rd. Designer Name Arrow Septic Designs INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity Bed Pretreatment Type >5 ft. from foundation? - - Q N/A ❑ YES ❑ NO >50 ft.from wells? ❑ ❑ ❑ • >50 ft. from surface water? ❑ El ❑ Z 0 ❑ < Cleanout between building and tank? ❑ ❑ ❑ U Tank baffles present? ❑ El 24" access risers over each compartment?- - ❑ ❑ ❑ W Effluent filter installed? ❑ II Septic tank capacity (working) co 1,500 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO .--i �O Manifold/D-box accessible from surface? ❑ 0 ❑ ❑ 0?2- Check valves installed? 0 ❑ OQ 4" Schedule/Class 3034 • Transport Line Size , Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ® NIA ❑ YES ❑ NO >100 ft. from wells?- ❑ ;� 0 ❑ ❑ El ❑ W >100 ft. from surface water? ❑ Liir. ft.from potable water lines? _=t7z t Zu' Z > 5 ft. from property lines and easements?- i ❑ 0 ❑ cc > 30 ft.from downgradient curtain/foundation drains? o El a ca Drainfield level and observation ports present ___ _ ® Graveless chamber or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- I .... tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES i NO • • Pump tank ca..... (flood) gal Manufacturer < 24" access riser(s) and a ible from surface?- - ■ ElE— a • Alarm or Control Panel Installed? ❑ ❑ ❑ ❑ ❑ 2 •Control Panel equipped with Timer/ ETM /Coun ❑ D. Cl- Pump installed in ❑ Bucket or • •- is ock or ❑ • a. • Pump Make/Model ❑ Floa or ❑ Transducer • Tank draw ••= in/min Pump capacity gpm Squirt Height ft a- Daily flow set at '•d -ump on time Pump off time Updated 321r2018 Mason County OSS Installation Report pg. 2 Parcel# 3.2005 4� 0003° ABANDONMENT RECORD S NI NO Were existing septic components abandoned as part of this project? If yes, please describe: No Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0 YES 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: Drairtield&manifold orientation&layout.Septicfpump 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. jvA di ..ii A , ► _8 �i -.,il;-1r� , 23 2J w,4,;y 23 *it Kt /a- ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with 1 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 1 further certify that all information contained on this 1 further certify that all information contained on this form and attaafied Record Drawing is accurate. form and attached Record Drawing is accurate. 0 /).- ---- ,,,...y5 SignatA of Installer 1_5_1 Date 44)� Pt',\,GAY\ Vkr q;;.). of - 1'Printed Name of Signee 1 MASON COUNTY PUBLIC HEALTH N . 5100349 •'��!� The undersigned approves this Installation Report and u� P,AULA JOY JOHNSON. r Record Drawing on behalf of Mason County Public �y`�•LjEi`!$�b dre';GNf2.• ir...),H (AP/Ill) ;) --?>-23 l' o - ( 3- 22. Sig/iatu` oiEnvironmental Health Specialist Date (stamp, signature and date) // THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/212018 33D - ` / -c6 - I" 50 `l- / D3S _ zoo _ /6S- 05kAi _ _ i . 'n0Va .Ac:-c1%oe� tALLY+tvktti ? Q 3�505 -`k-- ° �k. 4,0 I ,�a ` e3w,67,�.e Ru 51.e.tom► -WA- 485sq ,..`),, '�� " e; 0 Cleanoat %. 22 1,500 Gallon Septic Tank Z0-o' jr- P'teP '". . 2-Compartment with Effluent Filter ...vo w42. 0nA O3 D-Bog with speed-levelers f N� and cover to surface Gt O .' �. tc'r t' �( 5100349 lst\ 10'Y Coo ' r;mns1 ? PAULA JOY JOHNSON .;k D•F• Bed to {k LJOcNSLDESi Gi4M . c0` z bp` Resa,e o�-,iti2-4.- . d ® ,v � ©• tO , E to- -2L ao0ofe ?, i VI. S to Pe i • Pro fC 4 100 x44/ 3 R VI 4Y .pro w} ` S ie "1-1 Q-V e a ` pr. P.-o 1 ,4 i- lPc�i4Jle ��Y t i Y loci-+1o'^ 4