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HomeMy WebLinkAboutSWG2022-00119 - SWG As-Built - 3/27/2023 Mason County OSS Installation Report pg. 1 C,-C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00119 Parcel # 22127-76-90041 Applicant Name James Conti & Cheryl Hughes Subdivision (Name/Div/Block/Lot) Applicant Address 3439 NW 64th St City, State, Zip Seattle Wa 98107 Installer Name Jerry Upson Site Address 313 E Passage Point Ln Designer Name Micah Halverson INSTALLATION CHECKLIST © Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Glendon Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑� YES ❑ No >50 ft. from wells? - - ❑ El ❑ • >50 ft. from surface water? Zbuilding �-1 4V -IT o ❑ • Cleanout between and tank? -U Tank baffles present? - - j ❑ a24" access risers over each compartment?- - - - MAR 2 0 21J23 I ❑ W Effluent filter installed?- - - - - 00 ci) By Septic tank capacity (working) 1200 gat- araufacturer__--- Sound Placement C1 D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ g ❑ co, Z Check valves installed? - - ❑ ■❑ ❑ OQ 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 ❑ NO o >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ 00 EL- >10 ft. from potable water lines?- - ❑ * ❑ Z > 5 ft. from property lines and easements?- - 0 0 ❑ Q ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ ■❑ ❑ 0 Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO • Pump tank capacity (flood) 1275 gal Manufacturer Sound Placement Z < 24" access riser(s)and accessible from surface?- - ❑ ® ❑ dAlarm or Control Panel Installed? - - ❑ ® ❑ • Control Panel equipped with Timer/ ETM / Counter- - ❑ ® ❑ a_ Pump installed in ❑ Bucket or ❑ On Block or pi Other Orenco PVU a. 2 Pump Make/Model Orenco PF100511 ❑ Floats or IN Transducer a Tank draw down N/A in/min Pump capacity N/A gpm Squirt Height N/A ft Pump on time N/A Pump off time N/A Daily flow set at 180 gpd Updated 8/21i2018 Mason County OSS Installation Report pg. 2 Parcel# 2ZI 2'7 - 76 ---qOoNJ ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Ei YES al NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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 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. • ,. gnatur installer Date 't 11 J r/ (.'f-ice iS J 10 Printed Narfie of Signee 1�P y 1 MASON COUNTY PUBLIC HEALTH y�� '*o , 1 The undersigned approves this Installation Report and : 5103409 s-0 •Record Drawing on behalf of Mason County Public ` wcJwTl1ANIEt.MALVERsoN� „ L DESIGNER / Health: ww�ow.i.����v������`�►Ar g... .1\QI Citf.4 M E�►REs:oenet 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 co c,co S 3o kn ,. 30N �� ( mg 156'+i �► U' co o, aco a ., _%II z o o N 01 Plckeria • o a. ��. g PasBage co (.0 Vil - m.— .� q 3 o rn cn 6 m p (0 (�. . 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