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HomeMy WebLinkAboutSWG2020-00538 - SWG As-Built - 2/23/2023 C• G Mason County OSS Installation Report pg. 1 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 IN Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity Bed Pretreatment Type >5 ft. from foundation? - - 1=1 N/A ❑ YES ❑ NO >50 ft. from wells? - ❑ I ❑ >50 ft. from surface water? - - ❑ [ ❑ Z - ❑ 0 ❑ HCleanout between building and tank? Tank baffles present? - ❑ El E U ❑ d24" access risers over each compartment?- - ❑ 0 W Effluent filter installed?- ❑ III ❑ U) Septic tank capacity (working) 1,500 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ NIA El YES 0 NO❑ OOJ Manifold/D-box accessible from surface?- - ❑ 111 mZ Check valves installed? - 0 ❑ ❑ Da 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ® N/A ❑ YES ❑ NO CI >100 ft. from wells?- (�' 0 ❑ >100 ft. from surface water? - I L�.E " nogN W - - 0 ❑ W >10 ft. from potable water lines? 4` •-�r -�9�()� 0 ❑ � > 5 ft. from property lines and easements?- I - ❑ 0 ❑ a cc > 30 ft. from downgradient curtain/foundation drains? k 0 ❑ ❑ CI Drainfield level and observation ports present - - - - 5k -_.-_-_ © ❑ ® Graveeless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ .•s• tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES % NO Pump tank ca..... (flood) gal Manufacturer Z < 24" access riser(s) and a -. ible from surface?- ■ ❑ ❑ 1-- Alarm or Control Panel Installed? - - ❑ a ❑ ❑ E Control Panel equipped with Timer I ETM /Coun - ❑ D a Pump installed in ❑ Bucket or ■ •- = ock or ❑ • n- Pump Make/Model ❑ Flo or ❑ Transducer Squirt Height ft Tank draw •_ in/min Pump capacity gpmg a Pump off time Daily flow set at d �ump on time Updated8/2112018 Parcel# 32005_1 -Mason County OSS Installation Report pg. 2 00030 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ❑ YES p NO If yes, please describe: El NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - ❑ 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: Drainfield&manifold orientation&layout.Septicfpump tank location.North arrow.reserve dramfield,etdsang and propped buildings.location of wells,waterlines, wells.observation ports,deanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Prik / bit ,e'4 y l la e4 �� ' ' j:\\t8r,}144,.., 'SON FEB e 31 �.. COUNTYEN O 3 /.., ViRONMEi, n J4{v/ i v TAL ilkACTH - ® 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 atta 'ed Record Drawing is accurate. form and attached Record Drawing is accurate. ).- - Signet ' of Installer Date kt:41 Printed Name of Signee co +a~` -. i. MASON COUNTY PUBLIC HEALTH a^ • } PAULA JOY JOHNSON The undersigned approves this Installation Report and :%* 5tuo'_a9 ,}, to Record Drawing on behalf of Mason County Public + 1;Mt[S1S;G1JEt '•1 ExPiREs —23 23 (o - 322 ( - Si. atu 'r•'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 82tR018 330 ` I = 5•o t Oc 50 """-Krj ....... L00....... — r / o\be}/k-o.01r,04e - k Ac' �o Q 3).eo5 —Lk •00o3) ` \ 5.i v,� 7ra: r:e u , AIA NI She[ . }-om etc/Sa`{ 4 ® S 'o& � O fk � V ' 0 „ " / 0, "Hem lie � q� „ ., . s. OCleanout �•7 . O 4,500 Gallon Septic 2-00' � fox. 2-Compartment with Effluent Filter iv .e'Ko....va • 3 D-Box with speed-levelers } and cover to surface t O�. _ EP AULA JO J'OMNSONtilt' •; l�� f vo - • �'`t1 10 X( 0 Fr; D•F Ba �l{ � I_ g_t4Sto'DESia4ritt to` X be,` RerQ .M-g:W�— ed O -1:j A c a q t'1. 5 left a— . r Pt Pro OoStC� fCri %4 R , 2.. � V w4y14-0 e Si Rtr t o ` Avvo Li sl 4- 4.6 ,0�.�5 Cvee lc Y ?c Ijle/v-De- x Y