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HomeMy WebLinkAboutSWG2021-00273 - SWG As-Built - 10/17/2022 t Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 'ZO2l -- f)O Z.1 3 Parcel# Z ZOn r — 3 .--C100.3 i Applicant Name K4wt;,,..Pmpc e k-,- CLL Subdivision (Name/Div/Block/Lot) Applicant Address 5D(O SG Co ie._ P.e. City, State, Zip Si—t_ \ 04 - 98 S 31-( Installer Name OK c- (OOLs ty • Site Address /T IRO C i1s 1' is Q c- Designer Name ,/t c l- lvrfs.0^ . INSTALLATION CHECKLIST (full System Installation ❑ Tank(s)Only El Drainfield Only ❑ Repair ❑ Other System Type GatimcfCict Sc►tti4.. &)(y►r�l-c- The_ Pretreatment Type >5 ft. from foundation? ❑ NIA El YES El NO >50 ft. from wells? - ❑ (I ❑ Z >50 ft. from surface water? CI ® CI- -- -- - C Q leanout between building and tank? - - El ( CI U Tank baffles present? - ❑ ® ❑ a24" access risers over each compartment? - - CI ❑N. W Effluent filter installed?- - - ❑ ® ❑ Septic tank size I SbC') gal Manufacturer jouo-& PV;ct w•c►^ 1--- 0 D-box water level and speed levelers used? - - la@ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - (I CI II] m z Check valves installed? - -- - - - ❑ [ ❑ ❑Q 2 Transport Line Size 2. Schedule/Class 5 L L/C) Bedrooms installed (check one) El 2 El 3 ❑4 El 5 El 6 Commercial/Other >10 ft. from foundation? - ❑ N/A Kj YES ._--- -d '` >100 ft. from wells? - ❑ ® . - LJ lnn cn W >100 ft.from surface water? -. -- - - - -- 004 ❑r >10 ftz . from potable water lines?- - CI 0 • 1;�s — > 5 ft. from property lines and easements?- - ❑ I ; ❑, • - •L' 112 > 30 ft. from downgradient curtain/foundation drains? - - - - - -- -- - - ❑ TO i ❑. ; ii. Drainfield level and observation orts resent - ►a P P ❑ ® ❑' El Graveless chambers or K Clean gravel used? (check one) Proper cover installed over drainfield?- - El ,c4 Pump tank setbacks consistant with septic tank?- - ❑ N/A 0 YES ❑ No Y Pump tank size (S 85 galaL:,0 Manufacturer s' -- P(tCY t.-lck .1- 24" access riser(s) and accessible from surface?- - ❑ Ig ❑ ~ Alarm or Control Panel Installed? - - ❑ R ❑ a 2 Control Panel equipped with Timer/ETM / Counter- - - - - ❑ T6. El D Cl- Pump installed in �] Bucket or ❑ On Block or ❑ Other 2 Pump Make/Model�`6 cct-y 2 g o f2J-loats or ❑ Transducer a. Tank draw down /0 5 in/min Pump capacity �jZ gpm Squirt Height S �,� ft Pump on time /.'/0 r^ Pump off time Daily flow set at 2 70 gpd Updated 821/2010 Mason County OSS Installation Report pg. 2 Parcel# 3Z0c)c'' 3 3 - geed 1 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - -- - - - - •- - - -- - - - - El YES NO If yes, please describe: _ --- Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ 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. *Wien'Record Drawings contain: Drainrield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfietd,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits. • Rom-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 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. Spatur of!n taller Date �,Z�% anted Name of Signee t :: 4: �1 err f. y1 MASON COUNTY PUBLIC HEALTH f; `� c;`' The undersigned approves this Installation Report and � -%s <.-r ;5a' e,�, Record Drawing on behalf of Mason County Public �6S ,�7•;;c,.gl+T,,'�.o,;�y I;k;.+,�:;:St.1:a�' Health: r _r ,,4..r.. 7. kA—IVIVA" (61/ W (N12:b 1.7:017;17:8:0.1.;0/:. 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 tlpdalednnvzot© 7 .____ , C(0 m O N N O g 26 (AND Q q) = to o S� CP J Vt P W N -' # CO . zSv < Utii"uotil agl Cb O 5.i1 r* c02 O -0 o X • C6z - o(D Ss 6 Z (11 _ ,n-.. CD ISIl� . N O XI i cn S O (0 N ' - i- .N.• -a I11 y.�• gc" n .- IZ cti CO -, () (0Q. ( SU 0 - - = �_ N O 3 O - (D r+ Q & Q1 C� O Qo 75 Co a u' o ca N �. SU CD (D = Q .* (D Z. O Cri 0 — co co co (-AP \ -75 N N co �CO � � 6 s O �,; � � C (Cti CO h 4 Oo O K of ," • ..,, -II I -... ,.., ,. /),s, 3N \ S,\ 0..rci .."--e.. SII "7-^ :Lms4o'4 ,_, 9 ea N ik-r:Z a ___I 11 1_ 1109 IN, =. ; - - - - . - o CD / .: _ s ..i. m / �2^� ~ \ / +2tl ,.... r. ...,,,_M.r \Ghainlink Fence - / f.� - -- 0 \ rr \ iV + � J H / Via^. \ -j;: `J l• rn / / CS k \ / = \ 1 Ti I / rCS 1 f 1 1 I 1 MTT I I I t t N I I I �^o \ / / 4 CO -Y\`.. \\****--_ / / sa.9 @ \ _ / U \ fil / cn IC \ S. / 1)11 - \ // C> • ) \\ / C . i ( D :r \ / rTt ---I���� \ - ICJ t fi i -a � ` - "v 0 rri N r_. N rn A L N r 7r a M.Halverson Design LLC Drawn For: Site Info: SHEET NUNeLli PO Box 1519 Shelton Wa 98584 KAMIN PROPERTIES LLC 1146 E JOHNS PRAIRIE RD 4 Halversondesignllc(a�outlook.com Parcel#32005-33-90031 tEytsuaur.: