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HomeMy WebLinkAboutSWG2022-00559 - SWG As-Built - 3/30/2023 Mason County OSS Installation Report pg. 1 • C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00559 Parcel# 12217-14-90041 Applicant Name William&Deborah Massey Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 664 LOT: 1 SP#2760 PTN TR 4 G.L.2 E OF R/W,S 49/169 City, State, Zip Wauna, WA 98395 Installer Name Mason County Excavating Site Address 901 E North Bay Rd,Allyn Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? - - ❑ N/A ®YES ❑ NO >50 ft.from wells? - - U ff� -r 1 ®- ❑ © ❑ Z >50 ft. from surface water? - I - ❑ 0 • Cleanout between building and tank? - I -BAR-2-2.20n- ❑ ❑■ ❑ ✓ Tank baffles present? - ❑ II ❑ a24" access risers over each compartme t?- l ❑ MI Cl)W Effluent filter installed?- By F---- Septic tank capacity(working) 1,250 gal Manufacturer Hagerman C1 D-box water level and speed levelers used? - - 0 N/A ElYES ❑ NO p0 Manifold/D-box accessible from surface?- - ❑ ® ❑ OQ Check valves installed? - Ca '� ❑ III El 2 Transport Line Size 2 inch 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?- - ❑ ® ❑ 111 >100 ft. from surface water?- - El Ell El u. >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ ® ❑ ce >30 ft. from downgradient curtain/foundation drains?- - ❑ III 0 Drainfield level and observation ports present - - ❑ ® ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ MI ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO • Pump tank capacity(flood) 1,250 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - El NI ❑ 1.-- • Alarm or Control Panel Installed? - �" n - ❑ ❑ IN E Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other _ a• Pump Make/Model Liberty 280 © Floats or 0 Transducer 0. a Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 6 ft Pump on time 2 minutes Pump off time 6 hours Daily flow set at 360 gpd Updated 82t'2018 Mason County OSS Installation Report pg. 2 Parcel# 22 t� - 0 j ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - D YES spt. NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES El 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 lane location,North arrow.reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observaton ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 0 'il‘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 hed Record Drawing is accurate. form and attached Record Drawing is accurate. 03p —7; orl' Signature of Installer ate /\ t \ \ e• ti 4. Printed Name of Signee 111*,' MASON COUNTY PUBLIC HEALTH ` : w::, .:"). ^"f 5700349 The undersigned approves this Installation Report and p� PAULA JOY JOHNSON Record Drawing on behalf of Mason County Public a_ I.ICE�(J$L b��tGNE� . ' Health: Ei(PIR S ,c___ __1.,...,i, . Signature of Environme tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upcated satrzots u+rt+an dra;n - e 2'' Qo 60 80 r so f}Sbu: I + ' 5 5 k��q z1' IL 3 ().,).J�.�130'"''`-}T�z `1�1a°u Q'C� BKise 1 c.o ' _ I o„-,z-4 1 c1 14- 1c o41 / + -° Q o l Nollk t roe C ) u)A q % 24- ® b'�'`��OB`'_ o €i ` Qa j io �� it- l ' S4 #„} a tti4 /47,31 .1 rv-0- r — - •— -- f.a�� '` (4)3 �� �` 'P.ten Oo tit.. -L \IOA4` ' 0 Audi -Mal Alarm i:\.1 Key: oP i s-�0 Cleanout O1250 Gallon Septic Tank y 2-Compartment with Effluent Filter 0 125�0 Gallon Pump Chamber APPROVED u,;•+, .....II- 51ekw, P P R O Valve Control Box MAR 30 2023 MASON COUNTY ENV1 ONMENIAL HEALIN RE .. \AO` irP e------ *44 —cii .„.:-.... zie. 47- .... ‘1,,,,, imit..; t.1, 5,v03<9 is;o7r,.... PAJLA JOY JOHNSON� �`\ 1.1dINStriUgiairk' 3 -Zo -2.3