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HomeMy WebLinkAboutSWG2019-00423 - SWG As-Built - 4/10/2023p , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION _ Permit Number SWG 2019-00423 Parcel # 22018-51-00033 Applicant Name CHRIS SCHOENE Subdivision (Name/Div/Block/Lot) Applicant Address 1315 ROCKRESS DR SE City, State, Zip OLYMPIA WA 98513 Installer Name Site Address 50 E COLVOS PL E Designer Name JUSTIN RUSSELL INSTALLATION CHECKLIST 0 Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type N O't(\MIA/ 'S1)U Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑� YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z• >50 ft. from surface water? - - ❑ 0 ❑ < Cleanout between building and tank? - - ❑ El ❑ U Tank baffles present? - - ❑ 0 ❑ a 24" access risers over each compartment?- - ❑ ❑■ ❑ W Effluent filter installed?- VN R - ❑ El ❑ Septic tank capacity (working) 5") *''"s gal Manufacturer vLu j ..w,.-.-z 0 D-box water level and speed levelers used? - - AN/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ 41 ❑ co, 2. Check valves installed? - - 4 ❑ ❑ 0< Z E Transport Line Size Schedule/Class Se-i-► sq.v Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 41 YES ❑ NO O >100 ft. from wells?- - ❑ 4 ❑ W >100 ft. from surface water? - - ❑ Q ❑ ti >10 ft. from potable water lines?- - ❑ Q ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 LI Q ❑ Gil ❑ cc > 30 ft. from downgradient curtain/foundation drains? - - • Drainfield level and observation ports present - - ❑ 0 ❑ d Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A M YES ❑ NO • Pump tank capacity (*co 101,0 gal Manufacturer H ,r •--- • 24" access riser(s) and accessible from surface?- - ❑ 4 ❑ ~ Alarm or Control Panel Installed? - - ❑ 0 ❑ a 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ m a Pump installed in ❑ Bucket or [ On Block or ❑ Other T El Transducer a'• Pump Make/Model 7-de I-L E� N /�Z— loats or R. Tank draw down in/min Pump capacity 4$'116 gpm Squirt Height / ft Pump on time 1 IN/Ns,...) Z?$cc_- Pump off time 6 4,-.....4_ Daily flow set at Z' gpd Updated 9,21,7') e 1 ( Mason County OSS Installation Report pg. 2 Parcel# 22018-51-00033 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 41 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 be accurate and descriptive enough to relocate 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 permitsSE E ATTACH E ❑ 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 D ing is accur form and attached Record Drawing is accurate. (/ Signature of Installer Date �fr Ohl) I ,I Printed Name of Signee e �L l i ��� •, � 4/to/Z,� .. 7 MASON COUNTY PUBLIC HEALTH r Q'~ ` The undersigned approves this Installation Report and i ti`� •rA Record Drawing on behalf of Mason Count Public o� 22030834 y NSTIN S RUSSW • Health. ;...::.v►:.: %%%%%% EXPIRES 07t191 Signature of Environments ealth 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 o=Z o =+ -0 -00 0100000 -nm0 03C .rxi ts, D r7 0 Z cn -1 VTmmc = 0 00 TOciD 0 N = CTro D-0 O � rn --- � 0Ooo rnm „X, Cr, -1 p XIW ` mr -i � rnmi � XZ -D D xi 0A IIr � p CZDmn Cr 7CND D0 V7, -{ moz O - Dio < 2 = z m 0 A m D m � S r > v Dmy O ) OQS m m r r O R1 W D r-Dm ZCA 170 13 M -1 • O n z II = O II C,.> Z my Z Nc. tn -1r -I 0r Cv, n 3,1 Z D O 0.-'' 0 D -IA Z __ Z7 cis G)m = Dz Dm -00 73 > CO n 0 -< -n m 9`•6 . / • • � ca og �TF,p� . el 0 rn 0,P,kF • • r gtiti C — — 45..o' • O C — — y m C — — _ _ ' 0 m \ d�r \\ d \ _ `69£Z O ♦A/ ! ; +©► ♦y♦ W O z m m Cl) n c oD cf, _� o r "i m D D .9 -I WO -0 A z ) m m w D m • in �Ns,F o cn v0z ksy'•�� 3 70 GO M CCO Nio9 y ` , CD D N z� 4 � 17 aO No O �.- r 4: .,, O mW n o0 N DC o mS 0 N Z -� O U1 co —I O GO D N �'+ 3 < o = ; O i CZ N c cmn r m 0 Ow O c'n Z z W -0 y r r w m r a T C� rn (Dj on rn j1�1 o cn m n �" �.,/ w -I 0 m • 0 -, m < • 0 W Z w N o -. 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