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HomeMy WebLinkAboutSWG2022-00326 - SWG As-Built - 4/26/2023 • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH • APPLICANT/ PERMIT INFORMATION C g.)0 c_st„c Permit Number SWG 2022-00326 Parcel # 22007-50.r00026 I. Applicant Name LAWRENCE KELLY Subdivision (Nametiv/Block/Lot) Applicant Address 90 E IRONWOOD PL 'r.' •' City, State, Zip SHELTON, WA. 98584 Installer Name `BAMFORD SEPTIC REPAIR Site Address SAME Designer Name CINDY WAITE • INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ® Drainfield Only ❑ Repair ❑ Other System Type GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑YES ❑ NO >50 ft. from wells? - _ - - - El ❑ Z >50 ft. from surface water? - _�_ _� p - - ❑ ❑ ❑ Cleanout between building and tank? - - ❑ ❑ ❑ 0 Tank baffles present? - - AIR. Y 4_2D23 __,__- ❑ ❑ ❑ a24" access risers over each compartme . eW Effluent filter installed?- By - ❑ ❑ ❑ Septic tank size gal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A • YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ X Check valves installed? - - ❑■ ❑ ❑ 0 z Transport Line Size Schedule/Class Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Qommercial/Other >10 ft. from foundation?- - ❑ N/A © YES ❑ NO G >100 ft. from wells?- - • ❑ ❑ L1.1 >100 ft. from surface water? - - ❑ II El ti, >10 ft. from potable water lines?- - ❑ ❑� ❑ Z > 5 ft. from property lines and easements? ❑ 0 ❑ 12 > 30 ft. from downgradient curtain/foundation drains? - - - © ❑ ❑ to Drainfield level and observation ports present - - ❑ IN ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - -. - ❑ ■❑ ❑ Pump tank setbacks consistant with septic tank?- - -. - - - - -- - - - - - ❑ N/A ❑ YES U] NO ZPump tank size gal Manufacturer < 24" access riser(s) and accessible from surface?- - - - - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? ❑ ❑ ❑ a - jControl Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑ Floats or ❑ Transducer eL Tank draw down in/min a. Pumpcapacity acit p y gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason Counk LSS Me{a011etrian Report dog.. 1 - — Parcel 4 Were existing septic components abandoned as partI � t � ��� i If yes, please describe: project? __ -- `� -—— 13 vets NO ' 1 Were all components pumped o --.. P out and properly abandoned per WAG2 — ��3 46 27�.H 0300'11 . .___ - ® YES [� NO � 6Ui[. 116`9l". ems_ mlg is a permanent record and mus4 he accurate and descriptive antra h to � _vim- Drawings contain: Drainfield&manifold orientation a layout,Septic/pump tank location,North arrow,reserve riraintield,e.Ciatinp and proposed 3 re..locate in the geed of maintenance activities and future development. Typical Record wens,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation p posed buildings, ngs,location of wells,waterlines, • ,..._.�a.,=,, �� „�'---�r�� approval and related permits. 1.1 Dom, A/`reulvc tow dal Ale" Cayl1 . ,�•� • s -=� =Record Drawing Attached 1 1f,1'OCtil�n11I(3 _ (,fig f. .11aa�i6 !NGINEER TALLER P.� ^ fi �}a�R` t=:��r- fy that I installed the system in accordance with !� �, j the septic design stamped"APPROVED"by �� I certify that the system has been installed in accor- ?i County Public Health and that any deviations shown ' dance with the septic design stamped"APPROVED"by ! hem have been cleared/aypproved �� Mason County Public Health and that any deviations and Mason County public H alt end bothme the State �l shown here have been cleared/approved lthby both and Mason County Codes. H myself and Mason County Public Health end meet all I further certify that all information contained on this State and Mason Coun ty Codes fernLo and attar, e I further certify that all information contained on this rho' cord Drawing!s accurate.Iform and attached Record Drawing is accurate. 0 •11 di ' it 1 Signature of Installer - — A. 1 , a Date isv �� I 419,s41 Printed Name of Signee • A0�j (t ,� _ !��o�ash 9l MASON COUNTY��13L�C. ta=__.� +:�..�!11 %11. y��y • /+1 The undersigned approves this Installation Report and i' y 5 oaya 0 \V 41 Record Drawing on behalf of Mason County Public I� LICENSED DESIGNEW� ,� TA I II EXPIRES °silo, Signe re vironmental Health Specialist Date . THIS FORM MAY RE SCANNED AND AVAIL ABLE FOR PUBLIC Vim ON. (stamp, signature and date) THE MASON COUNTY WEB SITE Updated 8/21/2018 ..ce NIIIIIIIIMIll . . •r-' . I . . i 1 , f ... . --... 4,..„,.. ',..,..,..„ . 0 50 0 I 1 t° ,O.- ill I 1--,5. 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