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HomeMy WebLinkAboutSWG2022-00244 TANK ONLY - SWG Application / Design / As-Built - 4/28/2022 ��• TH STREET,SHELTON,WA 98584 r MASON COUNTY 415N6SHELTON:360-427-9670,EXT 400 f , '! COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400 ELMA:360-482-5269,EXT 400 r,v Budding.Pbmmng.Envi.o,nnent.J IIo.oIth Community livntd, \< ,t,,.-a+ FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2022-00244 OWNER GILES ET AL CHRISTOPHER L Phone: Address: 512 W Bambi Farms Rd SHELTON, WA 98584 APPLICANT GILES ET AL CHRISTOPHER L Phone: Address: 512 W Bambi Farms Rd SHELTON, WA 98584 Site Address: 253 SE MILL CREEK RD Primary Parcel Number: 320293200030 Permit Description: Septic tank replacement(ATF, illegal homeowner install) Permit Submitted Date: 04/28/2022 Permit Issued Date: 05/02/2022 Issued By: Luke Cencula Current Permit Fees Paid: $240.00 (additional fees may be required upon installation of system). Permit Expiration Date: 05/02/2023 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? No Shoreline? Yes Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring Additional Details: Septic tank replacement Permit Conditions: 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 3 Mason County Asbuilt Form and Record Drawing must be completed and signed by county certified installer. 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 5 Tank-only double fee must be paid for final approval. THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS. PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS. THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN APPROVED. FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES. For Final Inspection visit: www.co.mason.wa.us/health/environmental/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY .!".--`-,\ DATE RECEIVED: .� MASON COUNTY .—�-� ` v� �-- 1= I 1 COMMUNITY SERVICES AMOUN N : RECEIVED . W cn cn '` /I Public Health(Community Health/Environmental Health) ' \'' _• / 360-417-9670,ext.400 or 360-575 4467,ext.400 /� / O \\ 415 N.6th Street-Shelton,WA 98584 S /\/G .117� I - C.,/- �9' o J V V (JW o Z ui ON-SITE SEWAGE TANK ONLY APPLICATION D D APPLICANT PHONE m m 6, n1/6 &;/e..5 3 6 C)- ?6 C) - :1'7 c. q r- MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE S1Z LJ . i3 k + layrvt . m SITE ADDRESS-STREET,CITY,ZIP CODE ,7i, 5 E -2 5 3 KO, /( 6 v e-c-k Rd I (A) NAME OF DESIGNER PHONE 13 0 NAME OF INSTALLER PHONE 1 ri 0 i'VN e...• el L.,_,in 1, ‘,O - 3 6 - '2--7 c. q , N TYPE OF WORK(select one) DRINKING WATER SOURCE ❑ NEW CONSTRUCTION/UPGRADES ,_REPAIR/REPLACEMENT m PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM I A SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE ❑ OTHER / 2 �3(.Vc-5 w OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r El SURFACING SEWAGE EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS O t SUBMITTALS Jo50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS XI /� A PLOT PLAN(REQUIRED) A TANK CROSS SECTION(REQUIRED) jn 10FT+DRINKING WATER SUPPLY LINES 11v� ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) A. 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS R PLOT PLAN CHECKLIST 0I 7Igi PROPERTY LINES AND EASEMENTS gi EXISTING/PROPOSED STRUCTURES ZI EXISTING/PROPOSED OSS COMPONENTS AND LINES b WELLS WITHIN 100FT Ail WATER SUPPLY LINES rErDRIVEWAYS/PARKING z SURFACE WATERS,STREAMS,RIVERS,ETC... I DIRECTION OF SLOPE/CONTOURS g PERIMETER/CURTAIN DRAINS a.NORTH ARROW rilSCALE BAR I DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) - --. - 10 IT F-1 { ._.. ._____±... OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT 0 OTHER: COMMENTS/CONDITIONS SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE H , r)-0'>-3 , Cam_ s1>4 )01-'3- THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB ITE REVISED 12/7/2015 MASON COUNTY HEALTH DEPARTMENT 428 WEST BIRCH STREET • SHELTON, WASHINGTON 98584 PHONE (206) 426-5561 RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTEM OWNER e Yc7 I c AI. ale--oe ADDRESSg,I sox L�/ S �/ r! r THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. LEGAL ESA RIPTION J A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER 2 /-203 7�GT.3 4V Li 14 WITH PROPER MAINTENANCE AND CAREFUL USE OF ` �j? WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- , S"c�r D C_pr C fr c7 �/ a Ace C ` . VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH COMMENTS p �/ / KC/� L. AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SITE J F ELD / LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO. 7 IZE d X 0 0 FAULTY FIXTURES. DEPTH TO MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER DeV /' P.-sP.-se,/ it/7FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND / f._-._ GT nj P4 s r THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. CLEAN- SIZE ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR- SEPTIC TANK (S) /0 CP CICO L ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS DRAINFIELD FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH iLO MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA V O SQ. FT. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS DEPTH /," �� L�'CORRUGATED ❑ RIGII L7 CEMENT RECORD WHEN HE COMES. TDEPTH HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE ROCK l BELO // TOTAL CU. YDS. / +� PIPE DEPTH DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS SPACE RESERVED FOR RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD: /'h /+✓- SQ. FT. SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING ARE LATER CONTEMPLATED. NORTH SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO THE SEPTIC TANK AS THEY WOULD INTERFERE WITH CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE V . 0 .4-- / DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. �C� 3 -� THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE "-V-r—tt SUCH THAT SURFACE WATER IS NOT POCKETED ON THE (`U `1/ N. 5-6-'/ j DRAINFIELD. ANY SETTLING OF THE GROUND OVER THE TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX- jiM i :1) CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. `6 WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT ` �� p EQUAL TO ONE HALF INCH OF RAIN PER DAY. ` -L . FOOTING DRAINAGE, DOWNSPOUTS AND WATER \� / �/Q C SOFTENER RECHARGE WATER SHOULD NOT BE CON- V Nohl G // \ NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE n• DRAINFIELD AREA. THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE , �1 ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD �, AP��®� YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- ._ _. rt JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK `\, HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BEk) MAY 0 2 2022 t HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY CHANGING THE CHARACTERISTICS OF THE SOIL. THEIA" K ►SON COUNTY ENVIRONMENT Lay WIN NORMAL USE OF BOWL CLEANERS OR CLEANING COM- ��(� POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW SOUTH DOWN THE OPERATION OF THE SEPTIC TANK. -78--777 THIS- IS AN IMPORTANT DOCUMENT TE A R VED BY r I! Ite0 rEMTNITM-g.PMPIHOZ/)440.2#,eill•NI. tt F� E�I�T ALA�. P �, CA } ; c, DA E CERTIFIED BY e. aJ�}t� It t.,�.:.i .s i..�e!a"":'..lt .:11f•,.� SITE NO. qq5- I / 'S_W \ MASON COUNTY HEALTH DEPARTMENT FOR DEPARTMENT'USE.ONLY \ ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPI� NUMBER 428 WEST BIRCH STREET • SHELTON, WA. 98584 _ PHONE (206) 426-5561 1.219' ..„.. �G , GAO O- L"?sae '' LIC APPANT SIGNATURE ADDRESS / PHONE , SITE: APPROVED ❑ NOT PROVED PROPERTYNER / ' C 'R ?/(/ /1/f L. l? re S 5- •Pg_ 2 BY: A/t ADDRESS.? PHONE • / DESIGNED SYST REQUIRED /‘ / i It A t. y4 111,----; /1/-t -/2(•fSEWAGE GESEWAGE: APPROVED NOTCONTRACTOR •, � SIGNER APPROVED LEGAL DESCRIPTION BY: '),iv- o� rQ3 ©Faw44- Su,* 4_/1-7 , i i 67 Ave q3 / _A code_. 1 S�J` �it SOIL TYPE r - - TYPE OF ,�/J / /• d NO. OF Lor���XEPTH TO TER TABLE RC. RATE BUILDING fi ! l r /JZ�Y'�6EDROOMS � SIZ _ SINGLE FAMILY K PUBLIC WATER Li NAME SEPTIC TANKS} GAL. PU!P REQ. WATER SYSTEM SYSTEM gg� COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL 1d FEET 6 DIRECTIONS TO SITE:SI FILTRATION AREA___ J 4/ ' SQ. FEET � OF ,// 6 e c � A�L-/ 7,. J . ;vit AUANTITY AP ROVED SSTONE__ CU. YD. SAND CU. YD. /247r C. z' !,T I (: I FILL REQUIRED_ - __—CU. YDS. FINAL INSPECTION REQUIRED BEFORE BACKFILLING 1 DEPTH OF BACKFILL ~` (-- 2"ST W OR PAPER • �5.;,�i(::Y�.I - .vi,;k• STONE .:,si.:,;` CC) ..,4w OVER ILE - ,:6t 4 7. i0,4,4 :.,��;• PIPE SIZE t1 �Iy1�,��'l,.`f'1MI�1 t A 01 .,4-':!.ul;'i4:-l.? / STONE SITE PLAN AND SPECIAL STIPULATIONS I< i > I UNDER ILE (INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH I:. • /2"Gri f- ;;; Ft r/4 .1 . .. :. �� U �..,,,LAtt ,_ (1)\ r l7`iill* - s.3 cif- /??•if. ti : . ::: ,..37 COMMENTS: r u "d d I:..,. , r., Mnaso County DM "' THIS SITE PERMIT EXPIRES / !dFILTRATOR® 11111-1060 septic tanks _ - _ Features&Benefits • Strong injection molded polypropylene construction . I I • Lightweight plastic construction and inboard lifting lugs allow for easy i; I0(7 (7(1( , ,._. delivery and handling itiki(ii. • Integral heavy-duty green lids that 1 , interconnect with TWTM risers and pipe riser solutions 'KagaK+ta ill'r[e[li K of c!K K It K r Milli W �y r i �,' • Structurally reinforced access ports eliminate distortion during installation ' and pump-outs • Reinforced structural ribbing and fiberglass bulkheads offer additional �`' strength • Can be installed with 6"to 48" of cover The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank, or rainwater(non-potable)tank exceptional strength and watertightness. • No special water filling requirements Inlet Side are necessary • The tank may be backfilled with suitable TANK CUTAWAY Infiltrator native soil.See installation instructions — — -- TW Riser r - ti -System ------ for-guidance. - Partition baffle wall ' I HEAVY DUTY LID CUTAWAY• - • Reinforced 24"structural • I access port ' ROVED s ® Structural I . bulkheads '`''�Y J 2 2022 MID-SEAM•^� �41NTY ENVIRONMENTALHE�`ri Reinforced water tight mid-seartyC 0•c i--- gasketed connection f , .p-- ,,C [Protecting the Environment with Innovative Wastewater Treatment Solutions INFILTRATOR" IM-1060 General Specifications and Illustrations LIFTING STRAP LIFTING LUG RISERCONNECION (TYPICAL) (4 TOTAL) (TYPICAL) The IM-1060 is an injection molded two piece mid-seam $111111101111 .—..,..---......... %�_�plastic tank.The IM-1060 injection molded plastic design 1 1I 1161 l�l1 ,allows fora mid-seam joint that has precise dimensions A I' ul It !�� �_' ,V; A for accepting an engineered EPDM gasket. Infiltrator's l';� ° I U ° e gasket design utilizes technology from the water industry , � I I d ° ' 62.2 to deliver proven means of maintaining a watertight seal. It=% nit IL. pTMThe two-piece design is permanently fastened using a r;�_—• 1 series of non-corrosive plastic alignment dowels and ��aI�i� I� I�I�LJ�.Jrr L.JtJa- locking seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. 1270[3226)FXTFRIOR LENGTH Must be backfilled and installed in accordance with TOP VIEW Infiltrator Water Technologies, Infiltrator IM-Series Septic OUTLET Tank General Installation Instructions and for shallow Ill ground water conditions reference the Infiltrator IM-Series Tank Buoyancy Control Guidance. EII� k c 54.7 Please visit www.infiltratorwater.com/images/pdf/ g_E4_=-- =. =-.,_IL‘� [EXT RIOR ManualsGuides/TANK01.pdf for the latest information. 11111111111p HEIGHT S(TYPCAL) L LIFTING STRAP(TYPICAL) ` - IM-1060 ."i..._. Working Capacity 1094 gal(4141 L) Total Capacity 1287 gal(4872 L) END VIEW Airspace 16.5% Length 127"(3226 mm) 04(102) 0 24[610)ACCESS OPENINGS WITH LOCIONG LIDS(2) PVC OR ABS 0 4[1 e2)PVC OR Width 62.2"(1580 mm) INLET TEE -10.2(260)FREEBOARD ABS OUTLET TEE Length-to-Width Ratio 2.3 to 1 t INLET _ - 16.5% p AIRSPACE PI �_S UTL.ET Height 54.7" _-(1389 mm) --(IPA-T- 3 3.0 PEA - CO>E CODE Liquid Level 44"(1118 mm) 44.0 oS •1 FIBERGLASS NMFIBERGLASS Invert Drop 3"(76 mm) SUPPORT UQUID SUPPORT --.. (TYPICAL) DEPTH (TYPICAL) WITH BAFFLE Fiberglass Supports 2 WALL WHERE REQUIRED / Compartments 1 or 2 r N Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) 1 Maximum Pipe Diameter 6"(152 mm) CON11NUOUSKTOP Weight PPRO'J ED TAN HALF r GASKET TANK 112','i// ti MAY 0 2 2022 INTERIOR \\. Sti f. _ ',..., SEAM CLIP Ft \ \ aAM COUNTY ENVIRONMEN�A���� ALIGNMENT f DOWEL TANK BOTTOM 4 Business Park Road �" HALF P.O.Box 768 t Old Saybrook.CT 06475 INFILTRATOR® 860-577-7000•Fax 860-577-7001 MID-HEIGHT SEAM SECTION 1-800-221-4436 water technologies www.(nfiltratorswater.com U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending.Infiltrator,Equalizer, Qulck4,and SideWinder are registered trademarks of Infiltrator Water Technologies.Infiltrator Is a registered trademark In France.Infiltrator Water Technologies is a registered trademark in Mexico. Contour.MicroLeaching,PolyTuff,ChamberSpacer,MultiPort,PosiLock,QulckCut,QuickPlay,SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PotyLok,Inc.TUF-TfTE is a registered trademark of TUF-TITE,INC.Ultra-Rib is a trademark of IPEX Inc. 0 2016 Infiltrator Water Technologies,LLC.All rights reserved.Printed In U.S.A. IM02 1116 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436 KURT'S PRE-CAST P.O. Box 99 360 275.1996 Belfair, WA 98528 PROPERTY INFORMATION Location:253 SE MILL CREEK RD Shelton Tax ID:320293200030 Mail To GERALD M &SHELLY L WATTERS JR 251 SE MILL CREEK RD Use: SHELTON,WA 98584 GENERAL SYSTEM TYPE:Conventional (Non-Pressurized) ON ID:3202932000308 County Area: Oakland Bay MRA Fad ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT - Fold Here Here Inspected:04/19/2022 - Inspection Type:ROUTINE - Correction Status:No corrections needed Company: Work Performed By: Submitted 04/24/2022 by: KURT'S PRE-CAST Kurt Olson Kurt Olson COMMENTS& GENERAL INSPECTION NOTES No Deficiencies Noted new tank installed GENERAL SITE& SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected Components accessible for service: YES All required service performed(if no-specify omitted inspection items in notes): YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(structures/impervious surfaces) NO All riser lids securely fastened upon departure: YES Electrical repairs needed. If YES describe in comments: NO Root intrusion on any components. If YES describe in comments: NO Settling problems observed. If YES describe in comments: NO The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-2 Compartment This component was: Fully Inspected Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 0 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 0 Pumping recommended: NO This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportlD: 1062026 View inspection reports online at www.onlinerme.com Page 1 of 1 mom, ICONIX Waterworks (US) Inc. 2840 BLACK LAKE BLVD SW,SUITE B SALES SHIPMENT C.) ICONIX TUMWATER,WA 98512 COPY waterworks USA Tel:360 539 7518 III II I�III AIL I,ILII!Ili�llI � l IIII II Fax:360-489-1041 � �l www.iconixww.com Shipment Number:U2114040973 Shipment Date:07/21/21 Page: 1 Bill To: CHRIS Ship To: CHRIS CASH SALE-TUMWATER CASH SALE-TUMWATER ENTER CUSTOMER ADDRESS ENTER CUSTOMER ADDRESS ***ALL CASH SALES FINAL—NO RETURNS*** ***ALL CASH SALES FINAL—NO RETURNS*** TUMWATER,WA 98512 TUMWATER,WA 98512 USA USA Customer ID CASSALTUM SalesPerson Cash Sale-Tumwater P.O.Date 07/21/21 Ship Via Sales Tel No. 360-539-7518 P.O.Number TANK Ship Method Inside Sales Camden Heckel Our Order No. U2112042055 Ordered By CHRIS Creator CHECKEL Cust Job No. TANK Posted By TUMPOS2 Job Desc Ship Item No. Customer Item Description Unit Weight Ordered Shipped Back Ordered IIM10602P IM-1060 2 CPMT SEPTIC TANK EACH 1 1 W/PLUMBING TWO COMPARTMENT ("\7 Ship Weight: 0.00 (Pounds) 0.00 (KGs) WARNING:Weights not Listed for 2 item(s)out of 2 item(s) RECEIVED BY: DATE: (PRINT NAME) (SIGN HERE) • DELIVERY TIMES AND PRICING FOR ALL GOODS AND SERVICES ORDERED HEREIN ARE SUBJECT TO CHANGE.PAYMENT TERMS FOR ALL GOODS AND SERVICES WILL BE NET 30 DAYS FROM THE INVOICE DATE. INTEREST IS CHARGED AT 2%ON ALL OVERDUE AMOUNTS.ANY GOODS OR SERVICES PROVIDED BY ICONIX WILL BE SUBJECT TO A LIMITED WARRANTY PROVIDED THAT WHERE ICONIX IS NOT THE MANUFACTURER OF GOODS. CUSTOMER'S SOLE RECOURSE FOR DEFECTIVE GOODS WILL BE TO THE MANUFACTURERS EXPRESS WARRANTY,IF ANY.EXCEPT AS OTHERWISE SET OUT HEREIN,ALL GOODS AND SERVICES DESCRIBED HEREIN WILL BE PROVIDED SUBJECT TO ICONIX'S TERMS AND CONDITIONS WHICH SHALL SUPERSEDE AND TAKE PRECEDENCE OVER ANY OTHER TERMS AND CONDITIONS.THE ICONIX SALE TERMS MO CONDITIONS ARE AVAILABLE ON REQUEST OR ONLINE AT ICONIXWW.COM/UNITED-STATES/TERMS-AND-CONDITIONS-OF-SALE! • ICONIX Waterworks (US) Inc. INVOICE 2840 BLACK LAKE BLVD SW,SUITE B C.) ICONIX TUMWATER,WA 98512 USA waterworks Tel:360-539-7518 Fax:360-489-1041 Invoice Number.U2116036244 www.iconixww.com Invoice Date:07/21/21 Page:1 Bill To: CHRIS Ship To: CHRIS CASH SALE-TUMWATER CASH SALE-TUMWATER ENTER CUSTOMER ADDRESS ENTER CUSTOMER ADDRESS ***ALL CASH SALES FINAL—NO RETURNS*** ***ALL CASH SALES FINAL—NO RETURNS*** TUMWATER,WA 98512 TUMWATER,WA 98512 USA USA Cust No. CASSALTUM Ship Via P.O.Date 07/21/21 Terms Cash on Delivery Ship Date 07/21/21 P.O.Number TANK Due Date 07/22/21 SalesPerson Cash Sale-Tumwater Our Order No. U2112042055 PST Exempt No. Creator CHECKEL Cust Job Name TANK GST Exempt No. Posted By TUMPOS2 Ordered By: CHRIS Item No. Customer Item Description Unit Order Qty Quantity Unit Price Total Price IIM10602P IM-1060 2 CPMT SEPTIC TANK EACH 1 1 1,302.69 1,302.69 W/PLUMBING TWO COMPARTMENT Taxable Amount Tax Exempt Amount Subtotal: 1,302.69 1,302.69 0.00 Invoice Discount: 0.00 Total Sales Tax: 122.45 Prepay: 0.00 Total: 1,425.14 Please remit payment to:ICONIX Waterworks (US) Inc. PO BOX 1516 SNOHOMISH, WA 98291 USA Interest is charged at 2%per month on all overdue amounts DELIVERY TIMES AND PRICING FOR ALL GOODS AND SERVICES ORDERED HEREIN ARE SUBJECT TO CHANGE.PAYMENT TERMS FOR ALL GOODS AND SERVICES WILL BE NE-30 DAYS FROM THE INVOICE DATE. INTEREST IS CHARGED AT 2%ON ALL OVERDUE AMOUNTS.ANY GOODS OR SERVICES PROVIDED BY ICONIX WILL BE SUBJECT TO A LIMITED WARRANTY PROVIDED THAT WHERE ICONIX IS NOT THE MANUFACTURER OF GOODS,CUSTOMERS SOLE RECOURSE FOR DEFECTIVE GOODS WILL BE TO THE MANUFACTURER'S EXPRESS WARRANTY,IF ANY. EXCEPT AS OTHERWISE SET OUT HEREIN,ALL GOODS AND SERVICES DESCRIBED HEREIN WILL BE PROVIDED SUBJECT TO ICONIX'S TERMS AND CONDITONS WHICH SHALL SUPERSEDE AND TARE PRECEDENCE OVER ANY OTHER TERMS AND CONDITIONS.THE ICONIX SALE TERMS AND CONDITIONS ARE AVAILABLE ON REQUEST OR ONLINE AT ICONIXWN.COM/UNITEDSTATESJTERMS-AND-CONDITIONS-OF-SALE/ r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT�1 INFORMATION Permit Number SWG-- ?O2Z' °OZ 1 _` Parcel # 32,02c, 5 d Od�U Applicant Name 't1►'-!.5 (9 i/(s Subdivision (Name/Div/Block/Lot) Applicant Address 12_ GJ iii3a►119; FaYh'15 // City, State, Zip j t��n , �u // Installer Name C h r i5 6,iz5 /G-1 ac (h e5 Site Address 5j IS 3 f'Y4; // CP z-K" R Designer Name INSTALLATION CHECKLIST ❑ Full System Installation jank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type (Au I k Pretreatment Type >5 ft. from foundation? - - ❑ N/A J YES El NO >50 ft. from wells? - - ❑ IX ❑ Z >50 ft. from surface water? - - CI c. CI H CI between building and tank? - - ❑ [2 0 Tank baffles present? - - ❑ [ El a24" access risers over each compartment?- - ❑ (4 ❑ - W Effluent filter installed?- ,^-n_❑I T Nil CI N 6Septic tank size �o b gal Manufacturer ‘ � 0 D-box water level and speed levelers used? - - ❑ N/A Ig YES ❑ NO p0 Manifold/D-box accessible from surface?- - DZ CI m 2 Check valves installed? - - ❑ EZ ❑ oQ E Transport Line Size Schedule/Class 3S Bedrooms installed (check one) ❑ 2 IX 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 1; 1 YES ❑ NO >100 ft. from wells?- - ❑ ® ❑ Cl W >100 ft. from surface water? - - CI ® ❑ IL >10 ft. from potable water lines?- - ❑ © ❑ Z > 5 ft. from property lines and easements?- - ❑ [ ❑ d > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ cl Drainfield level and observation ports present - - ❑ P ❑ ❑ Graveless chambers or p Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ [ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A El YES ❑ NO • Pump tank size gal Manufacturer < 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - - ❑ ❑ El a E Control Panel equipped with Timer/ ETM/Counter- - ❑ El El D Q. Pump installed in ❑ Bucket or ❑ On Block or El Other d• Pump Make/Model El Floats or ❑ Transducer a. n. Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES [f NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - rg YES ❑ 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 8 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 permits. ❑ 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 Drawing is accurate. form and attached Record Drawing is accurate. 11V ►iG5 4-/28/2 Signature of Installer Date v15 6i (G� Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: 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 Updated 8.rz1/20-8 RECORD DRAWING (continued)