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HomeMy WebLinkAboutSWG2021-00677 - SWG As-Built - 5/11/2023 CLEAR FORM Mason County OSS Installation Report pg. 1 C�� MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2021-00677 Parcel# 222237500130 Applicant Name Soon 8 Autumn Perry Subdivision (Name/Div/Block/Lot) Applicant Address 650 NE BLACKSMITH LAKE DR City. State. Zip Bellair WA98528 Installer Name Jim Zmny Site Address 461 C Pathfinder Dr, Golfair Designer Name Jack Johnson INSTALLATION CHECKLIST 10 Full System Installation 0 Tank(S)Only 0 Drainfield Only 0 Repair ❑Other System Type Gravity Trenches Pretreatment Type it >5 ft.from foundation? - 0 N/A in YES ❑ No >50 ft. from wells? - --` - 0 ® 0 >50 ft. from surface water? • . n III El ❑ • Cleanout between building and tank? -- - El O Tank baffles present? - - ❑ • ❑ H- 24-access risers over each compartment?- - ❑ . 0 a III ❑ N Effluent filter installed?- - - 0 Septic tank capacity(working) '1200 gal Manufacturer Hagernan O D-box water level and speed levelers used? - - 0 N/A ® YES 0 NO �—I 0 II ❑ O Manifoki/D-box accessible from surface?- m 2 Check valves installed? - - • ❑ 0 CaQ 2 Transport Line Size 4' Schedule/Class 3034 Bedrooms installed (check one) 0 2 ❑3 ®4 ❑5 LI 6 LI Commercial1Other >10 ft.from foundation?- - ❑ NIA III YES 0 NO >100 ft. from wells?- - 0 W >100 ft. from surface water? - - El El® Er. >10 ft.from potable water lines?--- - 0 II 0 zQQ 5 ft. fivirt pwpeity lines and casements?- - 0 • ❑ f1` >30 ft.from downgradient curtain/foundation drains? •-- - ❑ 11 0 © Drainfield level and observation ports present • - ❑ e ❑ ❑ Graveless chambers or Ill Clean gravel used? (check one) Proper cover installed over drainfield?- ' ❑ • 0 Pump tank setbacks consistent with septic tank?- - S WA ❑ YES 0 NO Y Pump tank capacity(flood) gal Manufacturer < 24-access riser(s)and accessible from surface?- - ❑ 0 ❑ I— a.. Alarm or Control Panel Installed? - ----- ❑ El 2 Control Panel equipped with Timer/ETM 1 Counter- -- ❑ ❑ 0 m a Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model 0 Floats®orr 0(Traan ED a gp► Tank draw down intmin Pump capacity n ,A PPINR D`sducer - Pump on time Pump off time Daily flow set at gpd MAY 1 1 1ULJ Limt.4iinl.zo,t MASON COUNTY ENVIRONMENTAL HEALTH DJA Mason County OSS Installation Report pg. 2 Parcel IS ABANDONMENT SOO I J V ABANDONMENT RECORD were existing septic components ilb 3f'Ni1Dfi(!+Ct :tS pan CI lhf5 pParact? 0 YES 'rNO i f yes,p'eaSe describe ..... _..*..cro all components pumped out anti property abandoned per WAC24G 272A 030Q?.--�- .�• •. 0 YES 0 NO it RECORD DRAWING his a•gamma.*IKON..W mu*be await,end preurprne•rNwotpl w re locate u,tn.nW a .a.eMi.s..w tomn deviep.e•••a fyfarrt wo..o..: M1ewi g%wane et antaMl I nrrdo i on.•t.A.v 8 r+y.r.A. c 1.w'ure spent...mn MT or wonve Or.rie90*tsar.)/Irt el rvova4 tcolkA rryr:C...+w.W wool*,evMsn.+ .,,..,allallnlitIrt pats tit...art.M 01.e.rctasawrwv.c sut^!s tr+v% .r•n{iai Ro.r.a t?foe.+yt.ray tre.tr..)xrorvistrati.•Ar•.f...ta.twxw r(t.w.I wt itr++ ' .•:t Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with l certify that the system has been installed in accor- tha septic design stamped"APPROVED-by Mason dance with the septic design stamped-APPROVED'by county Priebe Health and that any deviations shown Macon County Public Health and flint nay deviations here have been cleared/approved by troth the designer shown here have been cleared/approved by both rind Masons County Public Health are/meet all State myself and Masao County Public Health and moot all and Mason County Codes State and Mason County Codes I further certify that all information coition d on firs I(wilier certify that all information)contained no this fo rid Ott hod Record Drawing is atcurata form are!attached Record Drawing is accurate. ,,� fo - APPROVED yx er ur++of!n`il.iG'vr ! Date _ -,,1G c-le_ ,D k v t-N~) MAY 1 1 2023 !'rurit•et IYunfu ul S,y,Pten r' MASON COUNTY;j" _-i ri_,<-1.k(,NP%;(T:. MASON COUNTY PUBLIC HEALTH •'. 10. / A fhe urrdeNSNOtKl npp,uvaa this kratnl thine t Repoit iRnl .. Record 0 n o on behalf of Mason C unty Public raw x rs Health tv•-_ .,'. hats .. 57((/ZO6 t., . Sign lure of Environmentallteritui Sp a14St a,,rr. js tamp.signature and date) 'hits FORM MAY RE Si;ANNLbANUAVAt.Ats.k i kai now it.lilt ION 1Nt-MAsIt>t•i c.UUNrY Wi',tt;uya "'"r"•w,d.,. • 3 Q 1 I rip v 3 a O 1 - --- 3 s'4 f\ \ til 0 \ 117/4. ‘ :..1k6'..\11\ t--- .ii: v 0) 1 `'" 0 0 D F4 ;i \\ c � ti ro r i p -1 ja' / I I. = A, s m /j/ I - � I Q. / 1 1 o I I Co 1 ft. 1 1 a / O 1 / 'a 1 // rri 1 / / ../ / 3eM/ #." ,�`` / N is :. �,// Property Line D Pathfinder Ur 7:21_ v LO 1-+ r rya � p Z t "4aB N ip O 12 II 4�� v+ 1 D O ryp r E ,A,. 5. -- � tq % DO r +as m ^' co m D