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HomeMy WebLinkAboutSWG2023-00125 - SWG As-Built - 5/10/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMI�FORMATION Permit Number SWG 2023-00125 Parcel# 22212-58-00040 Applicant Name Hugh Le Subdivision (Name/Div/Block/Lot) Applicant Address 11336 SE 192nd St LAKEWOOD PLAT L TR 16 City, State, Zip Renton,WA 98055 Installer Name Maples Excavating Site Address 1772.1 E State Route 106, Belfair Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s)Only ❑ Drainfiel Only 0 Repair ❑ Other System Type OSCAR X02 Pretreatment Type >5 ft.from foundation? - -—-# -- 0 N/A ❑■ YES ❑ NO >50 ft.from wells? - 4't--4- EI 0 0 r c/ Z >50 ft. from surface water? ^ ❑■ ❑ HCleanout between building and tank? - r3 --• 00 V Tank baffles present? - 0��-- ® ❑ 0 a 24"access risers over each compartment?- [U ❑ `W Effluent filter installed?- - -- II 0 Septic tank capacity(working) 1,200 gal Manu rer Roth 2-compartment i O D-box water level and speed levelers used? - - ❑■ NIA ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- _k4e a_-_ -s - ❑ II ❑ mZ Check valves installed? - -2, *-'^'--'' '-itik"` - ❑ II ❑ oa 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 0 6 ❑Commercial/Cther >10 ft. from foundation?- - ❑ N/A 8 YES ❑ NO ii 0 >100 ft. from wells?- - [I ❑ ❑ W >100 ft. from surface water? - - -- �a"' - El DI ti >10 ft. from potable water lines?- --f\/O-k - ❑ EU ❑ Z > 5 ft. from property lines and easements?- - ❑ [U ❑ Q ez > 30 ft.from downgradient curtain/foundation drains?- - OF ❑ ❑ Drainfield level and observation ports present - - 0 ❑ 0 Proper cover installed over drainfield?- - ❑ UI ❑ Pump tank setbacks consistent with septic tank?- - 0 N/A ® YES ❑ NO `.L Pump tank capacity(flood) 1,500 gal Manufacturer Roth 2-compartment < 24" access riser(s)and accessible from surface?- - 0 © ❑ a Alarm or Control Panel Installed? - - ❑ ® ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ m n- Pump installed in ❑ Bucket or © On Block or ❑ Other a Pump Make/Model AYMcDonald E-30 ❑Q Floats or ❑ Transducer tr 2 a_ Tank draw down in/min Pump capacity I I.S gpm Squirt Height — ft a ._) Pump on time 30 seconds Pump off time 3 minutes Daily flow set at 240 qpd Updated 8121i2018 I Mason County OSS Installation Report pg. 2 Parcel# 2221Zr 58' Doc)*() ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - 171,YES p NO If yes, please describe: - V YES El NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 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' Drainfidd&manifold orientation&layout.Septicipump tank location,Noah arrow,reserve drainfield,ebsting and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installaton approval and related permits. I .xRecord 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. /2 `�G - n 5 D l 1 Z3 H ature of installer D0Ce / live kil%-i (t. 5 ,., Ashy ' t Printed Name of Signee tt�� V 4 . •.•d;y MASON COUNTY PUBUC HEALTH •, ce. 5100349 •l The undersigned approves this Installation Report and " P.AUL.A JOY JOHNSON .g PP LtCl=1�f5EtS•q�Si�Ni1Fi" Record Drawing on behalf of Mason County Public �; �tC��, b EXPIRES UHr1 Health: ,SI(b(7:--5 5—q-2,3 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 8R120i8 • 1‘.--?----"li )400D Cict\I kL . `�� �_ r/ A l 1•53 u,L fir""- - - --, 10'X'S 0' © • 1.0x30 os�+rc . ' CSC 2_ viZAtN 1 .' L_ - - - - -4IrV•7- "S. '1111111 it Alm s f i rt1w _'`'f • L/- DY '� ! �, "-----HH SADillikC b `3 32 i t E b` "4'1 Li.�Q II Q II) t it J . VfifttcG t Cb ` /I\ 1 245 IN s I sue" T 9-1vEv4Ay I I O1'l1 S U Control Panel with audio-Vs Ala.W A3 Clea.nout fille7 4 v1p0 cranoa stptit/aernTaak 2,?_coaa�a t wrth as aio r A u s,�Cf � J• C 1,500 Craton Clarifier/Pimp Tank ! \ t :II MAey t i-, 2 CoapaiiQ c �OV P=p Tank � O (`b 20 33 4Q r '�1r*'..:`;�ti� (l,o 0 o Gat..to 0N'wax.) 1 J $ �,�+ CJ Headworks ' 'y���,4 i; 51.0349 .�st'' G OSC•AR XO2 Mound Drat'r'e7'j t 1� � * M�`,� hy.b+t.� +: PAULA JOY JOHNSOk % TL r_tc�us�E 'DESiGNr�t" � ,t-#22�.t2�58�0004 ��� �W-`c -r- re c--t. \o cv 5- —Z3 -esSwr<s @ems GA4.9 Psi G.Z 1 - 8 PLc G. 3 47 Ps'. Nft mi aser ��ow �� � M APPROVED MAY 10 2023 . - MASON COUNTY E'rV1RONMENTAL HEALTH, • * • RET