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HomeMy WebLinkAboutSWG2020-00405 - SWG As-Built - 5/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00405 Parcel # 32132-23-90034 Applicant Name DAVID WALTERICK Subdivision (Name/Div/Block/Lot) Applicant Address 650 E JENSEN RD City, State, Zip SHELTON, WA. 98584 Installer Name MIKKELSEN SEPTIC LLC Site Address SAME Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type SAND AUGMENTED DF WITH PD Pretreatment Type >5 ft. from foundation? - - 0 N/A ❑ YES ❑ NO >50 ft. from wells? - ❑ ❑ >50 ft. from surface water? - - ❑ z ❑ 0 ❑• Cleanout between building and tank? - - ❑ I U Tank baffles present? - ❑ a24"access risers over each compartment?- - ❑ 0 ❑ W Effluent filter installed?- El 0 ❑ ❑ 0 CISeptic tank size (Z.o G gal Manufacturer f4a_??e/ /7-70/,v 0 D-box water level and speed levelers used? - DO Manifold/D-box accessible from surface? © NSA ❑ YES ❑ NO co-2 Check valves installed? - ❑ ❑ 1.1 oQ - ❑ ❑ 0 2 Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑ 2 p 3 ❑4 ❑ 5 El 6 >10 ft, from foundation?- ❑Commercial/Other CI >100 ft. from wells? p ' ll la N/A ❑ YES ❑ NO J >100 ft. from surface water? - ;__ _,' U _ _ I nEl ❑ W Z >10 ft, from potable water lines?- _ ,g23_ - t !- ED El ❑ Q > 5 ft. from property lines and easements?- - 'n L -APR - - _ _ 11 ® ❑ 0 > 30 ft. from downgradient curtain/foundation d -i s?- - Drainfield level and observation ports present - - - _- 0 ID CI El Graveless chambers or 0 Clean gravel us-.? (check one) Proper cover installed over drainfield?- - ❑ .161 El Pump tank setbacks consistant with septic tank?- - ❑ N/A 0 YES ❑ NO Y Pump tank size i 20V gal Manufacturer hJa Z y Cr Iyj�.✓ 24" access riser(s) and accessible from surface? - ❑ 0 ❑ a Alarm or Control Panel Installed? - _ ❑re ❑ Control Panel equipped with Timer/ETM /Counter- _ 0 ❑ 0 a Pump installed in ❑ Bucket or © On Block or ❑ Other a' Pump Make/Model L r b t Z,7O r ❑ Floats or ElTransducer l,4 Tank draw down r' n- in/min Pump capacity gpm Squirt Height 6— ft Pump on time Pump off time (/ Daily flow set at gpd Li i " be c>1t.,v ` Y tri.A L' c..6 c 0-' f lGy cl,w, Updated 8/21/2078 1 Mason County OSS Installation Report Pg.2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? If yes, please describe: ❑ YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0 YES Se 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&manifold orientation&layout,Septic/pump tank location,North arrow,reserve dralnfield,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. �li / 0 re J /2-eerie is e at it_r //'1 7-(Ih.k /c(Ali,,, .,.., ,, kJ,.Y•e ` 3) 111V' b LtiI.1.1/17 ratr'J.1.4. . d 1 j,'ri) v. 4: ,I;Q1 ecord 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 and Mason County Codes, myself and Mason County Public Health and meet all State and Mason County Codes I further certify that all information contained on this /further certify that all information contained on this • form and attached Record Drawing is accurate. form and attached Record D :wing is accurate. 01 oei7/7 •11,0' r / 1 -gnature ler Date ,sfq- ,Ala 2Z s'oF. sy, . 11 Printed Name of ignee F14Zi4 41 )) MASON COUNTY PUBLIC HEALTH „ �'' ( �b VA The undersigned approves this Installation Report and y O�ip{B5Y10Ec4 a,� LICENSED E DESIGNER AITE ;file Record Drawing on behalf of Mason County Public "`„` Health: a lei. .....�k1, EXPRES 05,10, cl(6(z3 31 Signature of Environmental He /th8 Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 0/21/2018 . • a .- ....'.:.••. . I ' ,... -.vo* 1 .04 - ji il .17 0 `• 67" 71 f Pe/ ,,,,. • . ..... ,(-7c ilea? Pt bt ? ., \ 47 1) . - .___________________. li7 / ' I )criD ‘_:to •e' 4.- •••..\,.. . %---•-•'"4112.........1- k"e ____j...j19........_ . s''.• e % t'\41 . 0 11 I ..,.... li . We ( a91x qa ' e 04 4-,04_1• ("Iced',wit r 12 <--------Z-----c . Z) 97ektel r2r-srele v e r .------1 j Pe ft' . k t • APPROVED 1 6D i 2-0o et fve./a Du f Out(aril MAY 16 2023 rerbc. ÷dA.k )03 _ MASON COUNTY ENV1RONYENTAL HEALTH . ........... .._. . ( RET .• ,1\ , i .. ‘, ill , (E)I a ct 60 lt,444 / 1 i .0 1 ar ,•• 4. I, , , . .: •-• ' ,r„,4- .v, Ai 45" 1 @)' P * . -->. 0 c 46-4t- Ali ' ;7 ie. 0 eXt Vi awl il U IOU ,41- C AITE 1: i' 11 ktIt C0 l DOE IGN II, C ivve i wpe likvh• ia.71. s., :,10 11. •Vq1M7%.'• vhi1/1 II: CI 0 e Aside.I aFe k-kkg .ct, (79 pe.4,,j ,e i,j0 II • . i