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HomeMy WebLinkAboutSWG2022-00585 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT FORMATION Permit Number SWG 2022-00585 Parcel # 42024-42-00112 Applicant Name GERTRUDE PAR+70 r.✓ Subdivision (Name/Div/Block/Lot) Applicant Address 701 SE TOTTEN SHORES City, State, Zip SHELTON, WA. 98584 Installer Name MIKKELSEN SEPTIC LLC Site Address 2425 WEST RAILROAD AVE Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Rep1ir ❑ Other System Type SAND AUGMENTED PRESSSURE DIST Pretreatment Type >5 ft. from foundation? - - >50 ft. from wells? - ❑ N/A 0 YES El No - >50 ft. from surface water? - El ON El Z mnT2 o o ❑ Cleanout between building and tank? - - - - -U Tank baffles present? - MAY_ ❑ a24" access risers over each compartment?- r� �8�- ❑ ❑ W Effluent filter installed?- ❑ U ❑ Septic tank size ( moo gal Manufacturer Cdr. n,ct,ti 0 D-box water level and speed levelers used? - Q N/A ❑ YES LiNO 00 Manifold/D-box accessible from surface?. - ❑ co. Z Check valves installed? - ill ❑ OQ - El ❑ Li E Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES 0 NO 0 >100 ft. from wells?- -1 >100 ft. from surface water? - � 0 El- ❑ ❑ li >10 ft. from potable water lines?- ❑ O Z El Q > 5 ft. from property lines and easements?- - ❑ © ❑ o ce > 30 ft. from downgradient curtain/foundation drains?- - 0 ElDrainfield level and observation ports present - - 0 It El i El❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ O CI Pump tank setbacks consistant with septic tank?- ❑ N/A ® YES ❑ NO Pump tank size I 2emu gal Manufacturer tl4a Z ` CCw�K/ < 24"access riser(s) and accessible from surface?- d Alarm or Control Panel Installed? - ? 11 Control Panel equipped with Timer/ ETM/Counter- - ElID Pump installed in ❑ Bucket or 0 On Block or ❑ Other ` a' Pump Make/Model LIBERTY 280 _ 0 Floats or ❑ Transducer m Tank draw down a in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Jpdated 8121/2018 Mason County 088 Installation Report pas 2 Parcel# ABANDONMENT RECORD Were existing septic Components abandoned as part of this project? W •. If yes, please describe: 11E8 0 NO Were all components pumped out and properly abandoned per WAC2 2 2A-0300? - RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities arid tbtftaa D�awings contain: Dranfleid&manifold orientation&layout Se tic/ arrow,reserve drainfield,eidstIng and proposed buildings, balm of. Typical Record wells,observation ports,cleanouts,and other maintenance access points.tank Record Drawings may create additional delays In final installation and relatedf wells, Permits. approval and 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 actor- ( 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 hem have been cleared/approvedby both the designer shown hem have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all j 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. .1,17 lef/aile2P1 arl ynelure Date �1 L, 0 C�►mil 7f>�) .0 Q e� Printed Name of Sig ee ' —"- ,ors'a` ., - �0 A 0 MASON COUNTY PUBLIC HEALTH I S 04. Is 4t,� The undersigned approves this Installation Report and ' d' Sv E.watTE� ��it Record Drawing on behalf of Mason County Public LICENSED DESIGNER �� Health: 1 .►`�.� r.��.05/.. �����1, ExPRES 05rtoi IA%\ ! (01V1. C( (7—. 3 i • Signature of Environmenta Health Specialist ... Date i (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE urbaad entnote "-IY-rst / r�#f, T V APPROVED JUN 0 9 2023 /-er..t..,N9 Q"",,` MASON COUNTY ENVI �-�1— _../ 57^c4 ,oy to ,/ RONMEy Al HEALTH/2 / s bc-alc,4 .. RET c? 'hir -,, Q- Kv I) i APPROVED6 , ti NOV 2 9 2022 trifle, �'a AITE' ,/ IGNER MASON COUNTY ENVIRONMENTAL HEA H x\ z Lxr,,HES u5„0, RET Z�4 q / 0 �f t 5 4 id, �,esicjf•vc..� 1 E I f. 0) I2,0 cf..)cIf.e e> G 54}v1►` •Hui 412) Ry•• „„,e if) r(4) 1 ' pt. 0-,, 40.4 4. 0 //4..„a 6 f.)z �3 Sdw� AtGLf�[� Vf�r 41 Ir.: beds' S I��� 0 e;l w f)r 51" l uN ,��. AO' / w��. N\y/e; 4 eitvi-- 41) b e- 4.10, 4lls/?AI Srpf/` de . 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