HomeMy WebLinkAboutSWG2021-00467 - SWG As-Built - 6/15/2023 f t '7
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2021-00467 Parcel # 322 1 2-76-00 1 20
Applicant Name �: . a e-t.,Nci r, Subdivision (Name/Div/Block/Lot)
Applicant Address SI Z y Q •-,,ZL-1 L•-.r.��
City, State, Zip P,, -_ C t C U .. : `t t taller Name Shae Dien
Site Address 251 Santuary LN, Tahuya 183(4 Designer Name Olen Constuction
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6.- lJv�l ci (* )/ INSTALLATION CHECKLIST
System
Full S tem Installation_ o❑ Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other
System Type Gravity Trenches Pretreatment Type
>5 ft from foundation? - - ❑ N/A ® YES ❑ No
>50 ft. from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - CI Gig
Q Cleanout between building and tank? - - ❑ IN
0 Tank baffles present? - - ❑ ® ❑
4 24- access risers over each compartment? - - ❑ ® ❑
UJ Effluent filter installed?- - ❑ ® ❑
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Septic tank capacity (working) 1200 gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - - ❑ N/A $ YES ❑ NO
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00 Manifold/D-box accessible from surface?- - CI I ❑
u.
9 co Check valves installed? - - ® ❑ ❑
0a
Transport Line Size 4" Schedule/Class 3034
IBedrooms installed (check one) ❑ 2 [J 3 0 4 0 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A ® YES ❑ NO
0 >100 ft. from wells?- - ❑ Ill El
Li, >100 ft. from surface water? - - ❑ PI ❑
LL. >10 ft. from potable water lines?- - ❑ ® ❑
Z 5> ft. from property lines and easements"- - - - - -- - - -- - - .. - - 0 ® ❑
ec > 30 ft. from downgradient curtain/foundation drains? • - El ® ❑
0 Drainfield level and observation ports present - - ❑ ® ❑
lii Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ N El
Pump tank setbacks consistent with septic tank? - - 0 NIA ❑ YES ❑ NO
Pump tank capacity (Hood) _____ _-gal Manufacturer
Z
< 24" access riser(s)and accessible from surface? - - ❑ ❑ 0
a. Alarm or Control Panel Installed? • - - ❑ ❑ ❑
2 Control Panel equipped with Timer/ ETM /Counter• - ❑ ❑ ❑
D
n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other -
n- Pump Make/Model ❑ Floats or ❑ Transducer
EL
Tank draw down in/rein Pump capacity gpm Squirt Height ft
Pump on time T__ Pump off time ___ Daily flow set at god
Mason County OSS Installation Report pg. 2 Parcel# 3 2-7 I Z-_ 7(0- Ot)12 c.)
ABANDONMENT RECORD
Wore existing septic components abandoned as part of this pso;eft' - • YES m NO
It yes, please descnne. ___--
Were alI cxmlponents pumped out and property abandoned per WAC246-272A-0300? •- • ❑ YES 0 NO
RECORD DRAWING
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1J Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
f certify that I installed the system in accorrianco 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(hit any dovuNtons shown Mason County Public Health and that any deviations
here have been cleared approved by both the designer shown here have boon cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public ileum and meet on
and Mason County Codos. State and Mason County Codes
1 further certify that all information contained on this I further certify that all information contained on this
form e
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at Record Drawing is ar,curate. form and attached Record Drawing is accurate.
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Srgnattereof Installer Date
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Panted Name of Signet)
MASON COUNTY PUBLIC HEALTH
The undersigned approves this taste/lotion Report and tp»
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Record Drawing on behalf of Mason county Public a t.0 ouctvc!t.0 t
Health: (.nAtos; F1 e
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Signature of Envlron entni Health Specialist Date (stamp, signature and date)
THIS 1-()WA MAY UT-SCANNED AND AVAIL.ABLE FOR Pt Nit IC VIEW Ott THE MASON COUNTY WED SITE tx'""4 14jlra, i
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JUN 15 2°23
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