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HomeMy WebLinkAboutSWG2021-00458 - SWG As-Built - 6/23/2023 Mason County OSS Installation Report pg. 1 CC, MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2021-00458 Parcel H 220185100062 Applicant Name Glenn Butcher Subdivision(Name/Div/Block/Lot) Applicant Address PO Box 1273 Timberiakes — City. State, Zip Bothell WA 98041 Installer Name Mason County Excavtior1 Site Address 21 Eastlake Dr.Shelton Designer Name JrmZimny INSTALLATION CHECKLIST Q rut System lnstatletIon 0 Tnnk(s)Oniy ❑Dr,unhckd Ord) ❑Repau ❑Other System Type____ Gravity trenches ^_ Pretreatment Type >5 ft from foundation? . • 0/t*A ®Yes 0 NO ,50 ft.from wolfs/ - .. 0 © 0 >50 ft.from surface water? • - - - - - 0 NE 0 Z < Cleanout between budding and tank? - • ❑ PE 0 U Tank baffles procont' - 0 0] 0 d El access risers over each compartment?- • 0 A W Effluent fitter installed?- •• ❑ *I ❑ en Septic tank capacity(working) 1250 qai Manufacturer h. ,._nt_„i ' 0 D•box water level and speed levelers used? ❑wA mJ r[s 0 No OiJJ ManifoldfD-box accessible from surface? - - •• - - •• - - 0 ii ❑ co.I Check valves installed? - • ❑ ❑ 0 oQ Transport Line Size Schedule/Class - Bedrooms installed(check one) 0 2 ®3 ❑4 0 5 ❑6 ❑CommercialtOther >10 ft.from foundation?• • 0 WA g YES ❑ NO >100 ft.from wells?- - ❑ NO ❑ W >100 ft from surface water? - - 0 IN LL >10 rt.from potable water lines?• - ❑ ® 0 z — >5 ft. from property lines and easements/- 0 II ❑ Q cc >30 ft.from downgradient curtain/foundation drains/ - ❑ PI ❑ Drainfield level and observation ports present • - 0 PI 0 ® Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfietdv- - ❑ Mil ❑ Pump lank setbacks consistent with septic tank? • - ® I A ❑ YES ❑ No Y Pump tank capacity(flood) gal Manufacturer < 24'access riser(s)and accessible from surface'- ❑ [1 aAlarm or Control Panel Installed? • .. - _ _ - _ - NE 0 ❑ 2 Control Panel equipped with 1 imer I E I M I Counter• ig ❑ ❑ m Cr_ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other _ __ _ a.• Pump Make/Model 0 Floats or CITransducer eL a lank draw down in/min Pump capacity gpm Squirt Height 't Pump on time Pump off time Daily flow set at i;nr' Mason County OSS Installation Report pg. 2 Pa et# 220185100062 ABANDONMENT RECORD Were ewst,np septic comp rants abandoned as part or this progect7 • - - - - - - - --- - - -• ❑ YFs ® NO yes, please describe: _Were aW curnponants pumped out and properly abandoned per WAC216-272A-030C7 - 0 Yes NO RECORD DRAWING Ts,.,a a narnar.nt r.cnrd out moot bit amoral*ad t4wlie.s enough to r►out.r.Or n..d of nt.relono...*cower*rod ttdr.O.wbvsra rylLr n..•.f 11•a....te:M'r. r . a..1 d,:ur.tatd orri..it*i taw*.Ssps Pas**to*Itx.a n North arrow,rosary*eranrsil..w.+)rot prow***ttusdnps•locator.*look.ra,r.,,t, *etc t.a :teeno,.+,a.d d.r•tr.ewtoe awns pants. Inor¢t.R.rxrl 0....o^.oy a.tsb s4dt.vd 4ott»n tnar rflat<Mvt ggro.ot t.N danC pa.^•1. I ija Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with t certify that the system has been installed in occur the septic design stamped'APPROVED'by Mason dance with the septic design stamped AP ROVED-by County Public I tealth and dug any deviations shown Mason County Pubhc Health and that any deviations here have been clooredlapproved 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 It information contarneo on the I further certify that all rr.!ormativn contained on this r • • I ratt.aeh ci RccnrJ Drawing is accurntc. form and attached Record Drawing is arrtrrate l Sionature at Instatkir Date Pnnfed Name of Signet: MASON COUNTY PUBLIC HEALTH The undersigned upprovus this Instil/town Report and . Record Drawing on behalf of Mason County Public d ao" Wt. of SIGNER Health: ,, '`�' -1)*\CLA/trICiq (ziO S,4natvrp of Environmonfal Health Specialist Dote (stamp. signature and dare) THIS FORM MAY BE SCAN'FDANL)AVAILABLE FOR PUhI IC VIEW ON THE MASON COUNTY WE3 SITE ., , E. Timber Lake Dr West a) tco N O 4 m w �10,p Slope m N O O 2' O 00 O O O 7/ C D p 1 rt. O co [gyp rU ~- — v p < rT' '. V -< y V .. UJ I r a. \\\. i t a IV APPROVED N O J U N 2 6 2023 MASON COUNTY ENVIRONMENTAL HEALTH S RET 4 _ . ,. ,2 n G \ O Dr+ o o o �x � w,c r 0 9 c