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HomeMy WebLinkAboutSWG2023-00045 - SWG As-Built - 7/6/2023 ,Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00045 Parcel # 42017-22-00030 Applicant Name NORMA GONZALEZ Subdivision (Name/Div/Block/Lot) Applicant Address 13109 PARK AVE S City, State, Zip TACOMA, WA. 98444 Installer Name SCHOENING EXCAVATION Site Address 4471 W DAYTON AIRPORT RD Designer Name CINDY WAITE INSTALLATION CHECKLIST it Full System Installation ❑ Tank(s)Only El Drainfield Only ❑ Repair ❑Other System Type PRESSURE DIST Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES >50 ft. from wells? - El NO Z >50 ft. from surface water? - - ❑ 0 El HCleanout between building and tank'? .I�1 r� I _ _ _ ❑ El ❑ U Tank baffles present? - lUr El 1-: 24" access risers over each com artm 1 . - - - ❑ p i �1�� 5-2(123-v ❑ ElEl W Effluent filter installed?- LL,_ _ _ El 0 ❑ co Septic tank size 1530 gal By___ iti�. -_.,,,.-, INFILTRATOR (EXISTING) `O D box water level and speed levelers used? - El N/A El YES ❑ NO OXO Manifold/D box accessible from surface?- - ElEl QQCheck valves installed? - - ElE Transport Line Size 2 El ElSchedule/Class SCHEDULE 40 Bedrooms installed (check one) El 2 ❑ 3 04 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CD >100 ft. from wells? ❑ El--I >100 ft. from surface water? - ❑ w - ❑ El El Z >10 ft. from potable water lines?- El Q easements? ID Cl IX > 30 ft. from downgradient curtain/foundation drains? - - - - - -- - ❑ ❑ El o Drainfield level and observation ports present - © ❑ El ❑ Graveless chambers or K Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - _ - ❑ 0 ❑ Pump tank setbacks consistant with septic tank'? - - ) El N/A Q YES ❑ NO Y Pump tank size 1S.'c gal Manufacturer hfQgCSE.mdn/ Z < 24" access riser(s) and accessible from surface?- ❑ ® El E— a. Alarm or Control Panel Installed? - - ❑ I ❑ Control Panel equipped with Timer/ ETM /Counter- _- _ _ ._ _ ❑ © El a Pump installed in ElBucket or MO On Block or ❑ Other Aej M Pump Make/Model L09er4 2SU 7 El Floats or [vj Transducer Q. Tank draw down 1.5 in/min Pump capacity 4°,5 gpm Squirt Height ft Pump on time 1.5 m;n Pump off time 41Ars Daily flow set at 2,-7 o gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 42017-22-00030 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? - - ❑ YES 0 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,Septiclpurnp tank location.North arrow.reserve draintield,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. ® 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 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 l 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 D awing is accurate. X-J5 k45.23 Signature of Installer Date \ P� eft Printed Name/of Signee J •�P� N -�� ��Z 1 1� ,o, MASON COUNTY PUBLIC HEALTH n, �. .f, ? y�" . 51 418, N `✓1 The undersigned approves this Installation Report and ° c E.wIrE Record Drawing on behalf of Mason County Public LICENSED DESIGNER Health: Exr'14cs os,to, 2 '�, 7/6/23 k40616Cilly 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 8/21/2018 I i. * % �ivEH/•9e /00' 110i -\---------- APPROVED MASON COUNTY ENVIRONM NTAL HEALTH % 1-1-- RET I) ��v ; 3 0 z ,I &74 -T:,4 tit WV, —l-444A. Tit-4'45'P 04? L' ie Cts I-, CV q7z1-7 ` oti,;,,,,i,,L } i i 0 LaAd/4./. 0 cto i, /v,11/z.E'f ei�4t no s CD 1\ 0 IAILI al /,„e i :it) __ 4-32.,. 6Lc -Ora It r. S�Pco .A �a 1c �1. j 141 _ ����`�j ND E. AITEt1N a` / V ._.-._ LIC D D IGNER AelA ExiliiLS 05/10, yUe 4i/