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HomeMy WebLinkAboutSWG2021-00559 - SWG As-Built - 7/6/2023 ... Aason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH .APPLICANT/ PERMIT INFORMOION Permit Number SWG 2021-00559 Parcel# 32232-55-00025 Applicant Name Jim and Simone Dickinson Subdivision (Name/Div/Block/Lot) Applicant Address 300 E 5th St City, State, Zip Union,Wa 98592 Installer Name Active Underground LLC Site Address 91 E Warren Dr Designer Name Dale Tahja INSTALLATION:0E0(aST: 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type Pressure Pretreatment Type >5 ft. from foundation? - - 0 N/A ®YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft.from surface water? - MO F Cleanout between building and tank? -- --- -T- - -n ❑ 0 • U Tank baffles present? - t. _l�_�L -- © ❑ d24"access risers over each compartment?-- - UN-.2 ir 3- Q ❑ III Effluent filter installed?- _ ® ❑ rn Septic tank capacity(working) 1200 Lpal Manufacturer SPS 9 D-box water level and speed levelers used? - - _ - im WA ❑ YES ❑ NO DO ManifoldlD-box accessible from surface?- - 0 ® 0 u. mZ Check valves installed? - - ❑ ON 0 0 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 0 3 ❑4 0 5 El 6 0 Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- 0 I. 0 W >100 ft.from surface water? - - El ON EC >10 ft.from potable water lines?- . . - 0 ® ❑ erg >5 ft. from property lines and easements?- - 0 IN 0 cz > 30 ft. from downgradient curtain/foundation drains? Cl 0 0 0 Drainfield level and observation ports present - 0 ® 0 ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistent with septic tank?- - 0 N/A III YES ❑ NO Z Pump tank capacity(flood) 1250 gal Manufacturer SPS < 24"access riser(s)and accessible from surface?- - ❑ IN ❑ ~ a 0 El NO . Alarm or Control Panel Installed? - _ Control Panel equipped with Timer/ETM/Counter- - 0 0 0 Q- Pump installed in ❑ Bucket or ❑ On Block or 0 Other Pump Vault wi Holes 18"Off Floor a' PumpMake/Model Liberty280 � %...', Floats or El Transducer d Tank draw down 1.25 in/min Pump capacity 28 qpm Squirt Height 7 ft Pump on time 1min 36sec Pump off time 6 Daily flow set at 180 qpd A Updated 8/24/2018 .Mason County OSS Installation Report pg. 2 Parcel# 32232-55-00025 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES jj NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El 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. Grainfield&manlold ortentation&layout,Septic/pump tank location.North arrow,reserve drseMeld,existing and proposed buildings,location of wets,waterlines, wells,observation ports,deanouts,and other maintenance access points. incomplete Record Drawings may create additional delays in final installation approval and related permits. SI Record Drawing Attached CERTIPIWitiONOF INSTALLATiON INSTALLER DESIGNER/ENGINEER /certify that i installed the system in accordance with /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 I further certify that all information contained on this I further certify that all information contained on this form andehed-R�cprd Drawing is accurate. l form and attached Record Drawing is accurate. 4�4 �3 % t1 of Installer Date • + Q- • ti J QIM e Me e AC a r 4g Q' Printed Name of Signee �", 04 terry • MASON COUNTY PUBLIC HEALTH or 414. �. � tip , The undefsigned approves this Installation Report and 5 (Xi��4 \' \`1) } Record Drawingon behalf of Mason CountyPublic 1i Health: 0 DALE L. T. - A t. -. rp bbSic1�ER r 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 8/2112°18 r� . \\c-r_ . War cexN �Jr\NQ /� 4IP Ft / A •'1: / for` - 'r ,. � � a,u�^,j / kse ht, // , st } r / 0 C.. A „._. „...,..„ r)\iy:exi6,.\.1.(:).c.....,,c __.__ _______ ._ �z�o __0 O Oc %.,0\<_- .Gr i -,44q \ APPROVED 4 JUL 0 6 2023 /7� MASON COUNTY ENVIRONMENTAL HEALTH" � �� � r.7 \1 f