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HomeMy WebLinkAboutSWG2023-00074 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00074 Parcel # 32006-54-0000g Applicant Name SANTA SERVICE LLC Subdivision (Name/Div/Block/Lot) Applicant Address 2430 160TH AVE NE City, State. Zip BELLEVUE, WA 98008 Installer Name SCHOENING EXCAVATION Site Address 40 E FIR COURT Designer Name CINDY E WAITE INSTALLATION CHECKLIST IN Full System Installation ❑ Tank(s)Only ❑ Drainfield Only gi Repair ❑ Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - Val r - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - ❑ ❑ Z >50 ft. from surface water? - "- ❑ H Cleanout between building and tank? _ - ? - - _ E El ❑ 0 Tank baffles present? - ti - ❑ ❑ ❑ a24"access risers over each compartmen - - - - ❑ a O W Effluent filter installed?- - - - — - cn Septic tank size 1530 gal Manufacturer INFILTRATOR 0 D-box water level and speed levelers used? - N/A ❑ ❑ YES El OO Manifold/D box accessible from surface?- - ❑ 0 ❑ OQ Check valves installed? - _- - - - ❑ ❑ [1] 2 Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A El YES ❑ NO 0 >100 ft. from wells?- I] ❑ ❑ -1 >100 ft. from surface water? -wI ❑ ❑ II >10 ft. from potable water lines?- ❑ • ❑ Z - Q > 5 ft. from property lines and easements?- - - -- - - - - - ❑ 0 El CC > 30 ft. from downgradient curtain/foundation drains? - - - - -- - - - © ❑ ❑ 0 Drainfield level and observation ports present - - - ❑ NI ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? - ❑ El ❑ Pump tank setbacks consistant with septic tank? - -. - - ❑ N/A Q YES ❑ NO Y Pump tank size 1060 gal Manufacturer INFILTRATOR Z Q 24"access riser(s) and accessible from surface?- ❑ 0 LI 1-- a. Alarm or Control Panel Installed? ❑ IN ❑ E Control Panel equipped with Timer/ETM /Counter - - - - ❑ El ❑ v d Pump installed in ❑ Bucket or ® On Block or ❑ Other ` �u' ('l LIBERTY 250 At= OVE 1..�� El LIBERTY or ® Transducer a ank draw down 1.5 in/min Pump capacity 40.5 gpm Squirt Height 5 ft PIM 3r0i2021 1.1 MIN Pump off time 6HRS Daily flow set at 270 gpd MASON COUNTY ENVIRONMENTAL HEALTH r!� rUpdated�'1"zo's DJA od. ,Ja r kJ• Si M la I'roe (.�1 , , ,o A j^s. ....J'O,>.5 rdr/, r ek Mason County OSS Installation Report pg. 2 Parcel# 32006-54-0000$ ABANDONMENT RECORD Were existing septic components abandoned as part of this project'? - - Q YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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,Septic/pump tank location.North arrow,reserve drainfield,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 instal'ation 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 1 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. i iv 1 Signature of Installer Date or$ L1 A 010 4- jti- P r c yLt" �t.,vto-c- tv1,1 SAP OF,e,s,. �7A t I O Printed Name/ of Signee J i N' t a = _i_,t \e^ ' MASON COUNTY PUBLIC HEALTH I \ �, ,\ t/ The undersigned approves this Installation Report and o? CINDY E.WAITE "7 cA3 so LICENSED DESIGNER It Record Drawing on behalf of Mason County Public / v Health: /�o�Zo3 Exrir S ., ,o 6 z APPROVE L Signature of Environmental Health Specialist Date JUN T3(4192023signnaa{ture and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR M SONA COUNT T NVI�I IIVM �rTLR' {WEB SITE Updated 8r21/2018 DJA • • •b ' 'i E a APPROVED "` ;:,:.....�- ::>. —'- - JUN 3 0 2023 MASON COUNTY ENVIRONMENTAL HEALTH DJA -A f • ' 11 N X f:-z. 1 1 \ Ali, • \ \ s �1 N� 'L�j ` LICENSED Ur • \ J. \ 8 (ll Z to A ,\ Amok. ,M6.10•04. . ''''' III ' 4. 12" �VVI \ I * 0 , i ril ! ',, I.., ., V '.\ . i 1- p ; ,• -r .0 MAR 2 2 2023 t. lSO��^ n �'VViRO ��A 4.4 e ,�1 GUN c DJq NMENTAL HE>r s Ir.) ; ...,„„, \ ca if i, fl . \ (4 e : 1 9) 531 :D` Pw ' ,,,, \ A3."-a mO � O � CII0- mx i _ n mm • mmrN � - 2 +1 \ 0OrZZZo 1 -� •\ OoD —Im i*ofMOSy�.t C@ ; ;\ 91\,19 441, '1 ZOO -< r- O "�P ,„ . r, ;oii --< ?, A. N mr= i xi ximX) J" 44 30 D LICam WAITE '�J, y�,..•''. cn m x Ekvi,ES 05,,o, ` "\�\, ` J v \`