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HomeMy WebLinkAboutSWG2021-00024 - SWG As-Built - 6/28/2023 Mason County OSS Installation Report pg. 1 Q MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2i-- b0t2-" Parcel # 12108-43-00020 Applicant Name David Mullen Subdivision (Name/Div/Block/Lot) Applicant Address 490 E Stretch Island Rd S City, State, Zip Grapeview,98546 Installer Name Kevin Smith.Maplewood Construction Site Address Same as above Designer Name `"""" "-.".°:'''' a"'D*''' INSTALLATION CHECKLIST 113 Full System Installation ❑ Tank(s)Only El Drainfield Only ❑ Repair ❑Other System Type p vtmyp +13 t v J l Pretreatment Type >5 ft. from foundation? - - ❑ NIA x1 YES ❑ NO >50 ft. from wells? - ❑ ® ❑ >50 ft. from surface water? - ❑ I'I ❑ Z HCleanout between building and tank? - - ❑ It t, Tank baffles present? - . ❑ ® ❑ a24"access risers over each compartment?- . ❑ IN W Effluent filter installed?- ❑ ® ❑ cn Septic tank size 1,250 gal Manufacturer Hagerman Precast O D-box water level and speed levelers used? - ❑ N/A ® YES ❑ NO DOManifold/D-box accessible from surface?- - ❑ 0 El o?Z Check valves installed? - ❑ ❑ Il 0q n Transport Line Size 2" Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- ❑ N/A it YES ❑ NO G >100 ft. from wells?- - ❑ ® ❑ W >100 ft.from surface water? - - ❑ I ❑ LL >10 ft.from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - ❑ MO ❑ Q Q > 30 ft.from downgradient curtain/foundation drains? - - ® CI El Drainfield level and observation ports present - - - ❑ © ❑ ❑ Graveless chambers or It Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ IN ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES El NO • Pump tank size 1,250 gal Manufacturer Hagerman Precast Q24"access riser(s)and accessible from surface?- ❑ ® ❑ dAlarm or Control Panel Installed? - 0 I 0 2 Control Panel equipped with Timer/ETM/Counter- - ❑ III ❑ a. Pump installed in ❑ Bucket or Fri On Block or ❑ Other a. Pump Make/Model u bc,r'.k/ 2.3(.0 ® Floats or ❑ Transducer d Tank draw down L in/min Pump capacity gpm Squirt Height ftv t ft Pump on time i ►h:1 3c-,, Pump off time t't`>. Daily flow set at 36 C) gpd L;;ICwM 5.2':1^12. 1 Mason County OSS Installation Report pg. 2 Parcel# 12108-43-00020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - © YES 0 NO If yes. please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - • ❑� YES ❑ 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. Typ,cai Record D'aw:nga i.o.ita,n Cr air.ra!d 3 rrardcd onenta:.^..^.$layo....SenL.'Jpump tank it.aac.,Pi0rtrl arrow:,reserve drainfeld,etlst!ng and proposed`.,.n^.:ngs location of weds,mater:..^,e5, wells,observation ports.cleanouts.and other ma:rierance access points. Incomplete Record Drawings may create add.tiora!deiays in final lstallation approval and related permits. PL-GUlk.UZA ba ---7 k b A. ❑ 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 I further certify that all information contained on this I further certify that all information contained on this form and attached tyd Qr,G ig is accurate form and attached Record Drawing is accurate. I. ,-----,�„K.,--e-r---t 13Z2 �,_ , r, Signature of Installer Date ,- •• $, • •••••'� r, • „, Printed Name of Signee < •°' ,'t... ••,'a,1 MASON COUNTY PUBLIC HEALTH = " • w : • rrl '1 s 5 :I , 54 r The undersigned approves this Installation Report and er Lawrence M. Purdum•. '0,, Record Drawing on behalf of Mason County Public ta LICENSED DESIGNER /r� Health: EXPIRES 2/25/ 6fZ5i23 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 6,21n018 .ekl ' b 8 2. 4 /9568. 0 1 r i jill 1 14 iii titj 'jdll r" . ' I „ i li fp r 138 = IT H11d3H 1d1N3► 0IiIAN3�,Nf103 NOSVW f I tZOZ 8 Z N(1f d n ®9noiddV ,\ 1 ' i =1Z A D r (' a O 2m ric4000C9 S ti000 E- 05 � . mZ i Zl " r oNO ,D rn on� 2ZD c Z Q { m , r a xr pz �o = V c\--- . 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