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HomeMy WebLinkAboutSWG2021-00072 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 Cam. MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00072 Parcel # 322075000915 Applicant Name DAVID SWEET Subdivision (Name/Div/Block/Lot) Applicant Address 6308 GREENGATE PL SE N/A City, State, Zip PORT ORCHARD, WA 98367 Installer Name SONNY ROGERS (REI CTRS) Site Address 21951 NE N SHORE RD TAHUYA, Designer Name DAVID SWEET INSTALLATION CHECKLIST Q Full System Installation El Tank(s) Only El Drainfield Only El Repair ❑Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - - ❑ N/A ©YES ❑ NO >50 ft. from wells? - raitg`Z V -.E xi CI Y >50 ft. from surface water? - Ell ❑ Z H Cleanout between building and tank? - -MA 3-0-2M- 0 ❑ U Tank baffles present? - - ❑ CI ❑ a24"access risers over each compartment?- - - -BY - -0 0 CI LU Effluent filter installed?- - ❑ ❑l ❑ vi Septic tank capacity (working) 1070 gal Manufacturer INFILTRATOR IM-1060 o D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO J oO Manifold/D-box accessible from surface?- - ❑ 0 ❑ oQ Check valves installed? - - ❑ ❑] ❑ 2 Transport Line Size 2 IN Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 El 3 El 4 El 5 ❑6 El Commercial/Other >10 ft. from foundation?- - El N/A ® YES ❑ NO CI >100 ft. from wells?- - ❑ ❑■ ❑ W >100 ft. from surface water? - - CI III CI u. >10 ft. from potable water lines?- - ❑ © El Z > 5 ft. from property lines and easements?- - CI NI CId > 30 ft. from downgradient curtain/foundation drains? - - ❑ © ❑ Drainfield level and observation ports present - - ❑ 0 ❑ in Graveless chambers or El Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I. ❑ Pump tank setbacks consistent with septic tank? - - El N/A [U YES El NO Z Pump tank capacity (flood) 1070 gal Manufacturer INFILTRATOR IM-1060 < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ I— a. Alarm or Control Panel Installed? - - ❑ [U ❑ • Control Panel equipped with Timer/ ETM /Counter- - ❑ [U ❑ a Pump installed in El Bucket or El On Block or • Other ORENCO PUMP VAULT a PumpMake/Model ORENCO PF200511 � ® Floats or El Transducer a Tank draw down 7/8 in/min Pump capacity 21 gpm Squirt Height 2.6 ft Pump on time 4m17s Pump off time 11h55m Daily flow set at 180 gpd Updated 8/212018 Mason County OSS Installation Report pg. 2 Parcel# 322075000915 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES Q 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. 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,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 0 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 Record rawing is accurate. form and attached Record Drawing is accurate. 05:7/;,v, Signature Vidaller Date M ES S iv ST2A-44/7 l 0 C��.r aP wAsfib, <<s‹. Printed Name of Signee c MASON COUNTY PUBLIC HEALTH •O 4„981 The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public <•-SRFCISTERF° Health: S/O N AI- 1, ( q (Z3 5 ,3 Signature of Environmental Health Specialist Date (stamp, signature and date) /0 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 hiU Riu.^.CS J Ji s ik.,3:UO4 psluud r V{ %iiinao uoselp4 a, w{ P 1UUd 1111 ir©iMMIN1 ®I - � 11511 111111111 r aj Q., tr . QQ C ` c,w 6 ixlz UW in dd ` V _.' J o 0 4 1 \--21, i .. oc, . gr2,.,. 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