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HomeMy WebLinkAboutSWG2020-00172 - SWG As-Built - 7/11/2023 . rp) MOTMEV JUL 1 0 2023 BY: Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00172 Parcel# 52024-43-00030 Applicant Name ELI/ADRIANNE CADWELL Subdivision (Name/Div/Block/Lot) Applicant Address 3121 W LITTLE EGYPT RD ___ City, State, Zip SHELTON, WA. 98584 _ Installer Name WEATHER TIGHT Site Address SAME Designer Name CINDY WAITE INSTALLATION CHECKLIST © Full System Installation ❑Tank(s) Only ❑ Grainfield Only El Repair ❑Other System Type GRAVITY Pretreatment Type.__ >5 ft. from foundation? - __ v-�__ —— >50 ft. from wells? [2] NIA YES 0No >50 ft. from surface water? - ❑ 0 0 Ill El cc Cleanout between building and tank? - _ El o Tank baffles present? - El IN 0 d24"access risers over each compartment'?- -- 0 El ElLIJ filter installed?- ❑ 0 ❑ cn Septic tank size ?, 629 El L7 El gal _ Manufacturer __ y 0 D-box water level and speed levelers used? - OO Manifold/D box accessible from surface'? ❑ N/A ® YES 0 NO OQCheck valves installed? ® ❑ ❑ Transport Line Size 2 ® , [] Schedule/Class SCHEDULE 40__ Bedrooms installed (check one) ❑ 2 Q 3 >10 ft. from foundation?- 5 ❑6 ❑Commercial/Other 0 >100 ft. from wells?- 0 N/A 0 YES ❑ NO LLI -., >100 ft. from surface water? 0 El El Z >10ft. frompotablewaterlines?- - - _ _ .- _ _ ... _ _ - _. _ - _ - ❑ Q > 5 ft. from property lines and easements?- -- - - - _. - - _. _. _ _- _ - - ❑ El II 0 > 30 ft. from downgradient curtain/foundation drains'?- -. - - - - .. _ _ . ❑ ❑ Drainfield level and observation po present ® � El ❑ Graveless chambers or [ ❑ 0 ❑ Clean gravel used'? (check one) Proper cover installed over dranfield?- -- 0 © ❑ Pump tank setbacks consisty with septic tank?- - - .. - __ _ -_ - - - _ - — ---- ZPump tank size 2 C al ❑ N/A 12) YEs do 9 Manufacturer 1Il _1 }a,�, f� 24"access riser(s)and accessible from surface'?- - -. __ _ _ _ _ _ _ _ _ = a Alarm or Control Panel Installed? - - - - - - - - ❑ © ❑ Control Panel equipped 'h Timer/ETM/Counter- .- .- - - _. __ _ _ 0 0 ❑ C7 Ela Pump installed in 1/ a ■ •�ucket or El On Block or [] Other Pump Make/Model / S 2- ZG�/�t'/--._. _ --_____ - __ -___--_—_ a Tank draw down `) '� ❑ Floats or ID Transducer in/min Pump capacity.-__ —9pm Squirt Height 3 ft Pump on time Pump off time _ _ _ Daily flow set at Mason County OSS Installation Report pg. 2 Parcel# 52024-43-00030 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - -- - - -- _ _ _ -. If yes, please describe: El YES El NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - El 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 onentation&layout.Sept:Gpuntp tank location North arrow.reserve rirainfield,existing and proposed buildings,location of wells.waterlines wells observation ports cleanotes,and other maintenance access points Incomplete Record Drawings may c:;ealr:additional delays in final installation approval and related permits 7 \ rT .4fikp 4 D,d lyek ® 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"byMason 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 1 further certify that all information contained on this form and ttached Record Drawing is - e-- form and attached Record Drawing is accurate. Ai ot Signature of Installer i .1 Date t- ar , .i d) ,/ S " ���f ed ti Panted Name of Signee or 4,�. i .•t S i. : •ems.+ ,1 • e\l,�'v MASON COUNTY PUBLIC HEALTH ` The undersigned approves this Installation Report and oh rat t8 N'.` `� g pp p NDY E.WAIF 1..� V. Record Drawing on behalf of Mason CountyPublic LICENS£p DESIGNER • '� EXPIRES 05r1fi VI r /. .� w am. Ar ir. v ✓G�'� Sign; ,"vironmental Health Specialist Dato (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLF FOR PUBM vtFw nt,r J 1 r I • Y • \C. /- T' N 1)2,3 a_f( s,.fr►' 10,4 �' M a-3� " sZ ` .G " Qrfuchve- I .. .____±..]:), I - Phd_=____ _____________ \ . �•Q w• : � D 1. Residence CAA l 0 2. AudioNisual Alarm 3. Clean out between residence And Septic tank I 4. 1200 Double chamber septic tank Irp 5. 1200 Pump Tank (two risers required) �0 6. Transport Line �A^ I/4. 7. Valve Box r (1b p ✓�� /, 8. Primary drainfield (three 67' laterals) \ bNT/ 1?Q '�?3 9. Waterline 4e�NwFs4/7., 10. Reserve area 11. Soil logs #1 q0ti 12. Soil log #2 31,b 13. Soil log #3 14. Proposed well site -+ 4 i 4 i � i • .* oc t xsy 7A 44'4., __.7.---------::"------ Z.:1 li— ,..- \i\ IS 114,1 41 \‘'\ 0. c17.7::::::: � NDY E �AIT����I' LICENSED DESIGNER � EXPIRES 05.-/0, "��,� I0/ 5!2! I/t/, t jile r ,l- ieof • • 5 20 2.c/ -,13- o. ? 412, i l de 1,4 co.,bo Pig.L. re. e Pti e..fc rzn1 ir,4io I s,, • 11re n..._ . I . - I I , 5 , . a 1 . .