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HomeMy WebLinkAboutSWG2021-00689 - SWG As-Built - 9/11/2023 DocuSign Envelope ID:8DCCC75D-4731-441C-833F-AF287E43125B 4 Gt, Mason County OSS Installation Report pg. 1 CC MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00689 Parcel # 22029-21-90014 Applicant Name Bert Shincke Subdivision (Name/Div/Block/Lot) Applicant Address 1721 McCorkle Rd SE City, State, Zip Olympia Wa. 98501 Installer Name Manke Excavating LLC Site Address 80 SE Cannery point Rd Designer Name Micah Halverson INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type Septic Tank >5 ft. from foundation? - •}kC- ❑ N/A x❑ YES ❑ NO >50 ft. from wells? — — ❑ © ❑ z >50 ft. from surface water? - " f..- t— ❑ ❑ ❑ HCleanout between building and tank? - - - -��G -v - ❑ ❑ ❑ U Tank baffles present? - j___,,---P - - ❑ 0 ❑ d24" access risers over each compartment?- BY - - - ❑ ® ❑ W Effluent filter installed?- •- ❑ x❑ ❑ CO Septic tank size 1 200 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - x❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ El El oDZ Check valves installed? - - ❑ 0 ❑ 0< E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 2 x❑3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ippitavED ❑ N/A ® YES ❑ No C1 >100 ft. from wells?- ❑ x❑ ❑ W >100ft.fromsurfacewater? - - - - 1 -f-i3 - - ❑ © ❑ li >10 ft.from potable water lines?- ❑ x❑ ❑ Z ri�,�LN COUNTY ENVIRONMFUTALHEA�T-- > 5 ft.from property lines and easements?- - - - ------ ❑ © ❑ 41 re > 30 ft. from downgradient curtain/foundation dratrO - ❑ ® ❑ o Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A x❑ YES ❑ NO • Pump tank size 1275 gal Manufacturer Sound Placement z 24" access riser(s) and accessible from surface?- - ❑ ® ❑ 1-- Alarm or Control Panel Installed? - - ❑ ® ❑ a 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ D Cl- Pump installed in ❑ Bucket or ❑ On Block or ® Other Orenco EasyPak a• Pump Make/Model Orenco 3005 0 Floats or ❑ Transducer a • Tank draw down 2" in/min Pump capacity 45 gpm Squirt Height 5 ft Pump on time 1 min Pump off time 4 hrs Daily flow set at 270 gpd Updated 8,21/2018 DocuSign Envelope ID:8DCCC75D-4731-441 C-833F-AF287E43125B Mason County OSS Installation Report pg. 2 Parcel # 22029-21-90014 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES XQ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES El 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 installation approval and related permits. RptcrL APROVE MASON COON EP 2°23 TY ENVIRONMENTAL HEALTH LBW Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 farpogggAtpched Record Drawing is accurate. form and attached Record Drawing is accurate. t`Jl.`JCLJJLJl.RAOH.. Signature of Installer Date a i't .;f '14 Printed Name of Signee is, 1, MASON COUNTY PUBLIC HEALTH 1 k �tij�t The undersigned approves this Installation Report and i ` `Pi_ Record Drawing on behalf of Mason County Public ,� wrw 5100409 ' Health' - is TH �HA vERsoN j LKNS£D DESifahER -'�tit) , U N l — . ' Exp► s:oa+let Sign tureironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121)2018 y • f. ' c sx` iMe• #4, . . 44)1It , Ar r S .: „f r• - r^ .. . I ` c DJ -x t If ~ Ja _a N N N \ \ \ pNp� (QO+�—3 \ \ N N. 1 4. E. SEGANNERYFOINTOA 3 ry In • N — 3 7 C. 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