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HomeMy WebLinkAboutSWG2023-00001 - SWG As-Built - 8/29/2023 iimumi Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00001 Parcel # 22129-52-00007 Applicant Name Laura Ary Subdivision (Name/Div/Block/Lot) i Applicant Address 260 E Quenns Way City, State, Zip Shelton, WA 98584 Installer Name Johnson & Maddox Const Site Address 260 E Queens Way Designer Name BeckvRieger } INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Pretreatment Type Nu Water >5 ft. from foundation? - - ❑ N/A ® YES ❑ NO >50 ft.from wells? - •- ❑ N ❑ Y >50 ft. from surface water? - ❑ 1 ❑ Z HCleanout between building and tank? - - ❑ X ❑ U Tank baffles present? - - ❑ In ❑ a24"access risers over each compartment?- - ❑ ® El Effluent filter installed?- -- •- ❑ I ❑ rn Septic tank capacity (working) 1200 gal Manufacturer Sound placement 0 O D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - ® E: El o02 Check valves installed? - - ❑ ® ❑ ClQ 2 Transport Line Size 1.5" Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? - - ❑ N/A ® YES ❑ NO >100 ft. from wells? ❑ [� ❑ W >100 ft. from surface water? - - ❑ ill EL" >10 ft. from potable water lines?- - ❑ It ❑ z > 5 ft. from property lines and easements?- - ❑ Q ❑ Q cc > 30 ft. from downgradient curtain/foundation drains? - - ❑ 111 ❑ a Drainfield level and observation ports present - - ❑ Al ❑ © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑l ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A I] YES ❑ NO Y Pump tank capacity(flood) 1200 gal Manufacturer Miles Z < 24"access riser(s)and accessible from surface?- - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - ❑ ❑ ❑ a 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ APpt ❑ Bucket or ® On Block or El Other a alc Pump Me� Goulds PE31 U Floats or ❑ Transducer '3vG 1 IstC Elfin down .75 in/min Pump capacity 15.6 gpm Squirt Height 5 ft MASON NTY �ump�o�n�time 3.8 min Pump off time 4 hours _ Daily flow set at 360 gpd EN1'IRpryh1ENTAIHEA(],u ll tedBrzinoia UJA Mason County OSS Installation Report pg. 2 Parcel# 22129-52-00007 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ® 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: Dralnfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfiold,existing and proposed tuildings,location of wells,waterlines, wells.observation ports,cteanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits, ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER 1 certify that I installed the system in accordance with l 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. � —� 8-3-2023 S' at rG e 6T nstaller Date Lam Johnson Irk`'/ V `�c•: Printed Name of Signee MASON COUNTY PUBLIC HEALTH . The undersigned approves this Installation Report and 1 + gel;r J.Ri- er Record Drawing on behalf of Mason County Public 'ovx.,td4f D• t Healt . Exrl s 6 3 A 4.7 S furs of Environmental Health Specialist 0 (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8l21n0te A UG 2 9 �023 MASON COUNTY ENVIRONMENTAL NEA W DJA • _J . $ \ • k ; ; 0 /) (9 an` . ! t I ! ` (\ ~ z \ ; ` H HI VI <% ■ - w 4 «E \\C ` cU 3 m ® a cT. 2a et a. j / / \ \� /\ 1 § ( 3 ) 7 7 G ) t k } E. iiilhil a - Lu Q ) ., \ \ 3 , I I ' '«■ � --- — — i I ... 1111,1 _ k ... 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