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HomeMy WebLinkAboutSWG2023-00338 - SWG As-Built - 11/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT!PERMIT INFORMATION Permit Number SWG 2023-00338 Parcel# 22209-34-00190 Applicant Name Ronald Preston Subdivision (Name/Div/Block/Lot) Applicant Address 2816 W Bertona St TR 19 OF GOVT LOT 3 S 53/37 City. State, Zip Seattle,WA 98199 Installer Name Arrow Excavating Site Address 7070 NE North Shore Rd, Belfair Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type Pressure Bed Pretreatment Type >5 ft.from foundation? - r'10 house. \lE„} ❑N/A ❑YES ❑ No >50 ft. from wells? - ' na sr2g-t1 _MCI- 0 0 ❑ ' >50 ft. from surface water? _ e.� El 0 0 I, Y. Cleanout between building and tank? -- wa'e- ' _ - - ❑ 0 ❑ Tank,b$lfles/piSsent? - El II 0 2a 24"access ri rs over each compartment?- 0 II ❑ W I Effluent installed? ❑ I ❑ i. Septic tank capacity(working) 1,250 gal Manufacturer Hagerman G D-box water level and speed levelers used? ® N/A I:YES ❑ No oJ II 0 ❑ O Manifold/D-box accessible from surface? OLL p [1 * 0 mZ Check valves installed? - -- -At_ _f��'I �"^' 0 o2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 0 3 El 4 0 5 ❑6 0 Commercial/Other >10 ft from foundation?- 1ia ktaLs- C-'4a_} ❑ N/A ❑YES El NO a >100 E. from wells?- too WC.IS Tel ❑ ❑ ❑ W >100 ft from surface water? ❑ II tt >10 ft.from potable water lines?-_Y_-ink- 54teaCICkc._ -- 0 ❑ 0 QZ > 5 ft. from property lines and easements? 0 i. 0 R' > 30 ft from downgradient curtain/foundation drains? in 0 ❑ G Drainfield level and observation ports present 0 ® ❑ ❑ Giaveless chambers or w Clean gravel used? (check one) Proper cover installed over drainfield? ❑ ® ❑ Pump tank setbacks consistent with septic tank? ❑ N/A Q YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?p�y.�,� ❑ IN ❑ ~ Alarm or Control Panel Installed? --W v ❑ ❑ II o. El ® Li Control Panel equipped with Timer/ETM /Counter- ? a Pump installed in ❑ Bucket or II On Block or 0 Other O_g Pump Make/Model Liberty 280 ❑ Floats or MITransducer a Tank draw down 2.5 in/min Pump capacity 55 gpm Squirt Height 4 ft Pump on time 2 minutes Pump off time 6 hours Daly flow set at 440 qpd uresecamnma Mason County OSS Installation Report pg. 2 Parcel# 2220g 3 ` cOI 9-0 ABANDONMENT RECORD yy�� y YES � NO Were existing septic components abandoned as part lf this project? ` D. F. 1^^v- 9k ``YY'' If yes, please describe: �\a A A' R+j^"` "` YES � NO • Were all components pumped out and properly abandoned per VJAC246.277A-0300? RECORD DRAWING u n to reaacate in the need o1 maintenanceactivities and future development T.p. l Record m.s isa pe record and be and descriptive enough North Drawings cOn eeW. b - 0 ( gaol n f y reserve and proposed o o s .I ti of n ea, lls,observaon parts.Jeanouts,anc caner maintenance access points. Incomplete Record Drawings may create acditonal delays irna:alstallation approval and related permits.- f�l 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 1 further certify that all information contained on this I further certify that all information contained on this form and attac d Recording is accurate. form and attached Record Drawing is accurate. eture of Installer Date fi lb Printed Name of Signee U t MASON COUNTY PUBLIC HEALTH '+ 1' �'W ;.1 ar 1'. The undersigned approves this Installation Report and sc(-T erzvo<c :�, Record Drawing on behalf of Mason County Public -:-5 PAULA JOY JOHNSON .;;(2LICEYISEUYt v� Health: 61.5St S� �yT d [_�C� (4:W � I f t - '7 - 23 Signs re of Environment 1 Health Specialist Oate (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated8/21/2018 �V . ?a,,tay- 222�- . 00190 fu u -e Q A"e10-vt c 'r _ ; v��F etSSZB © ceanoat 1200 Gallon Septic tank 2-ComPattcieat with N. Went Filter , / 04\1200•Ga11On Ate? Chnraber APPRO V Er reY-noded � NOV 16 ?i'3 id .F. -IN--J. a-ba..A.do., cP r"C4CCJ'YirE6;:4:tiu_1 1NEgLiN ctd \ TV r eArnc aed \ d ma tA.w5e \ D Old rt. RQQ`> _ 'In e of �'C` "` `� '0 tBN V E 60 ri$ O CP tv:k=ce.\ slop -y' %ilea 2 Jr' E.-me iv„5 hoe ef GraP6tE e act!, �+� qto ¢< c T)4-4 A t 5c----1) Lzell M / &gym` ° �5 to 4e? / YJ \°d Q5 11 r` �. m' ccH s-f„�.,."ems `G - , s°.t ea�k \ ��d ' �l i 205 V- `y/.�p'.. Ppfr“. kv f CAcc',};c< glee¢ �s�Q % V. PAULA Y JOMNSON Ii,CEr,:te.pES�GTtEq' . + stiniz Exs+ku o5Ti 5l 11-123