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HomeMy WebLinkAboutSWG2022-00106 - SWG As-Built - 10/23/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2022-00106 Parcel # 42209-51-00076 Applicant Name Kristopher Names Subdivision (Name/Div/Block/Lot) Applicant Address 491 Sorensen St LAKE CUSHMAN#8 LOT: 76 City. State. Zip Buckley,WA 98321 Installer Name Maples Excavating Site Address 491 N Fairway Dr W Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield On-y ❑ Repair ❑Otner System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft. from foundation? ❑ N/A 0 YES ❑ NO >50 ft from wells? 0 ❑ ❑ 2 >50 ft.from surface water? 0 ❑ ❑ Q Cleanout between building and tank? - D 0 ❑ t— o Tank baffles present? - ❑ 0 ❑ t- 24" access risers over each compartment?- - ElEl ❑ W Effluent filter installed? ❑ ❑: ❑ w Septic tank capacity (working) 1,000 gal Manufacturer Hagerman 9 D-box water level and speed levelers used? 0 N/A ❑ YES 0] NO NI ❑ ❑ oO Manifold/D-box accessi5le from surface?- mZ Check valves installed? - ❑ 0 ❑ OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft from foundation?- - ❑ N/A 0 YES ❑ NO p >100 ft. from wells?- 1 -_.__- ._ . .... _ - 0 ❑ ❑ W >100 ft. from surface water? i 0 ❑ ❑ a >10 ft.from potable water lines?- ❑ ❑ ❑ Z▪ > 5 ft. from property sines and easements?- 1 p-. "-.'- -..• •❑ 0 ❑ re > 30 ft. from downgradient curtain/foundation drains? { II ❑ ❑ o Drainfield level and observation ports present - - - 4 br� ❑ Q ❑ ❑ Graveless chambers or • Clean gravel used? (neck one) Proper cover installed over drainfield' - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? . ❑ N/A 0 YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z ❑ 0 ❑ Q 24" access riser(s) and accessible from surface? ~ Alarm or Control Panel Installed? 0 0 ❑ a 2 Control Panel equipped with Timer/ETM/Counter- -- - ❑ 0 ❑ 7 O. Pump installed in ❑ Bucket or 0 On Block or ❑ Other O.• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer 0_ a Tank draw down 2" [Wm in Pump capacity 38 gpm Squirt Height 6 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 228 gpd • Mason County OSS Installation Report pg. 2 Parcel# o ABANDONMENT RECORD Were existing septic components abandoned as part of this project? YES NO If yes, please describe: YES NO Were all components pumped out and progeny abandoned per WAC246-272A-03007 - - 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 Dtstin95 mntain oranrield 8 nonacid°dente:on 8 layout Septic/pump tank location,Not'arrow.reserve Nanfitld.evsting and pr000sedfnWa�9 on approval omitlls.wdeemtiz .waterlines, wets,obsarvatien ports,Sean arc other maintenance access serfs.serfs. Incomplete Record Dm.+nga may create addional delays in final C -2 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 /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. 5. , ' ' /JZ �l /! �zU �� v� 2 Signature of Installer Date t /7 ag .0 Printed Name of Signee w etec raa„'..�rF. MASON COUNTY PUBLIC HEALTH i e• ���' .r The undersigned approves this Installation Report and '.' ;r Record Drawing on behalf of Mason County Public st a ' \ . PAULA re HI•SOn �•If Health: ,OFFS t)Dt_ >✓L(i c°(z3(23 _/ - - FXPIREi Durt t/ Signature of Envircnmen l aall-Health A1Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 1-1oeseo812117o1e racc<rfy zba-sr-000�b _ 36-80" v(7,MS (-HI N in "' ill " D 2 S-1-I F, I I Sect it: ( t to 2.Y_80 GrLS \ a fa Le ;o Ye r t..',..�Gam_ 0 ,, ° I ����``� �`�'r�� toi of G�r.,� S'Q}�- • To l/ Ii I A 1'i 1l CAT(wery \\T. �.,. V 14 r i 'Y�.\ f� �.�Iv^ \ hx'. % ( © - 'I < r ( yj Z \ ' I er ,� 0 I oS C ♦ 4 . F ' Alld10-V15Ua1 AlarmN . 0 Cleanout R f APPROVED A �""" �� 1 tO0 (radon Septic Tank mf ... ` 21“Ij 2-Compartment with ! / v• ° Effluent Filter OCT 23 2023 '. , ht PAUI&JCY 49 NON l 3 1000-Galion Pump Chs-I-Ir MASC'1COUN -rt„OYJENTALHEALT IC�SnoD i0npK '.