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HomeMy WebLinkAboutSWG2021-00140 - SWG As-Built - 4/12/2023 tMason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00140 Parcel# 321095000008 Applicant Name Trudy Diviney Subdivision (Name/Div/Block/Lot) Applicant Address 7527 145th AVE E City, State, Zip Sumner WA 98390 Installer Name Johnson&Maddox Site Address Fat F {ien4/0c K ("." Designer Name BradSmith INSTALLATION CHECKLIST I ® Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? - q}��rJS'giR 5277 0 N/A ®YES 0 NO >50 ft.from wells? - LL�b1ti" d5 V - 0 e ❑ Z >50 ft.from surface water? - -/w>Cr✓; -^-_'3- - - - 0 . . 0 a Cleanout between building and tank? - 0 e 0 0 Tank baffles present? - -Ent: 0 ® 0 1 24"access risers over each compartment? - ❑ II W Effluent filter installed? - ❑ ® 0 CO Septic tank capacity(working) iR 500 Nuwate gal Manufacturer Evergreen precast a D-box water level and speed levelers used? - IIN/A ❑ YES ❑ NO Ou Manifold/D-box accessible from surface?- - ❑ IN °0z Check valves installed? - - 0 it ❑ Oct 2 Transport Line Size 2' Schedule/Class Sch.40 Bedrooms installed(check one) ® 2 0 3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft.from foundation?- - ❑ NIA ®YES ❑ NO CI >100 ft. from wells?- 0 ® 0 W >100 ft. from surface water? - 0 MI "Li: >io ft. from potable water lines?- - ❑ M 0 z > 5 ft.from property lines and easements? ❑ II LE > 30 ft. from downgradient curtain/foundation drains? - - 0 ® 0 O Drainfield level and observation ports present - - 0 ® ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- 0 N/A ® YES ❑ NO rt Y Pump tank capacity(flood) 1000 gal Manufacturer Evergreen Precast a24"access riser(s)and accessible from surface?- 0 al ❑ F a Alarm or ontrol ane Installed? - - ❑ 1. 0 2 Control Pane equipped with Timer/ETM/Counter- - 0 IN 0 m a Pump installed in ❑ Bucket or It On Block or 0 Other a Pump Make/Model Hydromatic - Se-vb ® Floats or 0 Transducer O Tank draw down 2 in/min Pump capacity etifrgpm Squirt Height 61" ft a t4d Pump on time N/A Pump off time NA Daily flow set at !� gptl Updated a212010 'Mason County OSS Installation Report pg. 2 Parcel# 321095000008 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 par WAC246-272A-0300? - - ❑ YES D 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'. Dranneld&manifold anenlauon&layout SeptiUpump tank ocation,North arrow,reserve dainfieW,ensting and proposed buildings,Incatnn of walls,xaletlmne, walls,observa on pods,cleanouts,and older maintenance access points. Inuonipleie Record Drawings may create additional delays In final inslallaton approval and related permits. 0 ra.-.._et - S I - P r rir-mei - 5er_l-- r- Y> Se_,.o.Ji o,s J I,o,.r.. CBS's al Jr-r-uj ,kv,.. a..t..,,lr. — it t-..II<.,y r.,l.,,.- - 30 6e-4o.. J x "' f PPROVE APR 2 2023 .44 J@yy 'cord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with /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. `m aL/ // Pe-al -fin \\\ .'ern.re of •:taller Date it.2, ; 1x.A.ia fa Printed Ngrr+6 n/.Cignww MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: ' 1 • /I.24rout Siat of Environmental Health Specialist Date I (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121l1O 8 <c> > !..i . p% rnr, _ x . coi, t,,› 141 . 1 ,I. , 4 cr Pi rn°16.i.f4 pC 71 o }—, t/ 4z Cep b oz HEMLOCK LANE E-I TTII-�., I > _<mCM rc m`-Z -I00 - CD > rm,Z< 80 r > m o -ia A 54 m . -II r O i O m - nF azZ N �ti rnAQ ti o � m 2 O t A 44' .airS L.r_ it 16' Z 4cy. o CT)' v Lir, w o 0 77 A N N N W s- V V O O n 80' 1 1 II )1( O n nb Oa a0 O01 r� 1 )0r- -btib ac .NI S % "1NI 73 U N ' N N a< y r1 D AA AA n kadYr n m m ti c Z g 111 j Zv om HE E c al Ngi y Hly m0 ro I r„ x in w 4 a 5 a m el w o �J Z �V � [p odi c ca. m 7y � �i' .. m\ a �� �� 5 `e ° `^, Rr � 5. 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