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HomeMy WebLinkAboutSWG2023-00226 - SWG As-Built - 11/15/2023 Mason County OSS Installation Report pg. 1 -\ a1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION • Permit Number SWG 2023-00226 Parcel # 12206-50-00013 Applicant Name WILLIAM VONG Subdivision (Name/Div/Block/Lot) Applicant Address 3023 HUNTS POINT CIRCLE City, State, Zip BELLEVUE,WA. 98004 Installer Name TRIPLE A Site Address 18881 E STATE ROUTE 106 Designer Name CINDY WAITE INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type OSCAR COILS Pretreatment Type NUWATER ' >5 ft. from foundation? _ >50 ft. from wells? , ❑ N/A ❑� YEs ❑ No 2 IR El >50 ft. from surface water? - - ❑❑ SD 7-1 H Cleanout between building and tank? ElO Tank baffles present? - II E. 0 El a 24"access risers over each compartment?- ❑ O ❑ N Effluent filter installed?- ❑ Septic tank size 1060/BNR600 gal Manufacturer IIINFILTRAOR ❑ o D-box water level and speed levelers used? - • N/A ❑ YES ElNO p0 Manifold/D-box accessible from surface?. ii ❑ oQ u. Check valves installed? - ❑ ® O f Transport Line Size 1 Schedule/Class SCHEDULE 40 Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- ❑ NM © YES ❑ NO 0 >100 ft. from wells? ❑ ❑ ❑ W >100 ft. from surface water? a >10 ft. from potable water fines? ❑ El 0 1 > 5 ft. from property lines and easements?- ❑ ❑ Q > 30 ft. from downgradient curtain/foundation drains? - O ❑ Drainfield level and observation ports present - - ❑ © 0 Proper cover installed over drainfield?- e) Ore eta./J Pump tank setbacks consistent with septic tank? 0 NIA II YES ❑ NO `1 Pump tank size 1530 gal Manufacturer INFILTRATOR Z F 24"access riser(s)and accessible from surface? ❑ d Alarm or Control Panel Installed? - ❑ ❑❑ ,\ Control Panel equipped with Timer/ETM/Counter- ❑ IP a Pump installed in ❑ ❑ Other Bucket or ❑ On Block or ❑ C. f Pump Make/Model PER OSCAR 4 Floats or 0 Transducer C Tank draw down in/min Pump capacity gpm Squirt Height /'c- ft Pump on time Pump off time Daily flow set at gpd Updaled 1312 vmre Mason County OSS Installation Report pg. 2 Parcel# 12206-50-00013 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? 0 YES NO If yes, please tlesaibe. Were all components pumped out and properly abandoned per WAC246-272A-0300? - - JJ 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. T cai 9 Drawings contain; oramloid&manifold orientation&Iaout,s Septic/pimp YW aces Y ro oumptacXpte Record arrow, creme ad existing y ini I proposed anon approval of and elawdlpermis wells,observation ports,geanouts,and other maimenen�access points. Incomplete Record Drawings day create additional delays I nal Insialialion approve entl related permits (�// nL de.J ice PR 4o �U7 JJ7QJ( SEA' es. 7-2,/ 42ec/.ce coeds Ntti re rr'P ? i4' —r/ .-L CY✓lrAV? A dell a✓ �es'y✓ 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 actor 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 an 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' form and altgched Record Ora in is accurate. form and attached Record Drawing is accurate. Sigeure of Installer Date i t. w 1..5`aK� P t y Printed Name of Signee ;re .°,(olti `,';Al ij irye d : 'A 1 � • MASON COUNTY PUBLIC HEALTH J tit The undersigned approves this Installation Report and 3 � DYE AITE, .4I LICENSED DESIGNER III Record Drawing on behalf of Mason County Public ilk Health I:xmaes�m� � ���� 1, 7'� V I 1 i2J\ Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated erzlrzcrn r Q • O W V P P A W N ." ,i G a ' -1 C " Z N M — Is > CC Div 00 DOA X ¢t �,ia4 �., m V! SSOOp A C i- . NT ^ 1� Z413 c�, c c cn r m 1 e 54 51� �1� 9 mYnmrncOo o W or CINENS E nE y W A A r mrn > Z m Z UCENSED.DESIGNER m O O D Z O n T _ m E. � es ,w io,5. CIm 7 r T ., Q. cz � _1 L. Z � � D `� r= A • m � p / • . . _. _ ___ ,,., \ .. / ,,I- apt n r'' "Tif);: ji:::..7:11 c i/ a ..}O N.. �'+.10..;,/ -1 J/3 -a ., t l . \ 4 a4 � � c N � N 3 1 N N• ,-,, . r r USAPPROVED NOV 1520'3 i h i(ea.„ ; , ,i L h F� 4 :Ic, U�a c4tTN Io R 0 S- BASAL WIDTH R • w r. cr. $ o Z e N. CO I R O o 0 n h Ee i` e `ir m O ICJ th CA � J9 N ♦ h • m OD I. it I13 �. x z ,ffi :Cr; "ass \1/31; 2-, frt Yi ARE LICENSED DESIGNER s.ia, I