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HomeMy WebLinkAboutSWG2022-00616 - SWG As-Built - 10/10/2023 DocoSign Envelope ID-799FDEC5-9C8444AA-A535-DIDBACEC1340 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00616 Parcel # 52025-21-00020 Applicant Name GEIST JACOB &KAITUN Subdivision (Name/Div/Block/Lot) Applicant Address 51 F HFATHFRWOOD CT City, State, Zip SHELTON WA 98584 Installer Name Jamie Workman Site Address 2431 W HIGHLAND RD, Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation x❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Fxistinn Gravity Pretreatment Type >5 ft. from foundation? - 1. ❑ N/A x❑ YES 0 NO >50 ft. from wells? - -7 ❑ ® ❑ >50 ft. from surface water? - ' ❑ 00 Z 1-- =Cleanout between building and tank? - _ '-2 4I.Z3,- -- ❑ x❑ ❑ U Tank baffles present? - - i ❑ x❑ ❑ I- 24" access risers over each compartment?- ❑ ® ❑ 0. W Effluent filter installed? - ❑ El ❑ N Septic tank capacity (working) 1261 gal Manufacturer Hagerman O D-box water level and speed levelers used? - ❑ NIA x❑ YES ❑ NO -Ip0 Manifold/D-box accessible from surface? ❑ E ❑ 192 Check valves installed? - - x❑ ❑ ❑ OQ ✓ Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 x❑3 ❑4 0 5 ❑6 ❑Commercial/Other * Existing >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells? - ❑ x❑ ❑ J >100 ft. from surface water? - ❑ x❑ ❑ W u. >10 ft.from potable water lines?- - ❑ x❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ © 0 tY > 30 ft,from downgradient curtain/foundation drains? - - ❑ ® ❑ 0 Drainfield level and observation ports present - - ® ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - x❑ ❑ 0 Pump tank setbacks consistent with septic tank? - - x❑ N/A ❑ YES ❑ NO • Pump tank capacity(flood) gal Manufacturer Z < 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ F a Alarm or Control Panel Installed? - - DI El 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ ❑ 7 a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a• Pump Make/Model 0 Floats or ❑ Transducer M a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd updated 8121,3018 DocuSign Envelope ID.799FDEC5-9C84-44AA-A535-D7DBACEC1340 Mason County OSS Installation Report pg. 2 Parcel# 52025-21-00020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - D YES X❑ 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 Drainneld&manifold orientation&layout,Septic/pomp lank location.North arrow reserve grainfield.existing and proposed buildings,location of wells,waterlines, wells.observation ports,c1eanouta.and other maintenance access points. Incomplete Record Drawings may create additional delays in final instaVeimn approval and related permits. See Attached: Existing grainfield Asbuilt x❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 installed the system in accordance with 1 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 I further certify that all information contained on this I further certify that all information contained on this attached Record Drawing is accurate. form and attached Record Drawing is accurate. 8/21/2001 rtr.,n anuu.c Signature of Installer Date .7 ony III Jamie Workman tit •vp t Printed Name of Signee c\ 1 ttI MASON COUNTY PUBLIC HEALTH �� S p '+aft The undersigned approves this Installation Report and j 5100409 051 Record Drawing on behalf of Mason County Public wwaTwu+e IULVEItlON t Health: as LICENSED DESIGNER It v)C61i1 ( alto17;S ones:ow/ajj Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8)21/2018 DocuSi9n Envelope ID:799FDEC5-9C84-44AA-A535-DIDBAGEC1340 Revisal 07/12/93 - PARCEL IDNNTIPICATION Permit Number , swat_ / /417 Subdivision I e.Ln-/o a v a v a—v i e l oo ei:oe, Installer's Name F$J,NS' 'A 2 - Assessor's Parcel No. .SaoQS- Z/-rren-Tin Designer's Name P -el,/a CO/4 . Fe.- c AS-BUILT DRANIIIO (:; :1NoT AFaI lli J Sad.l's --•- 1:) v 4 ���( 7(rt/ � f r4 Vpe jc 4 9 a"> So ( . qt. i 1 siD_e°�" flee 1 1 Pi 'e v- 1151 -Y nc+ - ry a 'too 9a1 Taerekv_ceaa o L eu€— —a- T` ie' ya' 3e� yer % stub-our ? s,-/d 1 " "- "/-o + t'12r>Post'"D z?',f lD ' It.. L 1 f 1coe-4" CNf1Zmf Minor adJustaente to septic tank location and drainfield orientation made in the field by the installer are generally ac- °epteble to both the department and the designer, but could in certain came tvepromiee the viability of the system. It is the in- Steller'e responsibility to obtain prior written approval true either the health department or the designer before mating any devi- ations fres the design that street eyet® viability. any deviations from the approved design suet be •how above. f-y AS-BUILT CHECKLIST u Drainfield orientation ❑ Observation port location 9—Undisturbed native soil and layout ❑ between trenches Cleanout location Cy If-Trench/bed dimensions and u North arrow critical distances within Manifold placement a-- layou L-� Scale of drawing shown ' Orifice placement on scale bar 1f� D-Box/"Tt/"L" location EY Lateral placement, with Additional Mound Information eptic t chamber distances to edge of bed location (-y " Endelope width LJ Locetip of,..wells, roads ' ! ,d.oeatinRhoS`. b1.LTdtags .. -- . w.. ❑ Overall fill dimensions o _ao- ° ow• <-1,o - m• =ea ', Fs9, •• ° • 6�• n- C ag 2�o_o Ca ¢ 0 p� E5 S�9 " o cm 'F va d�° w a a.v awti �A$C o sc to" ° 3 �r �c �c�o c� 2 wwm Xoo gn N. ,, = =.- cr. ONw DI m r 0 3 m cs 08 0 3 - m — n n inw Existing OF & Reserve - �'See Attached r o N r Iii_ w a r U) 03 r- .5 �0N — - 9- p o N N 30 , 0 - WX 1 f � t cfl ,., r . cZ`'%. d Nam. o . oo `%%%ram ( @ 3 N fig^ �N ei' q`'%�`: #oniGN A y A R FR \�`". NJ i t in a m _a 2 z h o — No< N tSi O N s,c. b? °S ti O ra`ss o = m o CD r ul of C) Ar m n O r A z 0 r - - \/