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HomeMy WebLinkAboutSWG2019-00528 - SWG As-Built - 10/17/2023 M OCT 1 120 � Mason County OSS Installation Report g. 1 RECEIVED MASON COUNTY PUBLIC HEALTH APPLICA INFORMATION Permit Number SWG 2019-00528 Parcel# 32334-75-00050 Applicant Name Emily Davis&Kyle Phillips Subdivision (Name/Div/Block/Lot) Applicant Address 1..97 NE Kissin Tree Ln TR 5 OF SURVEY 8/10 City, State, Zip Tahuya,WA 98588 Installer Name Kyle Phillips Site Address 251 NE Kissin Tree Ln,Tahuya Designer Name Arrow Septic Designs -__.-INSTA t TIONCHECKLIST • Full System Installatioh ❑Tenkfs) Only 0,Drainfield Only ❑ Repair El Other System Type SlhaypW Pressurq Pretreatment Type >5 ft. from foundation? tk - - ❑ N/A Q YES ❑ NO 1 _ >50 ft.from wells? - 4 - F - ❑ IN ❑ • >50 ft from surface water? - (�A�-' - ID El ElO ❑ 4 Cleanout between building and tank? -�'� �`'owse' ❑ ® ❑ O Tank baffles present? ❑ r-* 24' access risers over each compartment? '- _ - ❑ ID 0. W Effluent filter installed? ❑ ❑� ❑ N Septic tank capacity (working) 1,000 + 1,060 gal Manufacturer Hagerman (shop)& Infiltrator(main) O D-boX water level and speed levelers used? - -- - - - • NIA ❑ YES E NO❑ oOJ Manifold/D-box accessible from surface' ❑ •u. mz Check valves installed? - - ❑ El ❑ 0Q f Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 016 ❑Commercial/Other >10 ft.from foundation? ❑ NIA Q YES ❑ NO >100 ft. from wells? ❑ El 0 W >100 ft. from surface water? - ❑ 0 ❑ LL >10 ft.from potable water lines? - ❑ . ❑ > 5 ft from property lines and easements?- - ❑ • ❑ 6 K > 30 ft from downgradient curtain/foundation drains"'- ❑ II El• Drainfield level and observation ports present - ❑ LE❑ Graveless chambers or 0 Clean gravel used? (check one) ■ DI cover installed over drainfield? ❑ Pump tank setbacks consistent with septic tank? - ❑ N/A la YES ❑ No Y Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator 2 • DI • access riser(s) and accessible from surface? ❑6~. Alarm or Control Panel Installed? - ElID❑ ❑ 2 Control Panel equipped with Timer I ETM /Counter- ❑ El D C Pump installed in © Bucket or ❑ On Block or ❑ Other � Pump Make/Model 1/2 hp, 280 Liberty ❑ Floats or DI Transducer 1 Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 7 ft Pump on time 1.8 minutes Pump off time 6 hours Daily flow set at 360oc gpd Mason County OSS Installation Report pg. 2 Parcel# 57_331— 7 5 —r70 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - 0 YES NO If yes, please describe. Were all components pumped out and properly abandoned per WAC246-272A-0300? ' - El YES ❑ NO RECORD DRAWING T 4 4 a PnWram word and mot W accurate and descriptive enWan to n4wao In the need el malm.nance activities and'future der Newnan. TVP'tal Rend Clangs amen naonaa I mantle on.nveon a 4wm'.Seazcvnp Tank ntllcn.Notv t^ow reserve ka f W eosang and piwow w'W k9s.lord for 1 wills.watertm.a. welt'.Mea+abon parts.denw6.and caner maintenance access Wmis incomplete Record IXevl^gs nay ante aod:mal delays fn tma mlelam approval aro'dazed w+rcLL. Record Drawing Attached CERTIFICATION OF INSTALLATION lll�i� INSTALLER DESIGNER/ENGINEER I certify that l installed the system in accordance with I certify that the system has been installed in accor- Tne 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 clearedlapproved 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 ail 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 wing is accurate. Signature of Installer Date ..(y, ,, tdyIc. PkWceS : n'f : . Printed Nadia of Signee p ' 4.v ' -Jr.., MASON COUNTY PUBLIC HEALTH .it'' 9 4 t` The undersigned approves this Installation Report and O PAULA JOY JOHNSON . uc�xr5 nE$IGN «.,D Record Drawing on behalf of Mason County Public `��EXPIRES ul si Healthl 0000/ ( O\II (ZS o —(o - z7 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEE SITE opdala arz.rzo's 33g' . No 3'xHt0' P d-c: Fr- ehclnas Q 5'0c,. so 0 40 so ao {v0 wikk. (esfxvt5 Above I err _ , As but K- un+te i1 �Vls d- 1aG10W a EYV\A 5` PaYecl$c3 33y {5 C�0�0 b 251 NE kissih"Gte Lam. q . . 9 � /APPROVEDi B OCT 17 2023 • OQ , MASONCOUN1 EN'v1RONYE'�TALHEALTH I. Propasea,- RET t snot, i wictet'Tnt t id. list OAudio-Visual Alarm 3 Cleanout 03 1000 Gallon Septic Tank 2-Compartment with Effluent Filter -a est.1-r0 el v 3 1000 Gallon Pump Chamber weth,a. :- 5 T pt+.ow _� I . OS Valve Control Box — NE. IC,iss fit Tru Ln-.— , T' t 7� P, ^. 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