HomeMy WebLinkAboutSWG2023-00293 - SWG As-Built - 1/3/2024i
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2023
RE CFVs/ ,
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HE• -
APPLICANT! PERMIT INFORMATION
Permit Number S'; G 2023-00293 Parcel# 223187500060
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Applicant Name Matthew Vanhorn Subdivision (Name/DivrBlock/Lots
Applicant Address 22804 45th Place West •
City. State. Zip Tahuya WA 98538 Installer Name Badger Excavation - Korbyn Hurley
Site Address 400 NE Dewatto Hills Rd-Tahuya Designer Name Pioneer Digging-Robert Paysse
INSTALLATION CHECKLIST
® Fuil System lnstaUtation ❑Tankisr On`y 0 grainfield Only ❑ Repa.r 0 Other
System Type 54nc4[inn. 4 rici--) Pretreatment Type
>5 ft. from foundation? • -. - ❑ N/A R<Es j] NO
>50 ft from wells? - - - - - - ❑ L?i ❑
z >50 ft. from surface water? - - ❑ (., / ❑
Cleanout between building and lank? ❑ l� I
U Tank baffles present? - - ❑ tr__,
a 24-access risers over each compartment?• - ❑ L��'J/• ❑
W Effluent filter installed?. -. -- . ❑ t�J 0
to
Septic tank capacity(working) t S0O gal Manufacturer heA ese 04,7
a D-box water level and speed levelers used'? - - rA ❑ YES ❑ NO
�J ❑ ❑
O Manifold.0-box accessible from surface?- •
mz Check valves installed? . - ❑ Er ❑
0 Q r �[O
E Transport Line Size Schedule/Class —
Bedrooms installed (check one) ❑ 2 ❑3 0 4 ❑ 5 D 6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A l3-144Es ❑ NO
0 >100 ft from wells'- • ❑ 0
W >100 ft from surface v.:ater? • - ❑ ,�,/ 0
a: >10 ft. from potable water lines?- ❑ ,t--sa,,// 0
Z > 5 ft. from property lines and easements? tr- - - -- - 0 0
Q ❑ iJ 0
� > 30 ft. from doimgradient curtain/foundation drains
a
Drainfield level and observation ports present - - 0
0 Gravetess chambers or yelfrean gravel used? check one)
Proper cover installed over drain field?• - - - - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank? - • ❑ N:AlES ❑ No
Y Pump tank capacity(flood) i5o 0 gal Manufacturer AAge►lotan precast-
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< 24' access riser(s) and accessible from surface?- - 0 IP 0
NEt/
a Alarm or Control Panel Installec? - - 0
2 Control Panel equipped with Timer!ET?..1 'Counter• - - ❑ ❑
rZ Pump:nstalied in ❑ Bucket or ❑ On Block or ❑ Other 3_01' SV p we If
Puma Make!Model Llbed,/ 2M 4 ❑ Floats or 3 Esc c r
d Tank draw down in/min Pump capacty_ cpm Squirt Height 19 id A' .
Pump off time Daily flov s_, a: gpd
Pump co time --- ----. _ -
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Mason County OSS Installation Report pg. 2 Flarcel# 223187500060
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project - - - - - - - [] YES 0 NO
If yes please describe ____ --____
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Were all components pumped out and properly abandoned per WAC246-272A-0300" • • ❑ YES Ell NO
RECORD DRAWING
This is a purmanint record and must ne accurate and doscrrptrve enough to re-locate In the need of maintenance activities and future.development. ?pV,,,fiec.."i
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a,I'*i 8 rr:a:uiiNrl Uier:tab-.n r.;ly+ait cepli. tutu,tat*iocahr.r W9th drt:W re.e,ve ata:'tfieLf a uM.ng art pcpcseo tNsidirig5 !N-Mitt of Were.Walefl les
r.. 'r:-.. : ,is I anoints 3rs1 other frarrWenan;.e d!-auS points inc.:elgrele Record L7raanngt may create nJORrMtai(friar;rr frrlat cSraltalton appreva,and relahW pelmets
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li Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
l certify that I installed the system in accordance twith 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 Sate and Mason County Codes
I further certify that all information contained on thin I further certify that all information contained on this
form and attached Record Drawing is accurate form and attached Record Drawing is accurate.
Signature of lnstailer Date AV }�`Q'�
1
K orb yn h wiry R/Z Y/ia_ I,Q . �f.
Printed Name of Srgree ,,or W„
MASON COUNTY PUBLIC HEALTH 1i ' ' •r
ftThe undersigned approves this Installation Report and foeFRY HSpAYSSE
Record Drawing on behalf of Mason County Public. . .•e.'r..''rc
Health. EXPIRES
4/VM(110 CAI (13 12--- :
q/ C,IZ
Signature of_n✓iron'nenta.,Hearth Specialist Date
(stamp. signature and dates
THIS FORM MAY BE SCANNED ANDAJAll ABLE FOR PUELIC VIEW ON THE MASON COW,'v 1'/EB SITE "1Cf.'1'2C'.
. .
RECORD DRAWING (continued)
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- - - APPROX. POND
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+ SEPTIC TANK
PUMP TANK
,' LOCATION `�
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INSTALLED
I DRAINFIELD
I 404O' / 9' OC
IN/ RESERVE
BETWEEN
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1
APP►�OVE 1
JAN 0 3 2023
MASON COUNTY E!rVIRONMENTAL HEALTH
RET
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, RCOE ET H3 W,YSSE .. ..
CORD DRAG I 4..., _ ._,.:::,.a
EXPIRES
CUS l EL 4f: : MATT1 IE06 VANHORN TEST HOLE I: TEST HOLE 2 TEST HOLE 2
PIONEER DIGGING INC. ROOTS@0-50 ROOTS@ `OOTSVG�
PARCEL# 22318 75-00060 @ 50 @ GO ROOTS @ 52
SEPTIC DESIGNS ADDRFSS: 400 DEWATTO HILLS RD
DISCLAIMER:OR SURVEYS
THIS VEYS NOT MEASURE.REFERENCES INCLUDE APPLICANT/COUNTYINTENDED
3083 E MASON BENSON R.D. GRAPEVIEW,WA 98546 DESIGNER ROBERT H.PAYSSCE PLATS
ARPOSES U�v5 FIELD PROPOSED
AY BE S BJECTE�FOOR SEPTIC
OTHER
OFFICE 3G0 42G 1803 FAX"360 427"2353 SHEET: ASBUILT SCALE I"=JOB DEPARTMENT/AGENCY RENEW.DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS.