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HomeMy WebLinkAboutSWG2021-00230 - SWG As-Built - 12/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00230 Parcel # 32116-75-00040 Applicant Name Accurate Development Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 76 TR 4 of Survey 5/30 City, State, Zip Allyn, WA 98524 Installer Name South Shore Construction Site Address 211 E Sunny Woods Rd W Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Otner System Type Sand Lined Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A O YES ❑ NO >50 ft. from wells? - - - - - - - ❑ El ❑ Z >50 ft. from surface water? - -- - ❑ 0 ❑ < Cleanout between building and tank? - - ❑ El ❑ o Tank baffles present? - - ❑ 0 ❑ a ❑ 24' access risers over each compartment?- - ❑ 0 w Effluent filter installed?- - ❑ ❑■ ❑ to Septic tank capacity (working) 1,250 gal Manufacturer Hagerman — o D-box water level and speed levelers used? - - Ei N/A ❑ YES ❑ NO J O Manifold/D-box accessible from surface?- - ❑ 0 ❑ o0Z Check valves installed? - - ❑ 0 ❑ 0< 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- - ❑ 0 ❑ w >100 ft. from surface water? - -- - El Ii ❑ ti. >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q ce > 30 ft. from downgradient curtain/foundation drains? - - ❑ IN ❑ cm Drainfieid level and observation ports present - - ❑ NI ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ NIA 0 YES ❑ NO Y Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - - - - - - 0 0 Q H a Alarm or Control Panel Installed? - - ❑ II ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - - - ❑ I. ❑ C- Pump installed in ❑ Bucket or [U On Block or ❑ Other 2 Pump Make/Model Liberty FL100 0 Floats or ❑ Transducer a • Tank draw down 3 in/min Pump capacity 66 gpm Squirt Height 5.5 ft Pump on time 1.8 Pump off time 6 hr Daily flow set at 480 gpd paaied en ^o;a • Mason County OSS Installation Report pg. 2 Parcel# ,5o.I\b-15-00040 - _ , ABANDONMENT RECORD _ Were existing septic components,abandoned as part of this project? El YES III NO If yes, please describe: YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - " 0 • .. RECORD DRAWING . . . This to a perwrshent record and must to accurate and descriptive enough to reaocete In the need of maintenance activities and future development Typical Record Drawings torttatrr Drarttidd&tT5eNldd orientation&layout,Septic/pump tank location,North arrow.reserve dnxnridd.wiser* end proposed buadnps,ocation of was,waterlines, wets,observation pats,demons,and*Mat maintenance soaaa points. Incomplete Record Drawings may ovate additional delays in final Ir sta aticn approval and related permits. • St Akt a.6(\-Q.,a. • • . ® 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 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 hem 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 fo n atta ed R rowing is a orate. form and attached Record Drawing is accurate. Signature of installer Date ' _ .c),,_.0.4-_&_ v.esr ,„1-q.__ ,2,- 12-Z3 j�� Printed Name of Signee -o. .. .•7r it.. MASON COUNTY PUBLIC HEALTH \� � � s•;:;r The undersigned approves this installation Report and o; iuv:>+n �•J> Record Drawing on behalf of Mason County Public :"Q^ PAULA JOY JOHNSON •1�(\ IC SKti b1= :' tfi.* 'i Health: b.: b�i`37 '"�iI (Z,(Z-7 /2-3 c 2,-21-23 Signature of Environmental Health Specialist Date (stamp, signature and date) Minor THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE upaat.d 82112°18 3';•-ca A cc'. --E Suhh\., \AJo045 .d vJ l O . J i No APPROVED APQr0,4mck'etj i ta0' kO df. DEC 2 7 202 MASON COUNTY ENMONME3NTAL HEALTH RET eL �O d S ' •N: ; r- ((1 pt ko r+t-`` \4-9, y too' S S 'l0 .(`oo< \ • P. nro 2,8x190 Cn i O'x h i �•�-�— Y`� 8 8 14 E- wL� �r;rna Sand- lnea a- / A. -FanK,S prtssur4i coralv\-c-‘e, dk t Lced wi+In r e s eYVZ 0 Audio-visual Alarm be(ow - 3 cie„out 3 1200 Gallon Septic Tank 2-Compartment with Effluent Filter v/ C 12,00 Gallon Pump Chamber SCa�e,.i ' -�o' e t o 7_5 So -,S oc4 A v kg.ur0.-�t �ev6oPME, kN 4 .7 . 6.,. _ ., ..„,, �arc-2, 3 .\k‘0-15-0004t 0 I ali ,_r:,4 i-..,,;/'. J-icy. PAULA JOY JOHNSON sq EX►IW 6TiT.i `C ( L-Zl-23