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HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 1/8/2024 II I //1 9t 6 4Y r\ c-co is d oit C o Li", Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Nurr oer `SWG Parcel # 22004-75-00180 Applicant Name LeRoy Bramer Subdivision (Name/Div/Block/Lot) Applicant Address 271 E Willchar Blvd City, State, Zip Shelton, Wa. 98584 Installer Name unknown Site Address same Designer Name unknown INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity Pretreatment Type >5 ft. from foundation? - - - ❑ N/A ❑■ YES ❑ N• O >50 ft, from wells? - ❑ I ❑ Z >50 ft. from surface water? - - El El ❑ H Cleanout between building and tank? - - El Ill El Tank baffles present? - -- - ❑ ® ❑ a 24" access risers over each compartment?- - ❑ El RI (W Effluent filter installed?- _ _ _ _ _. _ _ ❑ ID Septic tank capacity (working) 1200 gal Manufacturer unknown — CI D-box water level and speed levelers used? - -- - NE N/A El YES El N• O oO Manifold/D-box accessible from surface?- - - - -- -_ -_ ❑ ❑ El m— Check valves installed? ❑ ❑ ❑ , Z _ ciQ 2 Transport Line Size 4" Schedule/Class unknown Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ N• O CI >100 ft. from wells?- ❑ I ❑ W >100 ft. from surface water? ❑ II ❑ u. >10 ft. from potable water lines?- DE( t� ZU2� - - ID El ❑ Z > 5 ft. from property lines and easements'? - ❑ Q > 30 ft. from downgradient curtain/foundation drains?- ® I ❑ st [l ❑ Drainfield level and observation ports present------._. - ❑ ❑ ❑ ❑ Graveless chambers or IN Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ IN ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES IN NO • Pump tank capacity (flood) gal Manufacturer Z < 24" access riser(s)and accessible from surface?- - El ❑ ❑ a. Alarm or Control Panel Installed? - - ❑ ❑ ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - - -- - - - -- - - - ❑ ❑ ❑ 3 a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other _ k d PumpMake/Model g _ _ _ El Floats or El Transducer d Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 22004-75-00180 ' ABANDONMENT RECORD ,p-- Were existing septic components abandoned as part of this project? - - YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES El 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. Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related petrels. S:eSPA � a�>!.Jzi e �, �t. -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 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 form and ed Recor mg is accurate. form and attached Record Drawing is accurate. Sig ture o Installer . Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: f`ES( 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 8121/2018 221''f �{vr 1 o pej j c PGtP y Z•iti fC/u p P 120' ,/ 220' • -I- I-- 1 %71\s y' +1 A "' +1- r �2aa if— 7S— Go/PO 20 11uD Gam' ''. / "_,.. 2-00' • j/j! tyre • nJ �T .?G' Gei• c . 90a I /"-s .3U 1-1ua 11 vv r-whG yc ter0P1,-, r 1V1