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HomeMy WebLinkAboutSWG2021-00274 - SWG As-Built - 12/4/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2.O2,(- 002/3 9 Parcel # 12209-34-90091 Applicant Name Rainier Custom Homes Subdivision (Name/Div/Block/Lot) Applicant Address 306 Wells Ave S, Suite E City, State, Zip Renton, WA 98057 Installer Name A-Bell Excavating Site Address 121 E. Quail Hill Rd, Belfair, WA 98 Designer Name Rod Left INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type_ Standard Pressure ___ Pretreatment Type_ >5 ft. from foundation? -`-ro-. - ❑ N/A YES ❑ No >50 ft. from w,r*s? - - - --1}# - ❑ UI ❑ Z >50 ft. from suse(vpte�0 - - - - El E El Q Cleanout between buildCn?es i nd t� ? - - ❑ ❑I El Tank baffles present? - - - - .L- - El El El F- 24" access risers o h co artment?- - ❑ 0 El a- \ w Effluent filter installed?- - ❑ UI El Septic tank size 1250 gal Manufacturer Hagerman o D-box water level and speed levelers used? - - UI N/A ❑ YES ❑ NO J�O Manifold/D-box accessible from surface?- - � El in 2 Check valves installed? - - Cl ❑ El 0< 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 0 Commercial/Other >10 ft.from foundation?- - El N/A ❑� YES ❑ NO >100 ft. from wells?- - El El ❑ >100 ft. from surface water? - - El 0 El El El ❑ I >10 ft.from potable water lines?- - Z > 5 ft.from property lines and easements?- - ❑ 0 El Q - El El El2 > 30 ft.from downgradient curtain/foundation drains? a Drainfield level and observation ports present ❑ © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistant with septic tank? - - El N/A ■❑ YES ❑ NO • Pump tank size 1250 gal Manufacturer Hagerman z - El I] ElQ 24" access riser(s)and accessible from surface? 1-- Alarm or Control Panel Installed? ❑ IN 0 a. 2 Control Panel equipped with Timer/ETM/Counter- - El © El D n- Pump installed in ❑ Bucket or © On Block or ❑ Other a.• Pump Make/Model Liberty 290 ❑■ Floats or ❑ Transducer D_ Tank draw down IS- in/min Pump capacity 60 gpm Squirt Height 7' ft Pump on time 20 sec Pump off time _ 2hr Daily flow set at_ 240 gpd Updated 8/2112018 . Mason County OSS Installation Report pg. 2 Parcel it ABANDONMENT RECORD Were existing septc components abandoned as part of this project? - - Q YES K] NO If yes: please describe: Were all components pumped out and properly abandoned per WAC245-272A-0300? ' - ❑ YES ❑ NO • RECORD DRAWING This is a permanent record and mush be accurate and descriptive enough to re-locate in the need or maintenance activities and future development Typal 9e Dirt.r pr3•ne_::f S:msm'a;lcl.urvertx:a,.IsyaJt,Sep1N ts.:np tang id,..guan,iioru arrow,'eenn,e,icainrnei,abs—;nr.-arid pr..x•osed iukun;v,lu-+kon 9i r±li,'vea-W•im. • wrote se^.aten yxis :Aber n1forttb...r.ce. !racer T4ete Re:rrd Dr.wn�-,::.:.ay 7'ozl?t.wrpirr'nI aalaya Firtsi rr.G:r1,atad a a,73 • • • • 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 bath 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 • 1 further certify that all information contained on this I further certify that all information contained on this. form and atle . e ecord Drawing is accurate. form and attached Record Drawing is accurate. • 77 72 I • Signature of Installer Date • Z • 4r%,t'i Bur rt5 Printed Name of Sic,;nee J ', S e'm 'FZ MASON COUNTY PUBLIC HEALTH G� ROO LEFT LICENSED DESIGNER The p undersigned approves this Installation Report and elfromosaiiffirozvo»r_ tg EXPIRES 12/15/2. Record Drawing on behalf of Mason County Public Health: 17(4 123 Signature of Environmartal He_ di Specialist Dale (stamp, signature and date) THIS FORM MAY'6E SCANNED AND AVAILABLE FOR PU€LIC VIEW ON THE MASON COUNTY WEE SITE r z. F + t t iD E---> D o ° z D D 71 r r (mi1 mm Z• D 0 Z N rn= """^"" ^""" " ig- ro n o 3 O o A o K O g. v^�^Y " ^Y� a (n m Z m m •rn •. ; E- ^" > E > al • (ocozzS 5 m N 0 O Z 0 O .g. 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