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HomeMy WebLinkAboutSWG2023-00280 - SWG As-Built - 1/16/2024 r......._._—_--7----" Mason County OSS Installation Report pg. 1 - S4 COUN 1 PUBLIC HEALTH APPLICANT/ PERMIT INF RMAIVEU Permit Number SWG 2023-00280 Parcel# 12107-32-50300 Applicant Name Carlos Estrada& Rick Buckner Subdivision (Name/Div/Block/Lot) Applicant Address 11659 SE Black Rd LOT 3 OF LLS#10-02 AF# 1998830 PTN OF NW SW City, State, Zip Olalla,WA 98359 Installer Name Shumaker Construction Site Address 361 E Mclane Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type OSCAR-X02 Pretreatment Type X02 >5 ft. from foundation? - - ❑ N/A ©YES ❑ NO 1 >50 ft. from wells? - - ❑ II ❑ Z >50 ft. from surface water? - ..)- MI El- 0 Q Cleanout between building and tank? -- 1 3-- - ❑ 0 ❑ U Tank baffles present? - 111\ O � ❑ 0 0 a24" access risers over each compartment?-,✓ - ❑ 0 0 0 W Effluent filter installed?- . ❑ ❑ 0 Septic tank capacity (working) 1,250 gal Manufactur re-located Hagerman 0-r D-box water level and speed levelers used? - - ❑ N/A ❑ YES El NO�O Manifold/D-box accessible from surface?- heav9orK5 - El © ❑ u. mZ Check valves installed? - cek V -J?-aso--A--. - ❑ ® ❑ oa E Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A El YES ❑ NO O >100 ft. from wells?- - ❑ 0 0 . >100 ft. from surface water? - ,'j R • 0 0 W � . LL >10 ft. from potable water lines?- - - - - '' I. 0 ❑ Q > 5 ft. from property lines and easementsaA3--- - '/ -/-e- - - I , 0 DI cc > 30 ft.from downgradient curtain/foundation drat ilf8fy� - -�� - © ❑ inDrainfield level and observation ports present - V/R_ONl'9r ® ❑ A�HEAL rH Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A I YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman z CI © ❑ Q 24" access riser(s) and accessible from surface? I-- d Alarm or Control Panel Installed? ❑ II 0 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ D O. Pump installed in ❑ Bucket or ❑ On Block or 0 Other on bottom of tank d Pump Make/Model A.Y. McDonald E-30 0 Floats or ❑ Transducer 0_ a Tank draw down -- in/min Pump capacity 2.1 gpm Squirt Height -- ft Pump on time 30 seconds Pump off time 3 minutes Daily flow set at 360 gpd 1pdated€21'2C18 Parcel# IZ.I0 --- - 0 Mason County OSS Installation ReABrt pg. 2 ANDONMENT RECORD _ ❑ YES X NO Were existing septic components abandoned as part of :his project? If yes, please describe: ❑ YES ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING This is a permanent record and must dentation&layout.curate and Septic/pump tank locationescriptive enough to ,ocate in North arrow.reserve Grainfield, xsting and P opened bneed of maintenance activities and indings,lore cation of welopment l.watedines, pical Record gmay approval and related permits. Draw,o s contain:n: or cl ld&manandold the wells,observation ports.Jenocts,and other maintenance access points. Incomplete Record Drawings create additional delaysin final installa5on II IR 1 r • OVE 3`k v '. : JA N 1 6 2024 "u'+SON COut ry ENVIRONMENTAL HE L JawRecord Drawing Attached r 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 att e Drawing is accurate. . form and attached Record Drawing is accurate. \\ I Di /2 3 Signature of Installer Date ) PIN Printed NameSignee :. ": t�` 6 d - Z� . MASON COUNTY PUBLIC HEALTH I `�� The undersigned approves this Installation Report and f ' r .. .t,i, 51 u0349 Record Drawing on behalf of Mason County Public Y: PAULA JOY JOHNSON He c�1rN fj I .S�IGNett ` r ,/ _—� EXPIRES bTZ Sign t, T +ironmental Hea h Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated e,2 318 01111•Ernmarvimerr .. . • L____—.------ 45 u I 6 30 0 • ' I — 1 S.5Ifutiu ..... d • r Likt,jc. covs vca. /14 . 0 Control Panel with Audio-Visual Alarm it; 46, ./ . tl )' 2.etoccrIced Mvig 4._ ,.,- •. ..,,, 3 14.50 Gaon Seiptic/Aeraten Timk / 411, W '2 iv'•' •2-Corepartmeast with air cif:Miser 3 12.5o Gallen Clarif.m./Pump Tank / 1 /4%** 51G0349 ...tsq .4t5t. PAULA JOY JOHNSON . 2-Compartment f 50' .\...\,, DUN tti I K.: . 0 limdloorks St ri, 1‘.A. EXPt 1 N G OSCAR X02 Mound Drainfzelcl a;.A.•-',:\e--..If',/ 1 -.4—v4 / • . ../ . N ---- i wfigs 0..re. 04-r Coo -\, S"Ft'cck \ . 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