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HomeMy WebLinkAboutSWG2023-00319 - SWG As-Built - 1/26/2024 / oc• (-( Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG _2p23 -QO3/? Parcel# Sz-Uo9 - 7r"- 00p0 ,� Subdivision (Name/Div/Block/Lot) Applicant Name e,Q/-4 � �k‘£2 -= Applicant Address //5-2 G �=w ,Patnist W octo //v`e. /3z-/ - 95/-I r 4.0 rH City, State, Zip �zs,9 . /�z dsa/2- Installer Name less CZ,vsTR 0c.r1"✓ c`-(-- Site Address 33a w '/7.- Ain/4 wRn Designer Name -irrzis Te sr-72-a fi— t INSTALLATION CHECKLIST ❑ Full System installation anDrain-field Only ❑Repair 0 Other k(s)Only 0 System Type /,/e rs u/?% DisrR/aort°"1 Pretreatment Type , ❑NM ❑YES O >5 ft.from foundation'? - ❑ ❑ >50 ft.from wells? - ❑ ❑ >50 ft.from S ater? - ❑ ❑ ElCleanout between building a eta ?U ❑ ❑ Tank bates present? -- - ❑ 1 24"access F:11---- er each compartment?- ❑ El 0 uent filter installed?- N gal Manufacturer Septic tank capacity(working) - ❑ N/A ❑YES NO 0 D-box water level and speed levelers used? - El ❑ lit—i I p - OX CC . ❑ ❑ El00 z Check valves installed'?__________---- ----�_ Transport Line Size Schedule/Class 0 4 0 5 ❑6 ❑CommerciallOther edrooms installed (check one) 0 2 3❑ ❑ NIA Ell y ❑ No >10 ft. ro ndation?- CI ❑ ® >100 ft.from wells? - CI ❑ --1 >100 ft.from surface water'? - - -- ID El ElLL. >10 ft.from potable water lines?- ❑ El>5 ft.from property lines and easement ❑ ❑ 1 >30 ft.from downgradieni /foundation drains? ❑ CI Drainfield leve • • observation ports present I: z .veless chambers or 0 Clean gravel used? (check one) El ❑----- Proper cover installed over drainfield?- Pump tank setbacks consistent with septic tank? El N/A It s ❑ NO �crJ Oat Manufacturer ^/ ❑ ►� Pump tank capacity(flood) -- -- I 24"access riser(s)and accessible from surface?- - ------ - ❑ N a Alarm or Control Panel Installed? - ❑ 0 U»�✓a[�� ta Control Panel equipped with Timer/ETM/Counter- a Pump installed in 0 Buc et or K On Block or Other Transducer / ►; Floats or 0 Pump Make/Model��/ �� m Squirt Height ft 1.-, Tank draw down in/min Pump capacity________gP G. Daily flow set at__gods Pump on time / Pump off time • "-'' Updated 8/212078 • Mason County OSS Installation Report pg. Parcel# 5--2-6"C)9 — 7s' • ABANDONMENT RECORD _ rs o Were existing septic components abandoned as part of this project? - _ 0 YES ----Kif yes, please describe: Ill YES ND Were all components pumped out and property abandoned per WAC246-272A-0300? ' RECORD DRAWING_..... development. Typical Record Uci um tank location,North arrow,reserve drainfield,existing and proposed buildings,location of\veils,waterlines, This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future and related permits. wells, oDrawings contain: o ports, ci ld&man and odes main a layout Sep points, incomplete Record Drawings may create additional delays in rural Installation approval wells,observation ports,dearouts,and other maintenance access • • Ilk LPN 2 6RONM�N�P\-�� Mr Record Drawing Attached Ls.•••••• •=•01•201.05-Ir••• • • . ... — . • • —....._ . CERTIFICATION OF INSTALLATION - _ .._ _ ._ DESIGNER/ENGINEER � INSTALLER 1 certify that the system has been installed in accor- theJ certify that 1 installed the system in accordance with dance with the septic design stamped"APPROVED"by septic design stamped"APPROVED"by Mason he County Public Health and that any deviations shown ` Mason County Public Health and that any deviations hereehave been cleared/approved by both the designer shown here have been cleared/approved by both y cHealth and meet all and Mason County Public Health and meet all State I myself and Mason County Pubti State and Mason County Codes and Mason County Codes. I further certify that al!information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. , 2 '3 1 . • Date ke V �$.,''rL Signature of Installer Air % . ' Printed Name .. S. ._ 3•,, , MASON COUNTY PUBLIC HEALTH (.* 4 85084. ...•\7_.44(..' Fi . The undersigned approves this Installation Report and • ' Record Drawing on behalf of Mason County Public Hea t 9-Z-6 23 I--2(4-2 ' (stamp, signature and date) Si atu o nvironmental Health Specialist Date• updxiedarztnots THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE • 94) 6--°22— CC 0 2.6( Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2.,0 7. — !%iih 4 / Parcel # 52009-75-00110 Applicant Name Sarah Joy Pinkerton Subdivision (Name/Div/Block/Lot) Applicant Address 11526 EW Ramblewood Ave City, State, Zip Mesa,AZ 85212 Installer Name Bo Russell Site Address 330 W Little Nahwatzel Designer Name Chris Elstrott 1 , INSTALLATION CHECKLIST ® Full System Installation ID Only ElDrainfield Only ElRepair IDOther System Type Pressure distribution Pretreatment Type NIA >5 ft. from foundation? - - ❑ N/A Ej YES ❑ NO >50 ft.from wells? ❑ ® ❑ >50 ft.from surface water? - ❑ D D Z - NCleanout between building and tank? - ❑ IN E IE IN El Tank baffles present? - El 24"access risers over each compartment?- - ❑ III N Effluent filter installed? El- ❑ El Septic tank capacity (working) 1200 gal Manufacturer Sound Placement YES NO CI D-box water level and speed levelers used? - - ❑ N/A ❑ ❑ DO Manifold/D-box accessible from surface?- ❑ IN mZ Check valves installed? - ❑ 0 NI c Q 2 Transport Line Size 2 Schedule/Class Sch.40 ❑ 2 3 ❑4 El Ell6 ElCommercial/Otherr Bedrooms installed (check one) ❑>10 ft.from foundation?- ❑ N/A 0 YES ❑ NO ❑ 0 ❑El ft. from wells?- ❑ 4 O >100 ft.from surface water? - _ El © 0IN w i. >10 ft.from potable water lines? a 0 Z > 5 ft.from property lines and easements?- ❑ 0 Q a Q > 30 ft.from downgradient curtain/foundation drains? ❑ © 0 Drainfield level and observation ports present ® Graveless chambers or ❑ Clean gravel used? (check one) ❑ ❑ 0 Proper cover installed over drainfield? Pump tank setbacks consistent with septic tank? - ❑ N/A IL YES ❑ NO 0 Manufacturer Sound Placement • Pump tank capacity (flood) 1200 _gal MIZ0 0 < 24" access riser(s)and accessible from surface? _ aAlarm or Control Panel Installed? 0 I 2 Control Panel equipped with Timer/ETM/Counter El II El li- Pump installed in 0 Bucket or On Block or ❑ Other Q, Zoller N152 A Floats or 0 Transducer • Pump Make/Model 5' ft na. 1.8 in/min Pump capacity 45 gpm Squirt Height • Tank draw down 2 min 40 sec Pump off time 8 hours Daily flow set at 240 gpd Pump on time upd.t.earz,noia r Mason County OSS Installation Report pg. 2 Parcel# 52009-75-00110 ABANDONMENT RECORD YES Q NO Were existing septic components abandoned as part of this project? - - 0 — If yes, please describe: — YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING 4 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: Drainfletd&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location f weld relewaterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval a\I\ ..,......, 4 ict,a_..,c_____ IS," orz� „ 1‘ 1‘4 1AN � 62 MEND, !;EA�`ti ;, �UN�y ENVIRON MP 'ti , it/Record Drawing Attached • CERTIFICATION OF INSTALLATION DESIGNER/ ENGINEER INSTALLEReen• • in accor- !certify that I installed the system in accordance with I certify dancewith system has septic designbstamped JAPPROVED"by the septic design stamped APPROVED"by Mason County Public Health and that any deviations shown Mason County Public Health and that any deviations een pproved by th here have been cleared/approved by both the designer : shown here have myself and Mason bCounty Public Health and meet all and Mason County Public Health and meet all State : State and Mason County Codes and Mason County Codes. n I further certify that all information contained on this further ertachhd that Rel infocord Dat ira n ois to ineccu dote.this form and attached Reco d Drawing is accurate. 10/2/23 Signature of Installer Date Bo Russell Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public • Healt . 1 / u 4, . ,,,,.., \ - (p,-2 . (stamp, signature and date) Signa e u.nvironmental Health Specialist Date Updated arz,rzo,a THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE