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HomeMy WebLinkAboutSWG2023-00188 - SWG As-Built - 1/29/2024mom Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00188 Parcel # 12018-76-00020 Applicant Name DOMINIQUE WALLACE _ Subdivision (Name/Div/Block/Lot) Applicant Address 1509 REDWOOD PL SE City, State, Zip OLYMPIA, WA 98501 Installer Name WEATHER TIGHT CONSTRUCTI( Site Address 15.O 4/ ipf(cfrat. ieD Designer Name CINDY WRITE INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s) Only 0 Drainfield Only ❑ Repair ❑ Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - J �/A El [] NO >50 ft. from wells? - _ Z _ _ >50 ft. from surface water? - , q- , _ - ❑ ❑ HCleanout between building and tank? D j , _ - ❑ ❑ U S Tank baffles present? - 1 _ A t 9 20L4 - d - -24" access risers over each compartmeht?- - - - ❑ ❑ ❑ ❑ ❑ ❑ Cl) Effluent filter installed?- e _— TM „___---� ❑ ❑ ❑ Septic tank size gal l~ Manufacturer �0 D-box water level and speed levelers used? - - ❑ N/A El YES ❑ NO �O Manifold/D-box accessible from surface?- - ❑ II ❑ m— Check valves installed? - ❑ ❑ ❑ 0 Q E Transport Line Size Schedule/Class IBedrooms installed (check one) ❑ 2 ❑ 3 E 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - [i NIA ❑ YES ❑ NO C1 >100 ft. from wells? ❑ © ❑ W >100 ft. from surface water? - .- - ❑ II Z >10 ft. from potable water lines?- - - - IN El Q > 5 ft. from property lines and easement - - -lir _ ❑ Q > 30 ft. from downgradient curtain/foundan drains? - - - - -- - - - - EI ❑ ❑ Drainfield level and observation ports presttt to c ❑ I El® Graveless chambers or ❑ Clearrwel �s�dci'�'check one) Proper cover installed over drainfield?- 0 4 - - _ ❑ ■❑ ❑ 19 �; t Pump tank setbacks consistant with septic tar*? `� -les - IN N/A ❑ YES ❑ NO - Pump tank size gal . Man r Z �: H24" access riser(s)and accessible from surface- - - ❑ ❑ ❑ a Alarm or Control Panel Installed? - _ ❑ ❑ ❑ 2 Control Panel equipped with Timer i ETM /Counter- LI ❑ LI n d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other A EL M Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time _ Daily flow set at__ qpd Undated 81211[01e Mason County OSS Installation Report pg. 2 Parcel # 12018-76-00020 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES g NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES n 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 draintield.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 permits. iU I AI DAl .S—ide J 111 I's -,' e PPR° , FE, , ASON C00NT1�N�4 ? 1024 .Ie '2�Fhf NT4L/ ieikiii z Record Drawln''ttached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 attached Record ing is accurate. form and attached Record Drawing is accurate. I f -1 Signature of Installer D to ,�4- A4C 5 GD#t A c �~i p � h 6 J o SCR c xos �9�,R tilh4 Printed Name of Signee i �k. a ci '�'1�i`� y�1.t. MASON COUNTY PUBLIC HEALTH `'� 4,i /� ^`� CL Eoat WA E �"`�i !/t� The undersigned approves this Installation Report and r CEN ED DESIGN it Record Drawing on behalf of Mason County Public "'"`� �� • lift ���1 EXPIRES u5r10, Health: iill0 /r " V ( y Signatu of i mental Health Specialist Date (stamp. signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated ar,.t^D'8 . . • lk. °~s APPROVED MAY 1 7 2a23 +I,i a.... MASON COUNTY ENVIRONMENTAL HEALTP 1�� ',,If atr..i.r...,- . '4 510 8 all P V e� IN E. AITE It ' ND. n_ r LI ED G SIGNER �0� k„J) v = tu ` Aombzi. 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