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HomeMy WebLinkAboutSWG2024-00084 - SWG As-Built - 4/2/2024 i Mason County OSS Installation Report pg. 1 MASON COUNTY P EALTH APPLICANT/ PERMIT INFORMATION / Permit Number SWG 01-1 -600a4 Parcel# 51901— I- ZOo MqA A Applicant Name Bruce Findt np, Subdivision (Name/Div/Block/Lot /?"f z4 Applicant Address Po box 2076 lot 4 blk 2 lost lake park �f0 City, State, Zip Milton We 98354 Installer Name Goldy Septic Service LLC Site Address 861 W lost Lake Road Shelton Designer Name Home Owner Bruce Findt INSTALLATION CHECKLIST ❑ Full System Installation ®Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other System Type Pretreatment Type__ >5 ft.from foundation? --- ------ ❑WA YES NO >50ft.from wells? -- --- --- --- ---- ---- ---- -- r__ - ❑ ❑ Z . >50ft.from surface water? -__ _ _ __ _____ _ ____ _____ _- ❑ 0 ❑ r " Cleanout between building and tank? - ____ _______ ____ __. ❑ ® ❑ t.1 Tank baffles present? -- - - -- -- - - - -- - - --- - . ❑ ❑ a24"access risen;over each compartment?- -- - --- _ __-_ _ __ . ❑ ® ❑ N. Effluent filter installed?-- --- - _______ ___ ___ _ ___ _ _ _ . ❑ ❑ Septic tank capacity(working) 1250 gal Manufacturer Roth 0 D-box water level and speed levelers used? ------ ----- --- - ❑ WA ❑YES ❑ No 20 Manifold/D-box accessible from surface?------ ---------- - ❑ ❑ ❑ 6Z Check valves installed? - - - - - -- - - ---- - - - - - - - -- - - -- ❑ ❑ ❑ s Transport Line Size Schedule/Class Bedrooms installed(check one) ❑2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? ---- ---- - - - -- - -r--- ❑ wA ❑ YES NO -01100 ft.from wells?- -- --- - -- ------- -------- - ❑ ❑ ❑ W1100 ft.from surface water? --- --}- - - ❑ ❑ ❑ M >10ft.from potable water lines?- --- - --- -- ---- ----- -- - ❑ ❑ ❑ Z >5 ft.from ro ❑ ❑ ❑property lines and easements? >30 ft.from downgmdienl curtain/foundalion drains?- - - - - - - - - - ❑ ❑ ❑ Drainfield level and observation ports present - - -- -- - - - - -- ❑ ❑ ❑ 1 ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- ---- --- - -- - -- - - --- Pump tank setbacks consistent with septic tank?- ----------- - ❑ NIA ❑ YES ❑ NO 2 Pump tank capacity(flood) aal Manufacturer hd- 24"access riser(s)and accessible from surface?--- --- -- - -- -- ❑ ❑ Ela, Alarm or Control Panel Installed? - ------- -------- - --- ❑ ❑ ❑ f Control Panel equipped with Timer/ETM/Counter- -- ❑ ❑ ❑ 6 Pump installed in ❑ Bucket or ❑ On Block or ❑ Other IL. Pump Make/Model ❑ Floats or ❑Transducer 0. Tank draw down —in/min Pump capacity gpin Squirt Height_ ft Pump on time Pump o8 time Daily flaw set at gpd uowi.eAzrvo+e Mason County OSS Installation Report pg. 2 Parcel n 51901502004 ABANDONMENT RECORD Were existing septic components abandoned as part of this P oie�;^ ---- - -- - - - - - - -- Q YES ❑ NO It yes, please describe:Removed Failed tank and disposed Were all components pumped out and property abandoned per WAC246r272A-0300? ---- - --- YES ❑ NO RECORD DRAWING real b a p..M nemd end.9 ba al...aM Murlona anauab ro rMoute an Me naa i pr malnenanee aeuvlrea and..,a aavalopmant TM.l R.. Dnwlnp6mMain'. Dnlnfitld 8 meMkM pnennlbn&4yout,5epl)pump 1ad11anlion.NaM emmv.Weans tllainfreb,eaiel and pm(nced build•npz.Ibcaur nfwalk,WapNnn. xNb.[MBNaIYa[Offs.deamas,mots rmalmamnmmonma(pots. Inepmpkn Rurrd Onwhga may VMb aWXXMNI as"M final'auallatla appdval aN nvad pnmib. i ! ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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 clearend/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 Drawing is accurate. form and attached Record Drawing is accurate. 03/27124 tore o/Installer Dale Jake Gold+t. Printed Name of Signal MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Signature of Environmental Helifh Specialist Date� (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE l'bd°1°d°°1r01°