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HomeMy WebLinkAboutSWG2022-00061 - SWG As-Built - 4/18/2024 r / Mason County OSS Installation Report pg. 1 MASON COLIN. r'U,LIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00061 Parcel* 22132-52-00010 Applicant Name James&Catherine Moren Subdivision (Name/Div/Block/Lot) Applicant Address 1502 Pike St NW, Ste 4 GRAY ACRES Divisions Lot10-11 City, State, Zip Auburn,WA 98002 Installer Name Mason County ExcavBng Site Address 261 E Gray Ave Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation ❑Teri Only ❑ Drainfield Only ■ Repair ❑Other s a 11- a 'gym PumP System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? ------- - - -- - -- - --- --- - - - ❑NIA BYES ❑ NO >50ft.from wells? ------- - - - - -- - --- --- - - - - --- - - ❑ ❑■ ❑ IC Z El>50ft,from surface water? -- --- - - - - - - - -- ---- - - - - -- ❑ ❑■ H Cleanout between building and tank? ----- ---- - ❑ ❑■ ❑ tJ Tank baffles present? - - - ------ - - -- - - - - ❑ ❑■ ❑ h- 24"access risers over each compartment?-- -- ---- --- - - -- [� ❑■ ❑ u1 Effluent filter installed?----- ----- - -- +----- ---- - - - - ❑ ❑■ ❑ N Septic tank capacity(working) 1250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? -- ----- - -- -- --- ❑ WA ❑ YES NO QJ 0 Manifold/D-box accessible from surface?--- -- - --- -- - ----- ❑ ® ❑ n?Z Check valves installed? - -- -- AT Pyr1 e"rANk _ -- ---- - ❑ ® ❑ OQ t Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 04 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- -- - - - ---- --- - ---- - ------ ❑ NIA ® YES NO 0 >100 ft.from wells?---------------- - ------------ ❑ ❑■ ❑ w >100 ft.from surface water?--- -- ■ye 0 [I � ❑ >10 ft.from potable water lines?-- p-R(�y-�-E ❑ ❑■ El Z >5 ft.from property lines and eas �pD 1 - ■ El IX >30 ft. from downgradient curtai tionAPA48-2U24 -- ❑ ® ❑ 0 Drainfeld level and observation Pd7li'll" 0INTy ENVIRONMENTAL HEALTh ❑ A ❑ ® Graveless chambers or ❑ Clean gravel uieck one) Proper cover installed over drainfieltl?--- - --- -------- -- -- ❑ K ❑ Pump tank setbacks consistent with septic tank?-- ----- --- --- ❑ NIA Q YES ❑ NO Y Pump tank capacity(flood) 1250 gal Manufacturer Hagerman 2 ❑ ® ❑ H24-access rise,(.)and accessible from surtace?-- ---- - - - -- - - Alarm or Control Panel Installed? -- ---- ------ - - - - - --- - ❑ 0 ❑ 't Control Panel equipped with Timer/ETM/Counter--- - - - ----- ❑ ® ❑ 7 a Pump installed in ❑ Bucket or M On Block or ❑ Other a Pump Make/Model Liberty 280 ® Floats or ❑ Transducer o_ Tank draw down 1" in/min Pump capacity 23 gpin Squirt Height 3.5 ft Pump on time 5 Minutes Pump off time 6 Hours Daily flow set at 480 gpd u�amlis Mason County OSS Installation Report pg. 2 Parcel# "'� �`7.-5^L"ODDIO ABANDONM RECO ENT RD No Were existing septic Components abandoned as part of Pis project? - -----� -'-'-" - ® ems If yes, please deac,11; DILI A Q D, ifkd &{a✓LC `�° At YES NO " Were all Components pumped out and property abandoned per WAC246-272A-C30V --- RECORD DRAWING eM. rrT ¢I Re<WO mu a�� mwb,ne nru w...,an.na dewipava movan m rt-Imau b ma a,.a m mame,nao¢.rti.�ac.na am¢awNo„m Dra+vpamNan. Ora12Y<b manlydC uk'4eY.'n d Irywl aeptlWumpsnk button.NuN artcv'.rtssm baraitlE,me0n9 aM C�Ou` a W�EIn95.loatan Of�rc➢5.viateNnu, ..ego,pmemtlan paK,tleaiars.fN eTarmYmwn¢acev r»rn+. NFF,,.Remo D..p m5YA vsa¢� ¢�mlry5lnfinW IrvsWlsaon aPP�valaM rtkRU Pmn6. PPROVE APR a Zo24 MASON OUN CTY ENVIRONMENTAL HEA R JBW . 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 cleated/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 l further car*that all information Contained on this i further certify that all information contained an this form and atta,96ed Record Drawing is accurate. form and attached Record Drawing is accurate. 3-ag-a4 `S,ghatA of installer \ ' Date � . Printed Name of Signee + MASON COUNTY PUBLIC HEALTH " The undersigned approves this installation Report and yt`' ;.'�_s�a A Record Drawing on behalf of Mason County Public r^ FAULA JVY JDXNSCNi"h l:IC 'SE 'U 1 NER" Health: ExPIPES 1 2Y cv z�f S of RWnonmental Heath Speoalist Date (stamp, signature and dale) THIS FORM MAY BE SOANNEO AND AVAILABLE FCR PUBLIC VIEW ON THE MASON COUNTY NEB SITE �Pm'^e srz�rsms r arc�' #ZZf3L SZ-6e01 � ® neor6X �yP11 bs' oCa or SCaje: I � �ccw+iss�ePeAWpii . a 20 =!G 60 x L t ; r a k— {� . P ,�' I y;iStPn� dratxrald .�' �'s` 3O2a�`jvy i ap, t\ a o •n" �Xr`>f':r SFl6' �j ?-E S�I:bbtUt58f iY`CLii4 k lwtn l t;2"^o Exnr�s"psi I the Psad I y .0 `udio Visual A!= -;200 Gallon Seatc Tank � I � `✓ 2-^.o�pa�e,t cu:th . mmuent Firmer w 4 U +200 Czllon P==Cb=ber vValve Castro:Box i i © �u�w'e gel iG�S aax� i I bx.Sly, — w", ll veg4ive- i prigi larydre n�;Cld . .. 13 i 1 �YEncln.z5 ® 5' OG. W'<th t 3 x 33.5 raserve drg�itld PPROVE APR 18 2024 • j It i P,i MASON COUNTY ENVIRONMENTAL HEALTH c. Lfor) JBW