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HomeMy WebLinkAboutSWG2022-00013 - SWG As-Built - 4/3/2024 Do.Sign Envelope ID:C00509EA-FDRAEOA MBM20OA1933W Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 1-L97-Z- OEM l�7 Parcel# 123174300070 V Applicant Name Franklin Clark Subdivision (Name/Div/Block/Lot) 'P1B o Applicant Address P.O.BOX 1954 SILVERDALE City, State, Zip WA98383 Installer Name Jason Shaver/Finalvisl O Site Address 1750NE Old Mir HyyBeffairWA98528 E 3ignerName Franklin Clark INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other Low RltlgeTxhnologies System Type OSCAR LOWeFLOW Pretreatment Type �w.xrw >5 ft.from foundation? ---- - - - -- - - - - ---------- -- -- ❑NIA .YES ❑ NO >50 ft.from wells? - - -- --------------- " - - ❑ ❑ Z >50 ft.from surface water? --- -- -- ---- - - - -- ❑ El Cleanout between building andtank? ---------- - --- -- ❑ ❑ V Tank baffles present? -- -- -- ----- ---- -- -- - - - - - --- El 1-124"access risers over each compartment?---------- - -- - - - ❑ ❑ W Effluent filter installed?--------------- - - - - - - - - - -- - 0 ❑ rn 1500 Ha erman's Precast Septic tank size gal Manufacturer 9 O D-box water level and speed levelers used? -- ------------ - WA ❑YES ❑ No J 0O Manifold/D-box accessible from surface?--------- - - - - ❑ OW 6Z Check valves installed? ---- -- - - -- -- -- - — El ❑ C Se Transport Line Size 1-inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 E3 ❑4 r 5� 6 ❑Commercial/Other >10ft.from foundation?-- -- -- -- -- -- ---- - YES ❑ xo G >I DO ft.from wells?-________________ __ __ �L�7/ V � ❑ W >100 ft.from surface water?----------------- APR-0 024 ❑ a: >1Oft.from potable water lines?-------------- a60Ulllin I FFFMMMuuu ElZ >5ft.from property lines and easements?-- --------- -- --- 1Vr4t HE El gtrr-� Q >30 ft.from downgradient curtain/foundation drains?-------- - Drainfield level and observation ports present - -- - ---- -- -- -- ❑ 0 ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one)MOSCAR 45'-6"x 14'-0",with OS50 Coils Proper cover installed over drainfield?- --- --------------- ❑ 0 ❑ Pump tank setbacks consistent with septic tank?--------- --- - ❑ WA 0 YES ❑ NO X Pump tank size 1200 Oal Manufacturer Hagerman's Precast Z 24"access riser(s)and accessible from surface?--- - - - --- - --- ❑ ❑ aAlarm or Control Panel Installed? ----------------" ❑ El'- - S' Control Panel equipped with Timer/ETM/Counter- ---- -- -- -- ❑ � ❑ 7 a Pump installed in ❑ Bucket or ❑ On Block or 0 Other Pre Manufactures Requirements a' Pump Make/Model McDonald-2205OE2AJ 0 Floats or El Transducer M Tank draw down 1.75 GPM in/min Pump capacity N/A opin Squirt Height WA ft Pump on time 00/00/22 Pump off time 00/03/38 Daily flow set at 360 gpd IkEebY 82)2018 ry DocuSign Envelope ID C08509EA-FDF94EOA-B3BO-8200A1933CA1 Mason County OSS Installation Report pg. 2 Parcel# 123174300070 ABANDONMENT RECORD Were any existing septic components abadoned as part of this project? - - ------- --- - -- ❑ YES NO If yes,please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? ' - -WA- -' ❑ YES ❑ NO RECORD DRAWING This Is a pvmenem moord and must be accu ete and dnctlptive enough to maoora in Me n»0 a malMenance acriWtlea and NWre devebpmenL nominal RemN orawinga wnlais unsorted B mammld sorption d layout,sepndpump tank location.Pbdh know,,akerve dra idel6 emsflw and borrowed trustees,loWoon ok wells,waddm%, weuw,obeer✓auorpoda.ueanowa.ard mnHmamtanaseecceas points. noemplate R6oN onwmgw may beats assumed twe,s In final nstallation approval and relates,cema ns PR PAPv vE MAS011iDOUNTy,B RD 1024 J w f1V7A(8F41TH 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 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 f flad Record Drawing is accurate. form and attached Record Drawing is accurate. Sy 3/13/2024 7" Signature of Installer Date Jason Schauer Printed Name of Signed •+mt F0.rlaill Ja MASON COUNTY PUBLIC HEALTH 03/13/2024 The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public He 7 l� Sign ire nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upmmdaistrzme \ R mo Buippq k_e BUIRq m «@ f , ---- -- -------------- , � WeaSNkA_L 2 � } \\ \ . ) \ e � \ \ * ~ / � - ± G � kA \ . . . v puef¥ \\ _ m # ( ( / 3 t 2 � 3 > 2 $ , \ram } ƒ p { �\ ® i > 4 ; � ^ ` ° i �% 3 © �� � 6uip ine a6� bugsix3 /+ ,LOB Iko Q) Webs ado I f D + m c w OZo �M oar � �• � _ � C > =r a ?. v m � s