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HomeMy WebLinkAboutSWG2022-00357 - SWG As-Built - 6/3/2024 DocuSign Envelope ID'. 15A92414-7COA1F02-B928 lDC8CD6C4963 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00357 Parcel # 22014-11-90010 Applicant Name Steve Dumond Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 1967 TR 1 OF NE TR 1 OF SP#952 City, State, Zip Shelton Wa 98584 Installer Name Scott Johnson Site Address 146 E HARSTINE ISLAND RD S Designer Name Micah Halverson INSTALLATION CHECKLIST x❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type ATU to Pressure Trench Pretreatment Type BNR-500 >5ft. from foundation? - - - - - - - - -.---__AOM�' -- ❑ NIA x❑YES ❑ NO >50 ft.from wells? - - - - - - - - - - - -'i - " ri - '- ❑ ® ❑iZ >50ft.from surtace water? - - - - - - - r�;7- - - - - ❑ x❑ ❑FCleanout between building and tank? - -'Tlir - _ ❑ O ❑U Tank baffles present? - - - - - - - - - - r - - - - - - ❑ x❑ ❑H 24" access risers over each compartment!.' - - ❑ ® ❑ WEffluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - x❑ ❑ ❑ fA Septic tank size 5f10+NiiWatar gal Manufacturer Sound Placement O D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES ❑ NO 0J 0 Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ Q ❑ 17Z Check valves installed? - - - -- ❑ ❑ x❑ OQ 2 Transport Line Size tin. Schedule/Class 40 Bedrooms installed (check one) ❑ 2 x❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - -- ❑ NIA ® YES ❑ NO >100 ft. from wells? ❑ x❑ ❑ J >100 ft. from surface water? - - - - - - - - - - - - - - ❑ 0 Elu LL >10ft.from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ x❑ ❑ Z > 5 ft. from property lines and easements?- - - - - - - - - - - - - - -- ❑ ❑ ❑ K > 30 ft.from downgradient curtain/foundation drains? ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ © ❑ Pump tank setbacks consistant with septic tank?- - - - - - - - - - - - ❑ NIA ] YES ❑ No Y Pump tank size I294 gal Manufacturer Sound Placement Q24" access riser(s)and accessible from surface?- - - - - - - - - - - -- ❑ ® ❑ ~ Alarm or Control Panel Installed. ❑ ® ❑ Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - ❑ ® ❑ 7 a Pump installed in ® Bucket or ❑ On Block or ❑ Other [L Pump Make/Model Zoeller all52 ❑x Floats or ❑ Transducer :3 Tank draw down 2 in/min Pump capacity 45 gpm Squirt Height 8 ft IL Pump on time 1 min Pump off time 4 hrs Daily flow set at 270 gpd UGda@d 8R111rn3 Dacu Sign E nvelope IDS 18A92414-7COA-4F02-BD28-1 DC8CD6C4963 Mason County OSS Installation Report pg. 2 Parcel# 22014-11-90010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - -- ❑ YES X❑ NO If yes, please describe. Were all components pumped out and property abandoned per WAC246-272A-0300? - ❑ YES ❑ NO RECORD DRAWING cols is a pvmana.t reco.a and must be accurate and description enough to m4ocara In the need or maintenance ammnes and Nwrt development, Typical Ri oawmes wim ... oralnnon&mambW onenUnon 6layour sep!lapumplans mne!ed,all snow reeerve abandon .—tell and proposed buildings loosed o!wells,warn inee wells cbsercmion pon;currents.and other meln!enenm amess young. Incomplete Record Dravnnge may eme!e additional covers final Installation appmval and related permits. x❑ 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 1 further certify that all information contained on this I further certify that all information contained on this 7f gg(,Agpched Record Drawing is accurate. form and attached Record Drawing is accurate. 7 71 ^ — 5/99194 �yb Signatory, of Installer Signature o/Installer Data y� Scott Achnsain Printed Name of Signed .?4 , c d % 2, MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and ? smwag Record Drawing on behalf of Mason County Public +' ucen:.a;D=sic:yeR Health r,�lRr-e.�xta']� �6��� Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaeted 1rz112019 0 3; t m Tj m -irn � 0K ^'_ zZCf) e 5 S - _ r g N - C - O NQ C D N m _ rt,Fr �y rp N N O 0 NM (n Da 0� � 00, 0 D � C) rpM0 - 0 w n 1a" � aassy mmm � mZD0 s D w O w w 3 A w mrtmx � S S � N -O O � J < m 3v O � O o m tD M r m No r T S (D Sv mn G 0Tt j0 3 a .. �o n I1 c s:U A � � 6�0 timt 0 ^p �L N� � iW) V U xK m� W 0 Approximate Centerline of East Harstine Island Rd 5 VJ 0 C CAW- Abbreviated Description: TR 1 OF NE TR 1 OF SP #952 jl7s7rTN11"rrR7 M.HalverSOn Design LLC ouMONo. BreveL146 Parcel #22014-11-90010 PO BOX 1967 PO Box 1519 Shelton Wa 98584 Shelton, WA 96664 HARSTINE ISLAND RD S Halversondesi nllc outlook.com L:ij