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HomeMy WebLinkAboutSWG2021-00618 - SWG As-Built - 7/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2021-00618 Parcel# µai 7- 14e1 to/4' Applicant Name Karin Vartia Subdivision(Name/DIWBIock/Lot) Applicant Address 7002 Bailey ST 57 3143 1--t- If City, State, Zip Olympia,We.98513 Installer Name Timberline Excavating LLC Site Address 9// California.Rd.Shelton we. Designer Name JIM Henry Design Services INSTALLATION CHECKLIST ■ Full System Installation ❑Tank(s)Only ❑Dralnfield Only ❑Repair ❑Other System Type Sand lined pressure Bed Pretreatment Type N/A >5 ft.from foundation7 ---------------------------- ❑NIA ®YES NO >50 ft.from wells? ---------------------------- - ❑ ® ❑ _ >50ft.from surface water? ------------------------ ❑ 0 El FCleanout between building and tank? ------------------ - ❑ ® ❑ V Tank baffles present? --------------------------- ❑ ® ❑ 24'access risers over each compartment?---------------- ❑ ® ❑ W Effluent filler installed?-- ------------------------ - Septic tank capacity(working) 1250 gal Manufacturer Hagerman D-box water level and speed levelers used? --------------- ® NIA ❑YES ❑ NO OR Mangold/D-box accessible from surface?----------------- ❑ ❑ tP2 Check valves installed? --------------------------- ❑ ❑ 0 Transport Line Size 2 Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑5 ❑Commercial/Other >10 ft.from foundation?-------------------------.- ❑ NIA ©YES El No >100 ft.from wells?----------------------------- ❑ ❑ 9 >100 ft.from surface wateR------------------------ ❑ 0 ❑ i >10ft.from potable water lines?---------------------- ❑ 0 ❑ w >5 ft.from property lines and easements?--------------- - ❑ 0 ❑ a >30 ft.from downgradient curtain/foundation drains?---------- ❑ 0 Dreinfteld level and observation ports present ----- W Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dralnfleld?-------------------- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------- ❑ NIA ❑ yes NO zY Pump lank capacity(flood) 1250 gal Manufacturer Hagerman a 24'access riser(s)and accessible from surface?------------ - ❑ ® ❑ yAlarm or Control Panel Installed? --------------------- ❑ ❑ Control Panel equipped with Tmer/ETM/Counter----------- ❑ ❑ IL Pump installed in 0 Bucket or ❑ On Block or ❑ Other IL Pump Make/Model Liberty 280 ®Floats or ❑Transducer y Tank draw down 1.5 IMmin Pump capacity 80 gpm Squirt Height 5 ft Pump on lime 1:52 Pump off time 6 hours Deily flow set a< 270 gpd wmi.n envrole .. ... .... . . ... Mason County OSS Installation Report pg. 2 Parcel# 421271404010 lot 4 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? -------------- - YES 0 NO If yes,please describe: Were all components pumped out and properly abandoned per WAC246-272A-03DD? -------- © YES No RECORD DRAWING Too Ise permemho racora na muel he Iec..eM d—hots eooueh tO nJmete In the mW er mYmmsc.edWNn.no Mun ae"alepmanl. rygco RecaN emwage WMYn: p06iRgtl 6 meMlop oMMalpn 6laybvl.Seplklplsp knM bolbi.npq error,merve tlreMflertl,eebtlrpeM prcpe¢etl EUIMiip;bcelbn W"qb.webrAree. vngaWervetbn pan,tleenwk,W aPer melnlenanw aeu punk. IrcomgMa W¢ortl Rawinge mryveck oadtleml tlelaVe In One?bnellelbnemrosleM relYaa parmtl¢. ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system/n 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/appro and by both the designer shown here have been Geared/approved by both and Mason County Public Health and meet BY 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 tmm and attached RR�ecord�Drawing is accurate. form and attached Record Drawing is accurate. /s'^e` vssw�se 7113124 Signature of Installer Data Tate Choate Printed Name ofSignee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public' nallNaA eg Health: �lielu� ...... �It u.IT..; Signature of Envimnmantal H.Alh Specialist Deb (s(amp,signature and date) THIS FORM MAY BE SCANNED AND AVNIABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SRE aptlaee A4ea10 0 0 / / a / / ,Fao Y E / dip O n ME / � . / /�• �O / / / '//// 9 Z g z a' o / n / tnm � (iliD � m m m : 'p ' t G) N c A w ' O�z Ay O � � � 0 e m D ~ A m m y7 Z = m _ m0- Z cm 9 T 0 II to AIJD � y D O m y A m r timm DO DZf SO 2D —N^ / TyA 00 P $ 052 3: T >m� 0 . 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