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HomeMy WebLinkAboutSWG2019-00316 - SWG As-Built - 9/16/2024 Mason County OSS Installation Repoli pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANTI PERMIT INFORMATION Permit Number SwG 2019-00316 Parcel # 32120-75-00070 Applicant Name Sam Sun & Kyu Hoon Lee Subdivision (Name/Div/Block/Lot) Applicant Address 5001 73rd Ave NE City, State.. Zip Olympia WA 98516 Installer Name Workman Contracting Site Address 490 E Pinedirosa Rd, Union Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST Q Full System Installation p Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other. System Type 1.nShallow Pressure Pretreatment Type >5 ft, from foundation? - - -k - " - -- - - - - - - - ❑ N/A ® Yes NO >soft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ 2 >5oft. from surface water? - - - - - - - - - - - - " - - - - - ❑ ® ❑ H Cleanout between building and tank? - - - - - - - - - -- -- - - ❑ U Tank baffles present? - - - - - - - - - - - - —- - - " - ❑ ® ❑ 1-- 24' access risers over each compartment?- - - - - - - - - - - - - - - - ❑ ® ❑ WEffluent filter installetl?- - - - - - - - - - - - - " - - " - - " - - - - - - ❑ ® ❑ to Hagerman Septic tank capacity (working) 1,200 gal Manufacturer ❑ D-box water level and speed levelers used? - - - - - - - - - - - - - " - ❑ WA ❑ YES ® NO J OLL ManifoltllD-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ 0 o?z Check valves installed? - - - - - �- " - - " - - - ❑ ® ❑ ❑f Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 014 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - -tYO -'rs" C - - - - - - ❑ WA ® YES ❑ NO ❑ >100 ft, from wells?- - - - - - - - - - - - - " " " - ❑ ® ❑ W >100 ft, from surface water? - - - - - - - - - - - - - - - - - - - - - - - - L7 ® ❑ LL >10ft. from potable water lines?- - - - - - - - - - - - ❑ ® ❑ QZ > 5ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ ® ❑ C > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑ ® Graveiess chambers or ❑ Clean gravel used? (check one) Proper cover installed over dramfield?- - - - - - - - - - - - - - - - - - - ❑ ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ NIA © YES ❑ NO ZY Pump tank capacity (flood) 1.200 gai Manufacturer Hagerman Q 24" access rlseral,and acces5101e from surface?- - - - - - - - - - - - - ❑ ® ❑ ~ Alarm or Control Panel Installed? - - -a- � ❑ ❑ ❑ a jControl Panel equipped with Timer I ETM 1 Counter- - - - - - - - - - - ❑ ® ❑ n- Pump installed in E Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty 250 ® Floats or ❑ Transducer 06 Tank draw down 1.5 in/min Pump capacity 33 gpm Squirt Height 2 ft Pump on time 3.5 min Pump off time 6 hr Daily flow set at 462 1 uoeeim en- ao..a Parcel It S-o 1-0 -� s 000-10 Mason County OSS Installation Report p9. 2 pl3ANDONMENT RECORD NO Were existing "Ptio components abandoned as part of this project? If yea. Please describe: ❑ YES NO Were all components pumped out and propedy abandoned per WAC246272A-0300? "'-- RECORD DRAYM N I R F` Dn TIW N a p.mox+M �.mra W/nun N.n[aN.ak W.MPa'e.nnWn IF NMarn m N.NM a mNaA�.N. dwl....anniN.. aYnWp.2M dMr MInMM[O W.TDB D'hMf. InWTGM.PKeN CAwinq rent wb aEOlpan.l EaiH in IINI iN.LNEM nPoNnl v4 N.W roN�. prnwrp Dpnuw: OniMNtl a mnnRalC aNINtlM 6�youl APotlDIn^D Onk IONmn,Nam hoax,rwrn Mmnek.eubtin9.nU prapaeE Ouitlires. xeN,ohMNiDYI IpN. Record Drawing Attached CERTIRCATICI OF INSTALLATION INSTALLER DESIGNER/ENGINEER I Car*that I installed the system in accordance with I certfy that the system has been installed in acoor- 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 ail State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further Certlty 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. Smgnature of installer Date , ,�QMA.TG. �gCkw.n^1 Printed Name of Signee MA30N COUNTY PUBLIC HEALTH h The undersigned approves this installation Report and sr:� ��•+ PAULA JOY IONNWN-',.. Record Drawingon behalf of Mason County Publicc�" 'tF:Lf6 SE GIII& HeVC J� '• " 1 ct 1 43 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES SITE r Set 3� �v-�S'000 io APPROVED MASON COUhTYEM1VIRON M p iH RF O Auduo Vucual Alarm ® '!F Soon Q ® © 1200 Galion Septic Tank 38 2 Comparhamt with E@lueat Fluter O1�00 Gallon Pump Chamber QValve Coatrol aos PFUTA JOY)OMNSON', UY, f UUY$IGNEN