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HomeMy WebLinkAboutSWG2021-00174 - SWG As-Built - 10/16/2024 Mason County OSS Installation Report pg. 1 MASON COUN71r APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00174 Parcel# 32412-12-00180 OCT 1 1 2016 li Applicant Name RANDALL HOLBERG Subdivision (NamefD)WBl Applicant Address 2150 24TH ST SE )S Y City, State, Zip PUYALLUP WA. 98372 Installer Name %in(- and(�shy,zt) K Site Address 407 N RUSTIC RIDGE DR Designer Name CINDY WAffE INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Dralnfreld Only El Repair ❑Other T System Type PRESSURE DIST Pretreatment Type F„ >5 ft.from foundation? ------- ----->50 ft.from wells? ❑WA ■ree -___________________________- Z >50 ft.from surface water? --- ---- ------- ❑ 0 ❑ F Cleanout between building and tank? ------------------- ❑ ■ ❑ ❑ ❑ _V Tank baffles present? - - ------ ---------_________ I— 24"Q. access risers over each com ❑ ❑ LuEffluent filter installed?___ __ _______ ■ � Septic tank capacity(working)XZ� �� fi�srstfschser ❑ ❑ OJ D-box water level and speed levelers tell -_____-_ ____ DO Manifold/D-box accessible from surface?-_________ ❑M� ❑rFB ❑ rro tn= ------ ❑ ■ ❑ CQ Check valves installed? _______________ ❑ ■ ❑ S Transport Line Size 2 Schedule/Class SCHEDULE 40 Bedrooms installed(check one) ❑ 2 ■3 ❑4 ❑5 ❑8 >10ft.fromfoundabon?-------------------------- ❑CommerrJaUOther 00 ft. from wells?-___________________________- ❑ wn ■ res ❑ uo >1 G ❑ ■ ❑ W >100 ft. from surface wateR----'--________-- ❑ ■ El QM >10ft.from potable water lines?______________________ ❑ K >5 it from Property lines and easements?_______________- ❑ ® ❑> 30 ft.from downgredient artain/foundaaon drains?---______- ■ ❑ ❑ Dminfield level and observation Ports present - ___ -_ ----- ❑ Graveless chambers or ■ Clean gravel used? (check one) ❑ ■ ❑ Proper cover installed over drainfield?- --- --------------- ❑ ■ ❑ Pump tank setbacks consistent with aspic tank?------------- ❑ WA ■ Yes Y Pump tank capacity flood 1 2 r- II ❑ ao Z P P tY(flood)X sal Msnufadurx A. {- F24"access nser(s)and accessible from surface?------------- ❑ ■ ❑ d Alarm or Control Panel Instilled? ---- - ---------------- ❑ ■ ❑ Control Panel equipped with Timer f ETM I Counter-----_____- ❑ 0-XPump installed in © Bucket Or ❑ On Block or ❑ Olher ■ El Pump Make/Modelii(4 it " X ® Floats or ❑ Transducer a Tank draw down 7 irvmin Pump ospecity. JIflPm Squirt Height ti J 3 ft Pump on tlme Pump oRdmel /,- Daily flow,set at Mason County OSS Installation Report pg. 2 Parcel a 32412-12-00180 ABANDONMENTRECORD Were eldsdng septic components abandoned as part of this project? - - --- - - - - -- --- . YES ® NO If yes, please desrnbe: Were all components pumped out and properly abandoned per WAC246-272A-03009 - - --- -- - ❑ YEB ® NO RECORD DRAWING Tlb Y a plrmwxe nmi uq mu.r N m.Y Yr!O�plytlrm.nnrylr p rHocp In tlY rrM RI rrWNnrr�.Wvlla.n n0 Mur.tlnNWm.nt 4111 R. ommoa mmti� om.nYa 6 rroi:YY ulvn.umalsaa asonfmro Yn.Yamn,Nunn cow,re.en erwa.N.n.wN od InW^nb WNlhp.Yunm a wY,.nwar.., NYn,omamsm GRm.arvq,ak ttlYamYYY�rOrYipnlK LC ryNY RemE a.wYyn mry ennrn.MtlbW pYyn Y MW YSYYIM nppwY nrtl mYYa pwnb. des ry.✓ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER l certify that I installed the system in accordance with 1 certify that the system has been installed in accor- the septic design stamp ad'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 clearedfapproved 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 /further certify that all information contained on this I further certify that as information contained on this form and allacheef Record Drawing is accurate. form and attached Record Drawing is accurate. Z /Z' .e y Slgnstum dMsttaaser Date I Vr Say.PdnWNemeofSWsN& ay g V MASON COUNTY PUBLIC HEALTH ! 1� The undersigned approves this Installation Report and st t CIN 5' E.WANE Record Drawing on betralf of Mason County Public UMNSEp oesromep Health: Signature ofEnvircn ntal Heahh SpedaNst Data (stamp, signature and date) THIS FORM MAYBE SCANNFnnun AveR ABi F rlG onoi inrnnunut..m...o...,...a,.,..,,—,...f rw......�.m,. I- Proposed building site I04 ' 2. 1200 gallon septic tank0 -- ��-'-�— - 3L-7 1200 gallon Pump tank tiovisual alarm nsport line ve Box ary/reserve drainfleld envelope(47'x30') +Xcl spe 4 Ir„< In out erline be ce �d 1v• ou'eac ti P.Je oC WLly /J,�• n r i t o fr F e+ _ ale, !d►y n� ( `7 ray t gq I r ' l i ■�+ APP OVER OCT )s 2024 MASONCOUNIYEN ONMENTALHEAITH RE om001A 7Vi comas mom N 12btiG �isgc der, 32H►3- rz• a i z) 1 y6. 1