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HomeMy WebLinkAboutSWG2019-00100 - SWG As-Built - 11/3/2021 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2019-00100 Parcel fir 32116-76-00610 Applicant Name James Chandler Subdivision (Name/Div/Block/Lot) Applicant Address 41 E Sunnv Woods Drive TR 61 OF SURVEY 7121 (SUNNY WOODS) City, State, Zip Shefton,WA 98584 Installer Name House Brothers Site Addr ess Sam Designer Name Arnow Septic Designs Inc. e 9 INSTALLATK)N CHECKLIST 11 ® Full System Installation ❑Tani Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? -- ----- - - -"'- -- - - - - " --" --- - ❑NIA YES NO >50ft.from wells? --- - --- -- -- --- -- - -- - ------- -- ❑ ® ❑ Y >50 ft.from surface water? -- -- - - - ---- - ----- ❑ ® ❑ Cleanout between building andtank? ---------- ❑ U Tank baffles present? --- -- - - - ----- ---- -- ❑ 24"access risers over each compartment?---------- ------ ❑ ® ❑ a ❑ W Effluent filter installed?----- - - -- --- -- ' ----"-- "" - - ❑ N HB Precast Septic tank capacity(working) 1,100 of Manufacturer 0 D-box water level and speed levelers used? -- ------------- ❑ NIA ❑ YES NO J 00 Manifold/D-boz accessible from surface?-- -- -- --------- -- up�Z Check valves installed? ----- -- --- -- - ---" - ❑ 02 Transport Line Size 2" Schedule/Clan 4U Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑CommemiaVOther >10ft.from foundation?----- -------- -- -- --------- ❑ NIA YES NO 0 >100 ft.from wells?-------- --------------------- ❑ ■ ❑ W >100 ft.from surface water?- -- -- --- ---------------- ❑ El IL >10ft.from potable water lines?- -- ---- --------------- El Elz >5ft. from property lines and easements?----- -- --------- ❑ e ❑ Q � > 30 ft.from tlowngratlient cunainffountlation drains?------ --- - ❑ 0 ❑ Drainfield level and observation ports present -- ------------ ❑ ® ❑ ❑ Graveless chambers or S Clean gravel used? (check one) Proper cover installed over drainfield?-- - - - - ---- - -------- ❑ ❑ Pump tank setbacks consistent with septic tank?--- - -- - - ---- ❑ INA ❑ YES ❑ NO hc Pump tank capacity(flood) 1,250 pal Manufacturer HB Precast z ❑ H 24'access dser(s)and accessible from surface?------ ------- ❑ o. Alarm or Control Panel Installed? - - -- - -- - - - ❑ ❑ 2 Control Panel equipped with Timer/ETM!Counter-- - - - - -- --- ❑ ❑ a Pump installed in ❑ Bucket or a On Block or ❑ Other a Pump Make/Model Dberly 250 ! Floats or ❑ Transducer � Tank draw down 2" Nmin Pump capacity 40 gpm Squirt Height 5 B a Pump on time 1.5 min Pump oft time 6 fir Daily Bow set at 240 ppd �aune ea�rzoe Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD se .------------- . ❑ YES NO Were existing septic components abandoned as part of this project? if yes, please describe: Were all components pumped out and properly abandoned per WA0246-272A-03oo? ""-" '- ❑ YES ❑ NO RECORD DRAWING TNa U a pnmxnmt rears aM nwt a accunh eM dncrlptirs xaWn Is nbcn N-mM M'Miss .^n xNHtln ma tWun dMlopmant T,-1 Wmre oranno.wmsin. oraNam a manaoa mnnutan a Iayar.sepucFwne unx ac.dPv ram ammr..nP,..en�nn.a.eauua aM dr0.aaM W ianpa.IM3ran awsY.waredmes. wt..ro.a,veoon wru,dunoA,.M om.r m.�m.:ance acau Dona. In¢mpw nworo omane•m.r a.w.ddluNwd.I.n n nw iaauaMn.pp�.a re nwa nrn'a. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 cerdty that all information contained on this I further certify that ali Infomu I contained on this form ar7q abacYl�d Record Drawing is accurate. form and attached Record Drawing is accurate. 7/Y . .tom I ( - I - 2-* Signat re of installer Date Printed Neme of Signer .y MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Repoli and Record Drawing on behalf of Mason County Public y Health PAWA joy ichegUN $ .' t Okre,wI. n , Z- s-Z� Signature of Envimninelital Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES SITE upea.a arzrzon OAudio-Visual Alarm j © Cleanout © 1100 Gallon Septic Tank 2-Compar1ment with Effluent Filter O4 12W Gallon Pomp Chamber `7 h OB Valve Control Box �,,.,oc lope nelghlo°r (4) 3'-35 ® i. `Z n tl Scale-. f" = i�C Q SPAIIIA JOy JJOHNSJN �l ` ( 2 - 3— z1F I�rv�cs ,hc��wl\er gam, i�nr�A}Isr 37-1l la— ly-00(rIO 41 E S,�nnu tNoorJs ?7r APPROVED DEC 0 3 2024 MASON COUNTY ENVIRONMENTAL HEALTH RET