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HomeMy WebLinkAboutSWG2021-00440 - SWG As-Built - 12/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00440 Parcel# 22018-50-00041 Applicant Name Shanna Burdick Subdivision (Name/Div/Block/Lot) O Applicant Address 521325th Ave SE FC City,State, Zip Lacey,WA 98503 Installer Name Max Walker R IQ Site Address 220 E. Pickering Dr, Shelton Designer Name Rod Left `lo INSTALLATION CHECKLIST 7 Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other System Type Standard Pressure Pretreatment Type >5 ft.from foundation? --------- - ❑ N/A AYES NO >50 ft.from wells? ----------- f��4{)�{(}�r ❑ ❑ z >50 ft.from surface water? ------ 4.r�rCjf_V-LrC ❑ ❑ H Cleanout between building and tank? - DEC u U 20A ❑ N ❑ b Tank baffles present? --------- ------ -----� ❑ 0 ❑ a24"access risers over each compartm r� ❑ ❑ W IEffluent filter installed?--------- `y-_ ❑ ❑ GO Septic tank size 1250 gal Manufacturer Hagerman DID-box water level and speed levelers used? --------------- © WA ❑YES ❑ NO 00 Manifold/D-box accessible from surface?----------------- ® ❑ ❑ mZ Check valves installed? - --------------- ❑� ❑ ❑ ❑Q 2 Transport Line Size 2" Schedule/Class 3034 Bedrooms installed(check one) ©2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.fromfoundation?-------------------------- ❑ WA AYES ❑ NO 1100 ft.from wells?- ---------- ❑ 0 ❑ w >100 ft.from surface water?------------------------ ❑ ❑ LL >10 ft.from potable water lines?- ------------- ❑ ❑� ❑ Z >5ft.from property lines and easements?---------------- ❑ ❑� ❑ X ` >30 ft.from downgradient curtain/foundation drain?---------- ❑ ® ❑ Drainfield level and observation ports present -------------- ❑ ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dminfield?------------------- ❑ N ❑ Pump tank setbacks consistant with septic tank?------------- ❑ wA o YES ❑ NO 1' Pump tank size 1250 gal Manufacturer Hagerman z ' 24"access risers)antl accessible from surface7------------- ❑ 8 El a Alarm or Control Panel Installed? --------------------- ❑ ❑ Control Panel equipped with Timer/ETM/Counter----------- ❑ N ❑ a Pump installed in Q Bucket or ❑ On Block or ❑ Other a Pump Make/Model Liberty 240 ®Floats or ❑ Transducer a Tank draw down 1 in/min Pump capacity 26 gpm Squirt Height 61+ ft Pump on time 69sec Pump off time 3hr Daily flow,set at 239.2 gpd upe.i.e arzkrzmr Mason County OSS Installation Report pg. 2 Parcel# 22018-50-00041 ABANDONMENTRECORD Were existing septic components abandoned as part of this project? --- ❑ YES Q NO If yes,please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? --- ----- ❑ YES Q NO RECORD DRAWING D2=_ a perms"enr re ord and most he actuate antl devipptive¢mull It na locale in rho neetl of maintenance activities and(orate development Tya tad frond xincs contain. uppreld 6 manttolE orientalon&IaydR,sepldpump tank location,tbM Grow,reserve dranfie10,existing and proposed l ldings,lowron or wells,poison, wets,olerverionpart;offices.real core,IoyMmunce a¢®e ppes. interval RemN Drawings may create additional n9ays in final instillation approval and related part Ly Record Drawing Attach en 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 accal the septic design stampetl 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 Geared/approved by both the designer shown here have been cleared/approvend 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 certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. to=and attached Record Drawing is accurate. reoflnstaller Dam Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public ticlel eartwaa Health: 1ZI1 I ILI UPtRES 121151 Signature of EnWronmental He Specialist Date 1 (stamp, signature and date) THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SRE UpMsess"Ne Q J § / § ) \ ) j § \ 2 R , . _ e m _ \ \ \ m m � / CIO \ ) \ \ \ § 2 G - 9 m m q m � ) co\ z m m m / m k ) \ \ � = a Cl)& 2 2 K a \ \® ° c Z » m { z m C, k « ( { ( m j k \ \ m 2 � / % f�ffin ((m k k / O 7k2> Si ° �;o Si C � M � � ) ) rf, R a � | \ G m m y� CO j kC/:, rrl . ¥ . .. . . \ ease . \ \ > Z rrt ® § | TF \ \ rN ` « a z o CO ;a § ` ; M 9 \ � \ .) m . -0eco . . . . y \ y I m e o « m � § 0 G) 3 2 ° m / ` � / @ « q m R m rh S k) m ) § §k �G (0 �k 7k (m C2