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HomeMy WebLinkAboutSWG2023-00391 - SWG As-Built - 10/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00391 Parcel# 221144190010 Applicant Name Nick Reynolds Subdivision (Name/Div/Block/Lot) Applicant Address PO BOX 2133 LOT 1 OF SP#3163 AF#2198379&PTN OF NE SE City, State, Zip Allyn Wa 98524 Installer Name Aaron Shumaker Site Address 300 E Wildgrape Way Designer Name ilAVOSION1110 B K .M v 34 INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type y i3C-;b e( SSLirr t: Pretreatment Type >5 ft.from foundation? - - ❑ N/A ©YES ❑ NO >50 ft.from wells? - •- ❑ It 0 Z >50 ft.from surface water? - - ❑ II HCleanout between building and tank? - - 0 IN o Tank baffles present? - - ❑ IN 0 a24"access risers over each compartment?- - 0 II CI W Effluent filter installed?- •- ❑ ® ❑ en Septic tank capacity(working) 1250 gal Manufacturer Haggerman G D-box water level and speed levelers used? - - ❑ N/A ❑YES ❑ NO OO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ mz Check valves installed? - -- ❑ ❑ ❑ Oq 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 4 ❑ 5 0 6 ❑Commercial/Other >10 ft.from foundation?- -- ❑ N/A ® YES ❑ NO o >100 ft.from wells?- - ❑ ® ❑ W >100 ft.from surface water? - - 0 ® ❑ ti >10 ft.from potable water lines?- - ❑ ® 0 Z > 5 ft.from property lines and easements?- - ❑ ® ElX > 30 ft.from downgradient curtain/foundation drains?- - ❑ ® ❑ cq • E-a7 Drainfield level and observation ports present - - ❑ 0 ❑ " cn 0 Graveless chambers or Cleangravel used? (check 0 one) Proper cover installed over drainfield?- - 0 IN ❑ `k) w o a• Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES D N,o N Z Pump tank capacity(flood) 1250 gal Manufacturer Hanger-man . ig i < 24" access riser(s)and accessible from surface?- - 0 ® ❑ ! C, .r7 1-- Alarm or Control Panel Installed? - - ❑ 0 ❑ a 2 Control Panel equipped with Timer/ ETM/ Counter- - ❑ IN ❑ D - Pump installed in ® Bucket or ❑ On Block or ❑ Other a'• Pump Make/Model Liberty 290 oats or 0 Transducer ' = Tank draw down i in/min Pump capacity 7Q B qpm Squirt Height ID ft a Pump on time \ t`A OA,t.I f Pump off time I 0.5.)25 Daily flow set at tjSO, gpd Updated 8/2117018 Mason County OSS Installation Report pg. 2 Parcel# 221144190010 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - If yes. please describe: ❑ YES 0 NO were all components pumped out and properly abandoned per WAC246-272A-0300? El YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development Typtral Record Drawings contain. Orantleld A m3ntfold orientation&layout,Scptc pump tank location.North arreet reserve drarefreNt erist:ng and proposed l itilwr s,Iccntion of wefts waterlines, worts,observation ports,c:earcuts and other maintenance access pants. Inaxnptete Record Ontrngs may create ndd:uonai delays set final mstaliation approval and to stes Penn s. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /codify that I installed the system in 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/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 certify that all information contained on this I further certify that all information contained on this form and Otto tied Record Drawing is accurate. form and attached Record Drawing is accurate. 2g Signatur f Installer Date •> rutted Name of Signee ��`• P•ti yo• MASON COUNTY PUBLIC HEALTH ` � .624 The undersigned approves this Installation Report and .��� Record Drawing on behalf of Mason County Public �,• c1o0229 fir: E SMITH•. Health: i •i.it;fitE0li t5Vtidi- Orc�/1 .1 i.�76: Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE tro0ate4 srlt.2018 • �\ AP'.. \/i \� \�/\/ /.C,/�\/I /: \ \i r , il`.� / / jL LA n x <O > ay X* 7.1.;-, ,x 41 r.: = i mi\-v-it /1,4\/,, -1 i ,‘,4 !.,).( .. ‘ 1.\.\::\,. _....,2-. ./ . n m z >0 ,, x, • \Ili \ \t/ \,/ : 1-4. '1 ‘‘ . \ -1/..,7.1\ 1.. —. . A :2, . r' co .1 cczn -< mby . 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