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HomeMy WebLinkAboutSWG2022--00095 - SWG As-Built Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00095 Parcel # 12107-31-50011 Applicant Name David &Velma Parker Subdivision (Name/Div/Block/Lot) Applicant Address 1370 E Treasure Island Dr. City, State, Zip Allyn, WA, 98524 Installer Name Shumaker Construction Site Address 510 E Murray Rd N, Grapeview Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Trench Pretreatment Type >5 ft. from foundation? - /A ❑j YES ❑ NO >50 ft. from wells? - {� 8 ITTE I ❑ >50 ft. from surface water? , ❑■ ❑ Z H Cleanout between building and tank? - - - - - - -BEG 1-1-2025- 0 ❑ U Tank baffles present? - jc ____ ❑ ❑■ ❑ F- 24" access risers over each compartment?- - B ❑ 00 a 9 W Effluent filter installed?- 2_ -ems,- — -y-- C7 ❑ N Septic tank capacity (working) 1.250+1.000 gal Manufacturer Hagerman a D-box water level and speed levelers used? - - ❑ N/A ❑ YES ■❑ NO DO Manifold/D-box accessible from surface?- - E] El ❑ m- Check valves installed? - 0.21c .-Y C - ❑ I ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 1:1 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- - ❑ j ❑ W >100 ft. from surface water? - - ❑ 10 LT: >10 ft. from potable water lines?- - ❑ ❑� ❑ Z > 5 ft. from property lines and easements?- - ❑ ■❑ ❑ Q Ix > 30 ft. from downgradient curtain/foundation drains?- - ❑ ® ❑ cl Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO • Pump tank capacity (flood) (2) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ I ❑ f— Alarm or Control Panel Installed? - 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ 0 ❑ n a. Pump installed in ® Bucket or ❑ On Block or ❑ Other 2 Pump Make/Modes Liberty 290 ■❑ Floats or ❑ Transducer a Tank draw down 1.25 in/min Pump capacity 48 gprn Squirt Height 3 ft Pump on time 3.75 min. Pump off time 6 hr. Daily flow set at 720 gpd Jpcatec F.1212018 Mason County OSS Installation Report pg. 2 Parcel# 12-J'07- 3l- S-0 O 11 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [] YES 111 NO if yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES El NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record Drawings contain: Grainfield&manifold orientation&layout,SepGpump tank location,North arrow.reserve craini eid,existing and proposed buildings,location of wells.waterlines, wells.observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in,final installation approval and related permits. 3R.z. A-4-cLov\-* I Record Drawing Attached 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 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 att ee Re 'Drawing is accurate. form and attached Record Drawing is accurate. 11 Signature of Installer Date . Printed Name of Signee ei .MASON COUNTY PUBLIC HEALTH 4OOtrefi The undersigned approves this Installation Report and .,c. • Record Drawing on behalf of Mason County Public st)uaas Health: L.PAUI.A JOY JOHNSON 'Sk •-.:"'` n :°iGti�t1 s:CM 174 q a, K !�' ( 2-to -Ts- 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 updated 812t/2316 ISt 4o0.84` > _P - Ill Pro posed �P P 2025 S ,oP p�C 19 tookOUN�Eti\1R0h�ENZP� . 5a T h 0 MP�SON C RF'S vote 1Crow (y) 3�5°01) 3 Z5 pr i wl a ry dra FMf'rk1 -fir{hccu s 6) q' C.C. wt-11., reSeVve inb.c-twelh a K—UL: \ \\\ o Audio-Vin. sual A1arn - 1 3Cleanout Pro ® . ft O •125 0 Gallon Septic Tank R'�t{! i4' ,. 0b ,2-Compartment with 9�a Effluent Filter p^°duort d c4i 0I,00-o Gallon Pump Chamber �pUSP.6• i 2 - 4.,E ... 0Valve Control Box-2 ea. • / s, i 000p1/ Z-COnya rtur-i- r• , . � ; 5tpfit lahk w/e 1v(,)* ir,N, u SO(ic. S Fvrh1 in 4 oe boo-lh •L ,n�2tr•a !P � pft.thAle �o et. �s . • — & korra p� y N — 69103. ,ks —� f „„k7, .. . . scat., _. , ..,.. c,oi Fr.,.. .. • •, • .teltp , o ;o 40 4o 120 .- 5i00 . 'T i= 349 :V'st) ,_ .. PAUL_A JO'(JOHNSON ' \