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HomeMy WebLinkAboutSWG2022-00566 - SWG As-Built - 1/12/2026 CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH .. . AP# O14--` ,P RMI `JN:F ORMA IOW - L t Permit Number SWG 2022-00566 Parcel # 220207590090 Applicant Name MANLEY TRUST JULIE MAE Subdivision (Name/Div/Block/Lot) Applicant Address JULIE MAE MANLEY TRSE City, State, Zip HOODSPORT WA 98548 Installer Name WINKELMAN SITE WORK Site Address 250 E BIG SKOOKUM RD Designer Name DALE TAHJA ' IN TAL LATIOICHECKLIST , y } is Full System Installation O Tank(s)Only O Drainfield Only O Repair ❑Other System Type 4BR ATU TO OSCAR II Pretreatment Type NUWATER BNR-500 >5 ft.from foundation? - -re-- - El ®N/A YES ❑ NO >50 ft.froafld wells? - � R ❑ © ❑ ...,., ::-,>50 ft.Cleanout tank? -- ALT-7J4w.o-frzU2g - u ❑ ® ❑ Tank baffles present? - 0 it 0 iii r 24"access risers over each compartme t@Y - - O I O Effluent filter installed?- -- -- ❑ ® O . :Septic tank capacity(working) 1998 gal Manufacturer ound Placement Services D-box water level and speed levelers used? - - I N/A ❑YES ❑ NO LIE accessible from surface?- - O El O E Check valves installed? - - O ® O Transport Line Size 1" Schedule/Class SCH 140 Bedrooms installed (check one) ❑ 2 MI 3 04 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A No YES ❑ NO - >100 ft.from wells?- - ❑ I O >100 ft.from surface water? - >10 ft.from potable water lines?- - O ® ❑ ` >5 ft.from property lines and easements?- - O ® O Ate> 30 ft.from downgradient curtain/foundation drains?- - O IN O Drainfield level and observation ports present - - O I O • O Graveless chambers or O Clean gravel used? (check one) l • Proper cover installed over drainfield?- - O © O ,f,Pump tank setbacks consistent with septic tank?- - O N/A IN YES O NO Y Pump tank capacity(flood) 1000 gal Manufacturer +r • 24"access riser(s)and accessible from surface?- - O I O Alarm or Control Panel Installed? - Control Panel equipped with Timer/ETM/Counter- - O 0 O Pump installed in El Bucket or li On Block or ❑ Other liAtT .{Pump Make/Model AY McDonald ® Floats or O Transducer Tank draw down in/min Pump cap acity aci: p 12 qpm Squirt Height drip ft , Pump on time per oscar Pump off time per oscar Daily flow set at 360 gpd Updated 0/21/2018 t Mason County OSS Installation Report pg. 2 I Parcel it 220207590090 - t < COR0` Were existing septic components abandoned as part of this project? - - O YES 0 NO If yes,please describe: Were all components pumped out and properly abandoned per 1il/AC246-272A-0300? - - O YES 0 NO . i♦5 RECORD DRAWING P 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: DraInfield&manifold orientation&layout,Septic/pump tank location,Ranh arrow,reserve drainfield,existing and proposed buildings,location of wells,waterliines. wells,observation ports,cleanouts,and other maintenance access points. incomplete Record Drawings may create additional delays In final installation approval and related permits. II Record Drawing Attached ERTWJCi TION N TAk ATION . , _ . 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. • .C�/.Gf..-10— 1 f (7.�i i 1. Signatur Installer bate r' f *ck_.[,1'1 W n l rv�.`v, • "t • Printed Name of Signee i ,LL Vs 01 e e 1.0144 vo MASON COUNTY PUBLIC HEALTH 0,01 4 1 i 1 The undersigned approves this Installation Report and 4�. � , +1 Record Drawing on behalf of Mason County Public i j i 0 O ., Date L.Tahiti Health. o LICENSED DESIGN R i CtV 11 , I IZ 1 ._V,,,,VIVIV„_IANW 1164) Signature of Environme tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 i 1 • 1iov ',. \3\.\_,....__ __ _0„, ,, .. N _ c,,,-,,„e.A .\3:- ,x.,),0---is - c\000\c) •._ '4\so, \_=._ . \ \c\ts\ c:..„.\.1,\),,, y.,,\ .__ r 5\,(G 'ac) . -:-. ,__...D..___ GG - cct-N - \‘' Q.-- \°T)I ? ,,c___(-)\ir \)\-b\\\C \NC' c3c..O\Q r\ --2---I . t .\ .,,,,--\bir'4' • . 0,'r ` ° =, pie �� f r p r'Y ti s.� 5100214 t - O`er Dale L.Tahja ,+ LICENSED DESIGNER r 0 : ' jr'' - --1"ru .. 1 4‘ - /- / '0,::. . --../ • 0 r r i 1�\ I . 0 f G l 0 z tea, ri /� 1� —me r‘) z rn "_'-- - 'Jl , v\ ' r l