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HomeMy WebLinkAboutSWG2022-00577 - SWG As-Built - 10/14/2024 Mason County OSS Installation Report pg. 1 MASON COUNT APPLICANT/ PERMIT INFORMATION Permit Number SING 2022-00577 Parcel# 42018-11-90031 Applicant Name Pacific Building-Dan Rodius Subdivision (Name/Div/Block/Lo y Applicant Address 240 W Rock View PI LOT 1 OF SP#3004 AF#1896210 PTN OF NE NE City, State, Zip Shelton WA 98584 Installer Name Villines Excavation LLC Site Address 7412 W Shelton-Matlock Rd Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tani Only ❑ Drainfield Only ❑Repair Other Sara.Pump in cylill System Type Pressure Trench Pretreatment Type >5 ft,from foundation? -- --- -- - - -- --- ------ ----- -- ❑ NIA AYES Y ,No >50ft.from wells? -- - --- - - ----- - -.----- ------- -- ❑ Z >50ft.from surface wateR -- -- - --- - -- - - - -- - - - - ---- ❑ F Cleanout between building and tank? ----- - - - - --- -- - ---- ❑ 2t�� p Tank baffles present? -- - --- - -- - - --- - - -- - -- - ----- ❑ ® ❑ 1- 24'access risers over each compartment?-- -- - ------- ---- El ® El a ❑ ® E]W Effluent filter installed?- - - - - -- - -- - -- - - - - - - - - - ----- N Septic tank capacity(working) 1.300 gal Manufacturer Premier Plastic 0 D-box water level and speed levelers used? --- ------ ------ ❑ NIA ❑ YEs ® No �O Manifold/D-box accessible from surface?--- ----- - -- - - ---- ❑ E El roz Check valves installed? -- -- - - - - --- - - ----- - - - --- -- ❑ ® ❑ oa f Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 IM 4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- - - - -- - ----- - - - - - ---- -- - - - ❑ NIA EYES E] NO >100 ft.from wells?----- ------------- -- --------- ❑ ® ❑ W >100 ft.from surface water?- - - -- ---------- - --- - ---- ❑ ® El M >1Oft.from potable water lines?- ----- - --- ---- - - --- - - - ❑ ® ElQZ >5ft.from property lines and easements?--- ---- - ----- - - - ❑ E ❑ K >30ft.from downgradient curtain/foundation chains?-- -- - - -- - - ❑ ❑ Drainfield level and observation ports present - - -- - - - - - - - --- ❑ ® ❑ ❑ Graveless chambers or E Clean gravel used? (check one) Proper cover installed over drainfield?---- - ------- ----- -- ❑ E ❑ Pump tank setbacks consistent with septic tank?-- ---- ----- -- ❑ NIA ® YES ❑ No `L Pump tank capacity (flood) 1,300 at Manufacturer Premier Plastic Q 24-access nser(s)and accessible from surface?---- ----- - --- ElIN El~ Alarm or Control Panel Installed? - - -- - ------- ------ - - ❑ E ❑ a � Control Panel equipped with Timer/ETM/Counter- - -- - ---- - - ❑ ® ❑ 7 a Pump installed in ❑ Bucket or E On Black or E] Other a Pump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 53 gpm Squirt Height 5 ft Pump on time 2.25 min Pump off time 6 hr Daily flow set at 480 gpd uppaeesmnoie Mason County OSS Installation Report pg. 2 Parcel# 12D 8- y ���✓� ABANDONMENT RECORD IWere evsbrg septic components abandoned as pan of INS Prolect7 -__ __ _ _ _ ______ . ❑ We NO f yes,plasse describe: Ware all components pumped out and pmperry abandoned per WAC246-272A-U3oo? -------- ❑ ❑ No RECORD DRAWING TFb b�CA^�a rKa!atl coup M cerY YM YN>♦aw�maa b nbrn M tiv ne!M aRYuna�u�Bbd�s aW M1On Ew'RrpeRa. TW®I Rw'e0 pgr9r r.Min: PiifiW Bm YWl bYnmtimdYyaq rxpu'.T�mO UN I�un,NCM ertcw.revvalRY6NE.d'n6g v4P Wr�luhaY.YraEmd�aK.w+wfry�, �.ctrendem Vo�r.MiuN,wtl WnmebMenceacta px¢s, IMmngMe RcaN 6'wwpa^W eeMe MEIy,M di'FN Irel sOPL9n ePP�aw'RhIW Cv�^a. 1 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI 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 desatons shown Mason County Public Health and that any deviations here have been cleaneWapprovud 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 Meson Count'Codes. State and Mason County Codes I further certify that all information contained on this I further cvr ify that all infomration contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. C)7Jzs/zt} Signature al lnstailer Dale T2lcrV LS V ll-LINES J, Hinted llama of signae d MASON COUNTY PURUC HEALTH A • , The undersigned approves this Installadon Repoli afitl— Record Drawing on behalf of Mason Ggy�ty Public PAULA JOY JORNSON Health�j SDyC �� O 'L' _ t) iG EM Signature ofEnvimnman&Haab Specialist Date t lv O (stamp,signature and date) THIS FORM MAYBE SCANNEDANDAVN cTrBttC VkIY ON THE MFSON COUNiY WEB SRE IB2f�e q�TH 1 \ m D.F.Tve:.+rhas CbS q' .C. r' r 0 0 in 1?ARGEL#42018-h-9003I t4vusE 171l IZ W SkeacN-MATWLIF KR I Y� 1 i ®® 1 Q Audio-Visual Alarm Q . 1 Q Cieanout s w/ 's ® 2-Co Gallon Septic Tank k1/ ! -6\ - 2-Comps Filter with Effluent Filter l O 1200 Gallon Pump Chamber © Valve Control Box 1 � seiid4 Qw..P t� 141 JO .Ja •� ` ` WL1� P LA JOYJOHNSON'. elc bmfmagm4 SS �'�' �;, APPROVED J OCT 14 2024 MASON COUNTY ENVIRONMENTAL HEALTH DJA