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HomeMy WebLinkAboutSWG2021-00681 - SWG As-Built - 5/20/2022 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00681 Parcel # 32021-56-03003 Applicant Name TODD BROWN Subdivision (Name/Div/Block/Lot) Applicant Address 51 E PANORAMA DR SHORECREST ADD 3 City, State, Zip SHELTON, WA 98584 Installer Name TODD BROWN Site Address .�/ fAX/O1r,44J4 j7Z_ Designer Name TODD BROWN INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type PRESSURE / BED Pretreatment Type >5 ft. from foundation? - - ❑ N/A © YES ❑ NO >50 ft. from wells? - �i • >50 ft. from surface water? - t tr_ „ U--_1 1 - ❑■ ❑ ❑ 1.5 Cleanout between building and tank? - - -t ,t,- 1- jff- ❑ II V Tank baffles present? - 11 -Vt - ❑ ■❑ ❑ a24" access risers over each compartment By 24" - - El Ill El W Effluent filter installed?- �----- - El El ❑ Cl) raT =1,OOO t l•scsaey►br.,,., Septic tank capacity (working) 598 4-1o`- gal Manufacturer HAGERMAN PRECAST tS1.c. L,1ok L 0 D-box water level and speed levelers used? - - In N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - a ❑ ❑ mZ Check valves installed? - - ❑ ❑� ❑ 6Q E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑� 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- - ® ❑ ❑ W >100 ft. from surface water? - - a ❑ ❑ Y. >10 ft. from potable water lines?- - ❑ ® ❑ Z Q 5> ft. from property lines and easements?- - Ela ❑ cc > 30 ft.from downgradient curtain/foundation drains? - - a ❑ ❑ o Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or 0 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) 1022 gal Manufacturer HAGERMAN PRECAST Q 24" access riser(s) and accessible from surface?- - ❑ © ❑ ~ Alarm or Control Panel Installed? - - ❑ U ❑ 0- 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ MI ❑ - Pump installed in ❑ Bucket or a On Block or ❑ Other n'• Pump Make/Model ZOELLER N151 0 Floats or ❑ Transducer a Tank draw down .75 in/min Pump capacity 77 gpm Squirt Height 2 ft Pump on time 3 MIN Pump off time 6 HR Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 32021-56-03003 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 0 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: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,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. /k /ici7-4x-a___ A-770,k7 p. ---/z /4-- f.,_c) v6p. pitiils //4-w ,e1///4/13/ Q Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 1 furthe certify that all information contained on this I further certify that all information contained on this form nd attac Record Drawing is accurate. form and attached Record Drawing is accurate. 5/19/2022 ignature of Installer Date TODD BROWN Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: /_��t1 1 L(LI,(17-- / _ /r1/ej Signature of Environmerital 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 100/- O 76 0/ 9©t IN n 1, APPROVED O A . ® ; I JUN 24 2022 0 0 4 _ J MASON COUNTY ENVIRONMENTAL HEALTH © 0 m`'' L r r9' RET 0+ go m of 2 E-1712.00►'\ N 401 W f LZ-ss1,-/O PRi4 wAr 0 WO !-1iC 2-C 2M rust/ r h�- r/c TANK 0 /e pr o Iv.4` Aka Air f'G/1 Akfeek 30 GOArrIZOueg - ALi+Qkf 0 G LEAS/ Pirr 0 (i) /°/X/g. 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