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HomeMy WebLinkAboutSWG2022-00520 - SWG As-Built - 1/6/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00520 Parcel # 42024-34-90049 Applicant Name ASCW Investment LLC Subdivision (Name/Div/Block/Lot) Applicant Address 2000 W Shelton Valley Rd Berry Ridge Lot9 City, State, Zip Shelton,Wa 98584 Installer Name Logan Spear Site Address XXX Berry Ridge Rd Designer Name Micah Halverson INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Gravity-Bed Pretreatment Type >5 ft.from foundation? - - ❑■ N/A ❑ YES ❑ NO >50 ft. from wells? - - ❑ If ❑ Z• >50 ft.from surface water? - - ❑ 0 ❑ • Cleanout between building and tank? - - ® ❑ ❑ U Tank baffles present? - - ❑ ❑ 1111 a24" access risers over each compartment?- - ❑ ® ❑ W Effluent filter installed?- - ❑ II ❑ u) Septic tank capacity (working) 1284 gal Manufacturer House Brothers o D-box water level and speed levelers used? - - ❑ N/A ® YES ❑ NO DOManifold/D-box accessible from surface?- - ❑ II ❑ o0Z Check valves installed? - - ® ❑ ❑ ❑Q 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ® N/A ❑ YES ❑ NO >100 ft. from wells?- - ❑ I ❑ ci W >100 ft. from surface water? - - ❑ I LI ti >10 ft.from potable water lines?- - ❑ ® ❑ Z Q 5> ft.from property lines and easements?- - ❑ Pi ct > 30 ft.from downgradient curtain/foundation drains? - - ® ❑ ❑ • Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or (U Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ • ❑ Pump tank setbacks consistent with septic tank? - - ❑■ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal Manufacturer Q 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ w I. a Alarm or Control Panel Installed? - ❑ ❑ r , 2 Control Panel equipped with Timer/ETM /Counter- . - 0 vi ,, ❑ d Pump installed in ❑ Bucket or ❑ On Block o Othe =r ma�yS�;i r2 ' i1• Pump Make/Model JAN 0 Oats QUV ❑ Transducer Tank draw down in/min Pump capaal�'COUNTY ENUI��IGMb1EfV�}�uN Height ft ., a � E Pump on time Pump off time JBW Daily flow set at gpV,= _ Updated 8,21/2018 Mason County OSS Installation Report pg. 2 Parcel # 42024-34-90049 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES E■ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El 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. 4PP Ap y3 MAsONco J qN o 6 a _,;-� ` Je l� iVIW6//vTq( NFg4TH Woe.._ �uG L e+ L 0 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 d attached Record Drawing is accurate. form and attached Record Drawing is accurate. 't- JJ2eit iifra • na r of Installer D e t tit Ai;or L_o14t Speci ✓ Printed Nafie of Signee ' 11 n i MASON COUNTY PUBLIC HEALTH �J /moo`: �. The undersigned approves this Installation Report and • j g 41 I Record Drawing on behalf of Mason County Public \ ;9 S MICAH T 1 H a . �I DESIGNER 1 0 ,,,,,A, /4,--.Zi" Ex B a ici 40. i6) Sig.at 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 8/21,2018 / . ,-,i1 5..-6-, 7)..k oig. . I / w..., . [ %, lq -4.20 5. I ,/ i § W liIE al7.. / t Z Ea • - Su N'Q Q. g. D D "CO / 4. i'(D a , N.J fir+ p LIiZ' i lv O O N Q m h3 t! / / r tWa 1 o 3co D I (moo z.��( m _ - I /'—' ► mn) (o1o ,--(o -' / L 00 //' ___ __T3 6. I / cf. I \,;.-...,. i W go• \ N o0 \ II o N � _�J , \ \.1 •• 8 / r• `tr,F yy1R� Ca �i q�c�Wr�,�-- \ & oo i a A/ __ - 4TA7��'9J�A RR� E I Ui �� N B K $x�y � _ 2 S' ..• lrr NO.0 ,o \ .. Z ��y'r t? I Psi) r,,,, rn .p ter,, N ( I \ \ 119gr .) .Pq,)-- r I /V. .:= -- -2 P. \ I I ‘\ =,,o S) 161'+/ i o. \ g. I -- -- — / , \ II 1 I / ‘11 \ co / S.0\ le d \-� l- -1 © ayr_� \ _ = Z (o o I , \ b @ � o� a. I \ rZ _ � N (� © r \ C �12'+i i \ ii / s a \ / / Owner/Applicant. Site Info. Parcel#42024-34-90049 SHEET NUMBER M.Halverson Design LLC ASC WI INVESTMENTS ON VALLEY RD >ooc W Berry Ridge Rd 7 PO Box 1519 Shelton Wa 98584 200Shelton,Wa 98584 Shelton, Wa REVISION N Halversondesignllci6outlook.com