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HomeMy WebLinkAboutSWG2021-00591 - SWG As-Built - 1/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00591 Parcel # 32130-75-90102 Applicant Name Tyler& Samantha Kilts Subdivision (Name/Div/Block/Lot) Applicant Address 301 SE Hidden Springs Dr TR 10-B OF SURV 4/74 TR B OF SP#802#375454 City. State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address 61 E Capital Peak Dr, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type -- >5 ft. from foundation? - -- - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ I ❑ • >50 ft. from surface water? - - © ❑ ❑ Z - ❑ 0 ❑ HCleanout between building and tank? o Tank baffles present? ❑ 0 ❑ h 24" access risers over each compartment?- - ❑ I ❑ W Effluent filter installed?- - "• - ❑ 0 ❑ cn Hagerman Septic tank size 1,250 gal Manufacturer Ha 9 ❑ D-box water level and speed levelers used? - - - - 0 NIA ❑ YES ❑ NO J oO Manifold/D-box accessible from surface?- - ❑ El 0 mZ Check valves installed? - -- ��- - ❑ 0 ❑ Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 El 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - -- - -. - -- - - ❑ N/A• Ni YES ❑ NO >100 ft. from wells?- 0 El I - ❑ --I >100 ft. from surface water? 0 ❑ ❑ - - Er.. >10 ft. from potable water lines?- ❑ 0 ❑ Z 5 ft. from property lines and easements?- -- - - - - - ❑ I ❑ Q - 0 ❑ ❑ IY > 30 ft. from downgradient curtain/foundation drains? Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ® YES ❑ NO Pump tank size 1,250 gal Manufacturer Hagerman zCI < 24" access nser(s) and accessible from surface? ❑ il ❑ ~ Alarm or Control Panel Installed? - - ❑ • a 2 Control Panel equipped with Timer/ ETM /Counter- - - - -- El ® ❑ D n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other d Pump Make/Model AY McDonald 404011 EFA ■❑ Floats or ❑ Transducer a 2 6 ft Tank draw down 2.5 in/min Pump capacity 44 gpm Squirt Height Pump on time 2.7 min Pump off time 6 hr Daily flow set at 480 gpd uc,da14,dri2u 0•a Parcel# 32-1 Mason County OSS Installation Report pg. 2 ✓D — 15 - 6lo I D l ABANDONMENT RECORD YES � NO Were existing septic components abandoned as par of this project? If yes, please describe: YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 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 location,North arrow.reserve buildings,location of wells,o s contain: Drts,cled anouts, manrfoldd thertation&layout.ance Se posts.tank mplete Record Drawings may create additional delays in final installation approval and rreelatedterlines, permits. wells,observation ports, and other maintenance access po. n _.) NqLRecord 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 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. �n //G'/ 0 Z I I-- 7 2 Signature of Installer Date At 4-tivvkse_ oitait 5 • Printed Name of Signee MASON COUNTY PUBLIC HEALTH `•�� �t_ '',Xh LcS A. The undersigned approves this Installation Report and r�t;: , ' Record Drawing on behalf of Mason County Public P ULA JOY JOHNor)N .I. Health: `d A1=S:GN _" 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 Updatec 8212018 LI- T 1 r P 0ma • iitS a .r 321 _75-9oioz 1_10' roI Cc o +fai-fil. r ScaIt :i"= 0 ' O\ I�i s ��� APP R v 1�r jr- 10 2 0 202'3 ITN r� ZS �a ENVONMENT A�H�` I MASON COUNT REIRZ I tea .. r L5) , 3.k54'irr, , N., Q t�e�Ch,� S c .: o:, uG (A)/ PS•evvf ae 1 G w © . \ of.. am. `t, / �, • I istr. 0 I% Slop{ / 6 0 Audio-Visual Alarm n / Cleanout Q 3 1250 Gallon Septic Tank _ - �[ 2-Compartment with Effluent Filter -__ _ _ 0 �/ 1Z50 Gallon Pump Chamber / w;tti anti •5 pho h - O Valve Control Box J,, N A / V „,s. !",`•' -..,,`�� 3o' /LQ •►_.`01 .,,: ..; re;:g sue, So. -;.I 4T %C sic'19.9 •.q4.- �=•` PAULA JOY.JOH NSON •' k CL»' L a» / / rxH�kes�by JAN 2 0 2023