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HomeMy WebLinkAboutSWG2021-00664 - SWG As-Built - 2/7/2023 C3j Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00664 Parcel # 42135-50-00049 Applicant Name Becker Homes LLC Subdivision (Name/Div/Block/Lot) Applicant Address 13407 117th Ave Ct E City, State. Zip Puyallup, WA 98374 Installer Name Able Industrial, LLC Site Address 801 W Clear Lake Rd, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ No >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - 0 ❑ ❑ HCleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ ❑■ ❑ a24" access risers over each compartment?- - ❑ Q ❑ W Effluent filter installed?- - ❑ 0 ❑ 0) Septic tank capacity (working) 1,250 gal Manufacturer Hagerman D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ mZ Check valves installed? - - - -2v' x - ❑ 0 ❑ oa 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 0 YES ❑ NO CI >100 ft. from wells?- - ( IN ❑■ ❑ >100 ft. from surface water?LLJ I E -it-f-U- [. ❑ LL >10 ft. from potable water lines?- - !III ❑❑■ El Q > 5 ft. from property lines and easements?- - - I I -JAN- - �(JI t I1, 0 ❑ Q > 30 ft. from downgradient curtain/foundation dr.tins?- - j El El Drainfield level and observation ports present - Et' - - • lil ❑ ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑■ YES ❑ NO • Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman < 24' access riser(s) and accessible from surface?- - ❑ I] ❑ 0.. Alarm or Control Panel Installed? - �00v� - ❑ ❑ El E Control Panel equipped with Timer/ ETM/Counter- - ❑ El ❑ n 3- Pump installed in ❑ Bucket or 0 On Block or ❑ Other 0' Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a_ a Tank draw down 1.25 in/min Pump capacity 28 gpm Squirt Height 2 ft Pump on time 4 min Pump off time 6 hr Daily flow set at 480 qpd Updated 8/21/20 1 8 Iiii Mason County OSS installation Report pg. 2 Parcel t__ (Jy�j0- O� °� ABANDONMENT RECORD - El YES g NO Were existing septic components abandoned as part of this project? If yes, please describe: El NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ YES 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 ng proposed Drawings contain: Grainfield&man`old orientation.&layout.Septicipump tank location, Record Drawings may create add,reserve drainfield,itional delays in fina s�lla5on approval andtion of e1esatedpei waterlines.. wells,observation Po++s•cleanouts,and other maintenance access points. 5 c_ tb\-1- ,Ac).-vL7 ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with l 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 cor Dr ng is accurate. form and attached Record Drawing is accurate. Signature of Installer Date y-r'"'5,i PA;cLa ell 7u,�cA.4(_— '•: I Printed Name of Signeejs?f MASON COUNTY PUBLIC HEALTH . i . i;; ., Q... The undersigned approves this Installation Report and y t. .7 rj' Record Drawing on behalf of Mason County Public ,-• s+oc3ac ;�r PAULA JOY JOHNSON . He 1.16 tS s ti8SiGNM . fr6c'zi D(PIRES ,5/ Signature of Environmental Health Specialist Date (stamp, sr I "gna �"re anu uate) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8.21/2018 1 r, I O x(po Reserve V. Abu, 1 ± L-- — — — sl� 0 5 CCktr How►e5 LLC 'n xcDo {'"'Ary 0 _�. ,Farce I 112135-50-000 yq 901 W Clear Gales DrDP A 0 0 r r7 , Scale: /"-3a • �5 3o ,its1 A FER 0 7 2023 MASON COi1N! ENviROt _'TAL HEALTH 22 .. 4BR © ° -kvv5E CDaudio-vis _ Alarm L Cleanout / / ' © 1253 Gaflon: .tic Tank 2 • ems.:•t with - / Effluent It co U' / 0 1250 Gallon - ••p Chamber 710L ' /7 / )-- ci i-f" • .. ,,ti 2.-may �. 1 -1' 51v0349 f W'e `� 'la-� PAULA JOY JO INSON pp,,,,(� EXPIRES 0 1�- lYls 2 1K` 1 .11 tc5. 68