HomeMy WebLinkAboutSWG2019-00474 - SWG As-Built - 2/7/2023 .0•
Mason County OSS Installation Report pg, 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG SWG2019-00474
Parcel# 32127-53-00127 i
Applicant Name JENSEN BAKKEN HOMES Subdivision (Name/Div/Block/Lot)
Applicant Address 201E BALLENTRAE
City, State, Zip SHELTON, WA. 98584 Installer Name MIKKELSEN SEPTIC LLC Site Address
491E DARTMOOR Designer Name CINDY WAITE
INSTALLATION CHECKLIST
I Full System Installation ❑Tank(s)Only
❑ Drainfield Only ❑Repair ❑Other
System Type PRESSURE Pretreatment Type BNR NUWATER
>5 ft. from foundation? -
>50 ft. from wells? - ❑ N/A ®YES ® No
-
Z >50 ft. from surface water? - _ CO 0 0
-
Cleanout between building and tank? - _ _ _ _1_� 1 lit El El
V Tank baffles present? - U 0 0
a24" access risers over each compartment?--' JAN 2 6 �U23 El 0El i
LU Effluent filter installed?- 0 II El
Septic tank size 1200 gal BY anu 0 El El• HAGERMAN
aD-box water level and speed levelers used? - _
0o Manifold/D-box accessible from surface?-
N/A ❑ YEs 0 No
QZ Check valves installed? - ❑ I ❑
Transport Line Size 0 I El
>10 ft. from foundation?-
Bedrooms installed (check one) 0 2 ❑3 ❑4
❑ 5 ❑6 ❑Comercial/Other
Schedule/Class SCHEDULE 40
CI >100 ft. from wells?- 0 N/A YES ❑ NO
j >100 ft. from surface water? - II ill ❑
I El ❑
z >10 ft. from potable water lines?-
❑ ❑
> 5 ft. from property lines and easements?- -
—'?
12 >30 ft. from downgradient curtain/foundation drains?- _ ❑ I ❑
Drainfield level and observation ports present - I 0 0
❑ Graveless chambers or ® Clean gravel used? (check one) ❑ I
El
Proper cover installed over drainfield?-
❑ I El
Pump tank setbacks consistant with septic tank? -
Z Pump tank size 1200 0 N/A ill YES
El NO
gal IVianufacturer HAGERMAN
< 24" access riser(s)and accessible from surface?
d Alarm or Control Panel Installed? - ❑ Ill 0
I
Control Panel equipped with Timer/ETM/Counter - - _ _ _ _ _ _ - ❑ ®0 I ❑
a Pump installed in 0
O. ❑ Bucket or ® On Block or ❑ Other
2 Pump Make/Model 250 LIBERTY
Tank draw down 1.5/1 El Floats or ❑ Transducer
a in/min Pump capacity 37
.pm Squirt Height 4 ft
Pump on time 1 Pump off time 4
Daily flow set at 240
-__- - --_gpd
Updated 8/21/2018
Mason County ®SS fnw:$a98atoon Report pg. � Parcel#
Were existing septic components abandoned as part of this project? --
t If yes, please describe: _ J_i YES Np�!
Were all components pumped out and properly abandoned per WAC246-272A-0300?
YES 0 NO
_ RICO DRAINING:,..
This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development Typical Recrord
Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location.North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
Y.wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits."a
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°t/, CQ�9,j G' xi�olatie,.l a it p oi4' 'Ai ric'it i' fr /S' rt. 0� c+is; S 0
ue & �� / ig Record Drawing Attached
C!laRTIF0CAT9G�� �f� �(G`a AI
INSTALLER
T' SIGNERI ENGINEER
. /certify that!installed the system in accordance with 1 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 Mason County Public Health and meet all State by both ()
, and Mason County Codes. myself and Mason County Public Health and meet all
i I further certify that all information contained on this ' I State and Mason County Codes
further certify that all information contained on this
fo _and atta� ecord Drawing is accurate.
' form and attached Record Dr:wing is accurate.
Signature of installer Date i
�` 1
e c.reAr `I -24(26 20 �� iij
__Printed Nam of Slgnee �,�5'w ' S t! ✓l�
MASON COUNTY PUBLIC HEALTH : 1
• .y.
The undersigned approves this Installation Report and ,r�` v�E.ESIGE �'•'i�
Record Drawing on behalf of Mason County Public LICENSED DESIGNER I,
Health: evM���������� �����1,
EXPIRES 05/10,
y Feb ion
Signature of Environmental Health Specialist Date
I (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
(iodated 8/21/2018
.y
APPROVED -��r _�- a 0/27
c° FEB 0 7 2023 i
MASON COUNTY ENVIRONMENTAL HEALTH I
RETO
01 Dls9
q
1. Audio/visual alarm
2. Nuwater BNR 500
3. 1200 gallon pump tank(with two risers)
.dil. } 4. Transport line 2"schedule 40
5. Valve box
4 6. Drainheld 3-45' laterals, I '
4/ ?• Reserve area _ schedule
140
8. Feeder lines 2"schedule 40
r
9. Water line
]• 0 �'`--- APPROVED
1z2.4-4
JAN 2 9 2020
it FILE
COUNTY ENVIRONMENTAL HEALTH
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