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HomeMy WebLinkAboutSWG2022-00594 - SWG As-Built - 2/8/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00594 Parcel # 32127-50-00023 Applicant Name Scott Anthony Subdivision (Name/Div/Block/Lot) Applicant Address 631 E Ballantrae Dr Lake Limerick/Div 1/Lot 22 &23 City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address Same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST IIIII Full System Installation lyc(S-C\ ❑ Drainfield Only ❑ Repair ❑ Other Upgrade 2->3 Bedrooms System e� `'n \= \`l1-M,�P1reess Bed Pretreatment Type >5 ft. from fou ion? ti 4S— tUb - - - ❑ N/A ❑■ YES ❑ NO >50 ft. from well, - ❑■ ❑ ❑ • >50 ft. from surf -water? -\ - -- - ❑ ❑■ ❑ Z �_.�f H Cleanout between Oil nk? - a` - ❑ ❑■ ❑ ✓ Tank baffles prese . - - ❑ ❑■ ❑ d24" access risers over each compartment?- - El ❑■ ❑ W Effluent filter installed?- - ❑ ❑■ ❑ co Septic tank capacity (working) 1,250 gal Manufacturer Snyder o D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO J O Manifold/D-box accessible from surface?- - ❑■ ❑ ❑ QQCheck valves installed? - ��' - ❑ 0 ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ■❑ YES ❑ NO 13 >100 ft. from wells?- - El ❑ ❑ W >100 ft. from surface water? - - ❑ E ❑ u. >10 ft. from potable water lines?- kwY`""P L^--"Q- •Sk'e.-ck-- ❑ ❑ ❑ � > 5 ft. from property lines and easements?- - ❑ LI7 ❑ a le > 30 ft. from downgradient curtain/foundation drains?- - ® ❑ ❑ o Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or © 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) 1,287 gal Manufacturer Infiltrator 24" access riser(s) and accessible from surface?- - ❑ © ❑ 4. Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ • ❑ n a. Pump installed in ❑ Bucket or 0 On Block or ❑ Other a'• Pump Make/Model Zoeller N152 [' Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 38 gpm Squirt Height 5 ft Pump on time 2.3 Minutes Pump off time 6 Hours Daily flow set at 360 gpd Updated P.212013 Mason County OSS Installation Report pg. 2 Parcel# S2\2 ► -SO 00 r)2-5 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - MI YES NO If yes, please describe: nravy\-c-t0 d AlnaY\AD VI c t c \ YG MoV c t Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 111 YES 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 Recorc Drawings contain Drainfield&manrfold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells.observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final utstatation approval and related permits. EE T"ACHE D 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 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. \8-z3 gature of Installer Date vt,,t,at 5 Printed Name of Signee01 w,a •q,; y MASON COUNTY PUBLIC HEALTH :w The undersigned approves this Installation Report and �i�•. } 01�1. sfoosea Record Drawing on behalf of Mason County Public . r PAULA JOY JOHNSON Hea/t L'ICfvS� iYiG'riEfi'' xPtr�.s sli s ��,� l�j E , - 3o-Z3 Signature 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 8Rt12°18 • 5 co--- PthillOYILl b c s;. S° '\'`'_ 3 ,,2' r Vice 1 3 212 7-5 v-ooc 2; l o a- z�> ! L1.fz. �.o;- z2-) (031 Bq tick -rae Dr 1 ! 1 - ?r ,c. ;off 0 h;q h wa=c r _ , \ 32',/ iSL4`2. . + =1 \ i \. 1 1 Dec . APPROVE . l ! 1..% w? 1 :�� F F R 0 R 2023 i v l i 1 i o 0 ®,\ 0US•e l 1 J iI______ ___, t }_-••I R e{. w a i t • 1 / a- ` v c p c --rr S o,r- tint 0 W\,i, s 1 ev: ,A. .f ; 1 Key. i t 0 Audio-�1isua Alarm1 I ! Ciearcut 1 !! 0afckcte % 33 1250 Gallon Sep-dc Tank 1 j W 'h .G. d 2-Compartment with = Effluent Filter t '� r-c� �`�`'� 01000 Gallon ?u-r--p Chamber `; I (128Z "Flood_ GAa..1-"Th 1 ,i' it I 1 ! i 2 i0" { i 0 .1, er ....-5; 4 t. • 1 ._ I 1 .0 :,-4-1-5. reSeT-ve 1 l/` ' S- — — f � '� ftk� .L s.nJ49yG, PAULAJO:Y JOHNSON .r�� • s 2 `5' —14ki' StUj4.# , ! gati ni-r0e V 'tReS7L_ \— 1- 3o— z