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HomeMy WebLinkAboutSWG2021-00381 - SWG As-Built - 2/8/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00381 Parcel # 51901-41-90010 Applicant Name Judith Lucke Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1165 LOT 1 OF SP#2894 AF#560893 PTN OF GOVT LOT 7 City, State, Zip Shelton,WA 98584 Installer Name Grade Pros, LLC Site Address 95 W Lost Lake Park Ct, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft. from foundtion? - ���} i- - - - - ❑ N/A � YES � NO >50 ft. from wells? �-UQ U°s Z >50 ft. from surface water? - 3 Zo-23- - ❑ ❑ < Cleanout between building and tank? ; --�N - - ❑ ■❑ ❑ V Tank baffles present? - - •❑ • ❑ (~ 24" access risers over each compartment?�-- - - ❑ X ❑ W Effluent filter installed?- �� - ❑ LI ❑ en Septic tank size 1,200 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - 0 El mZ Check valves installed? - " c' '"P -k-W'‘� - ❑ ❑� ❑ ciQ M Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- - ❑ ❑■ ❑ W >100 ft. from surface water? - - ❑ El ❑ L% >10 ft. from potable water lines?- - ❑ I ❑ Z Q > 5 ft. from property lines and easements?- - ❑ ❑ El Q > 30 ft. from downgradient curtain/foundation drains? - - El [II ❑ Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ■❑ YES ❑ NO Pump tank size 1,000 gal Manufacturer Sound Placement Q 24" access riser(s) and accessible from surface?- - ❑ ® ❑ H a Alarm or Control Panel Installed? - - ❑ I. ❑ 2 Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ ❑ n- Pump installed in ❑ Bucket or © On Block or ❑ Other a• Pump Make/Model Liberty FL51M 111 Floats or ❑ Transducer d Tank draw down 3 in/min Pump capacity 60 gpm Squirt Height 9 ft Pump on time 1.5 minutes Pump off time 6 hr Daily flow set at 360 gpd Updated 8:21/2018 Mason County OSS Installation Report pg. 2 Parce' = 510�-4►- QC�� ABANDONMENT RECORD YES ® NO Were existing septic components abandoned as pad of this project? If yes. please describe. YES - NO Were all components pumped out and properly abandoned per WAC246-272A-0300" [� RECORD DRAWING This is a p,ertnanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. ;wcj' Record_ Dr. gs contain rkajnI etd&mar.ro6 orientation&iayou'. Septic.pump tank tocallim.Nom arrow.reserve draifl etd.existing and prnocsed Puidnps :xat:on werts N3ier ices. wails.observation parts. anouts.and other mae'•lenirce axess points Inc;,mplete Record Drawings may create additional delays in fnai u+stalatuot approval and rPaed perms EE ® 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 l 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. I —l9-Z3 Signature of Installer Date r, S 4.-�t�ti•._ sit���.— `t Printed Name of Signee at .y . �r MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and ,"� $ v'. '1 yf 57C0349 Record Drawing on behalf of Mason County Public • PAULA JOY JOHNSON-?' Health. 1- ». , 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 uac, 9'214ot" 4g`� `' . 0 3o bo go 0-4 . / , cALNA-K-0-. ..,4612111-17---_ . 14 r- — --� 1Dr�C i Fr;whar�( 4 • Lusk L.a. I- ,_____I v.v. el/ i 6 . e ttt5x t rg`S 101,541ReSes4 e- --:' Po' RO V L ''' FEB 0 8 2023 • ASON COUNTY ENVIRONMENTAL HEALTH , .°... 0'itb, . 11�dG�: o 7-t7 1 enS ewt / . oi fi, . , / O �� r' .S`,% 1 r 55;53 9 1� f 'j� PAULA J:..Y JCF' SON ..�kns EXPIRE nG^I•i r i - - i es �� /� G.1 1 l.J 4.5sltst iar 1;wt N �� i t i of a , 5if*`C 4. ` 0.5ma.r Y. o-c- L-c,S+ 1-0-k€ Fey- Pre, - Sim cis a -coy- \,_,off" I SPA C 1 a d *e4 l ,D,•e.„„, ,,, , a.c l o y . ri.41.. , \V,,,,,;. , k Kew / 6ectc^o'./ y ,et w a44,v* Audio-Visual Alarm \. :, ` Rex S 0 Cleanout !/' Nx 1200 Gallon Septic Tank 2-Compartment with / Effluent Filter . l�5 J,, O4 1000'Grailon Pump Chamber ` O ao' ea-5�� -cot- iv�grei5, .1. 11(44 )...... J eeJress a.,.d cci-ltl-t-:cs 1,., -eve.- a-F t at a ,