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HomeMy WebLinkAboutSWG2022-00239 - SWG Application / Design - 2/8/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00239 Parcel # 42135-50-00046 Applicant Name Becker Homes LLC Subdivision (Name/Div/Block/Lot) Applicant Address 13407 117th Ave Ct E Clear Lake- Lot 29 City, State, Zip Puyallup, WA 98374 Installer Name Able Industrial LLC Site Address 781 W Clear Lake Rd, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation El 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? - - ❑ X ❑ Z >50 ft.from surface water? - - 0 El 1-- Cleanout between building and tank? - - ❑ El ❑ U Tank baffles present? - - ❑ II ❑ r:- 24" access risers over each compartment?- - ❑ ❑■ ❑ a W Effluent filter installed?- - ❑ 0 ❑ U, Septic tank capacity (working) 1,250 gal Manufacturer Hagerman D-box water level and speed levelers used? - - 0 N/A ❑ YES El NO 0J O Manifold/D-box accessible from surface?- - ❑ ❑� CI m2 Check valves installed? - - ❑ CI ❑ ❑< E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- A Q YES ❑ NO 0 >100 ft. from wells? Of 1{E c El ❑ W >100 ft. from surface water? - - CI u. >10 ft. from potable water lines?- , ' AN-314-0',i Q I CI z Q > 5 ft. from property lines and easements?- --- -ILLLL - - - II cc > 30 ft. from downgradient curtain/foundation drains -- - - - -- -- igl j ❑ ❑ ca Drainfield level and observation ports present - .-____.._._._._._ - -E © ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑U YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - ❑ • ❑ dAlarm or Control Panel Installed? - ��� - CI CI NI E Control Panel equipped with Timer/ETM /Counter- - ❑ It ❑ m d. Pump installed in ❑ Bucket or [U On Block or El Other n' Pump Make/Model Liberty 280 0 Floats or ❑ Transducer E 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 gpd Uptlated 8/21/2018 Mason County OSS installation Report pg. 2 Parcels .1-11135' 5Q' VUOy ABANDONMENT RECORD 0 Were existing septic components abandoned as part of this project? - - ❑ YES N NO If yes, please describe: ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El 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 Recorc Drawings contain: Drainf eld&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed br,.lcings,location of wells,waterlines. wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 5 . __ f \---1- Ac- -\ --7 ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that i 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 cor 'Dr ng is accurate. form and attached Record Drawing is accurate. zW.' , -------- J`-r__-,-----' 1-1 $- 23 ti Signature of Installer Date �; ttA. t f L Printed Name of Signee . ` N ', � MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 513c349 �`' ; N�- PAULA JOY JOHNSON•yl Record Drawing on behalf of Mason County Public 4. .. ��c�rs�r?pEs�GNea.. Health: EXPIIIF: 7 7 y FC.� 7c'Z3 1 — 3023 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 821/2018 �. ASbui if PPROVED $P<<(er Homo LL6 FEB 0 8 2023 Para l#` 2135.50-00o iC MASON COUNTY EKVIRC MENTAL HEALTH Key: 781 W GKa( Lakc Dr 3 Audio-Visual Alarm „, 3 Cleanout O3 1250 Gallon Septic Tank 0 2-Compartment with 1 Effluent Filter s O1250 Gallon Pump Chamber 41 I ., I v i ® a — X x JjJ 0 1 ,� Viz ; .� HOVVe • . MIme • .��e�mee j• r ..W' L••••. ' ..rit N CP li \ '-' \ Carl 01 \ \ .:04% ..Q: �4 Z Part, writ �h 4 i'4°1,(4 r, '�� 7_•j',.' 5,0.34, _; PAULA JUY JOHNSON EXPIRES ssr / - 1 -3o -Z3 i \ ~-f-- \NI C,Izar Lake Dr 20. Ea s hvu.h f 1 1 65. ‘P8• Scole: i": so, 0 15 ?0 4S 60