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HomeMy WebLinkAboutSWG2022-00557 - SWG Application / Design - 2/9/2023 • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00557 Parcel # 31904-55-00071 Applicant Name Gedora Leasing Company Subdivision (Name/Div/Block/Lot) Applicant Address 121 W Sentry Court Fawn Lake/Div 6/Lot 71 City, State, Zip Shelton, WA 98584 Installer Name Mason County Excavating Site Address 220 SE Clematis Ave Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - 0 ❑ 0 Z >50 ft. from surface water? - - ❑■ ❑ ❑ H Cleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ • ❑ a24"access risers over each compartment?- - ❑ 0 ❑ W Effluent filter installed?- - ❑ El ❑ co Septic tank capacity (working) 1,200 gal Manufacturer Hagerman O D-box water level and speed levelers used? - - 0 N/A 0 YES ❑ NO DO Manifold/D-box accessible from surface?• - LI 0 El -m Check valves installed? - - - �*' �'eu->-" `�"' - ❑ 0 ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 0 3 0 4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- a"�' ❑ N/A ❑ YES Q NO a >100 ft. from wells?- - 0 [] ❑ -J >100 ft. from surface water? - • El IllW z >10 ft. from potable water lines?- - ❑ 0 ❑ > 5 ft. from property lines and easements?- - -9- G^---rs- ❑ ❑ El > 30 ft. from downgradient curtain/foundation drains?- 0 ❑ ❑ cl Drainfield level and observation ports present - - ❑ © ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 U ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A I YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z < 24"access riser(s)and accessible from surface?- - D El El a Alarm or Control Panel Installed? - • ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ II ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other a PumpMake/Model Liberty280 � [' Floats or ❑ Transducer a Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height 5 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 228 gpd Up2atea 8:21.2018 F E B 0 9 2023 Mason County OSS Installation Report pg. 2 Parcel# Ia0`t-55'000 l ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes, please describe: D1i31, -i-et. Ac. reYw & r o.& St_re.,+�kc- & ctiac,.do && Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ■ 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 Record Drawings contain. Drainield&manifold orientation&layua.SeptcJpump tank location.North arrow.reserve drainfield,ebsting and proposed buildings,location of wells,waterlines, Its.observation ports.deaiouts,and other maintenance access points. Incomplete Record Drawings may ceate additional delays in final installation approval and related permits. SEE Al—TACk -E9 rk Q 1 t 0: • 0 9 2p23 �EB NMENSALHEA`�� JeW ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that l 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 atta Z-7-23 hed Record Drawing is accurate. form and attached Record Drawing is accurate. { Signature of Installer Date /-+ j Printed Name of Signee rZ'. .•?,: J• MASON COUNTY PUBLIC HEALTH - •�ti ' The undersigned approves this Installation Report and y c �`^`} Record Drawing on behalf of Mason County Public `, ;V 51oo7_09 He�a/th: 7 aAULA JOYrl�aoN• ,'�{�5;.1 LA . ICIc� TSlt�vEit_' /� 2A rr11 �'� irnnmental Health pecialst Date / i t 4 0 Y ? d % (stamp, signature an date) / HIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a212ot8 (3)3'x3S' (')3tX30 Pr may4 f D• *( A-%c ¢s 5 v' i 't= G5+0C'A 151 le 20 30 9 5,1S.\-- - __. i 0 As-cout Lcv G 4v, a 1 "rJ5- � zc' z 2S' ' 20 5E C: 4Iia Qnv \-r_ 5AN22.t•-ik 1 1g5'91 Pac-r k. 4." rti°4° 51'. 1 .(v 24 x2er . 1 ,,,,„ I (E, . a . —: . Q® �t✓-s E L°E b r - T NGt-tec 0.G = l 3S- Lc- . Hey: gO - Audio-Visual Alarm c�e.� Cle nowt 3 1200 Gallon Septic Tank 2-Compartment with Effluent Filter O 1000 Gallon Pump Chamber 5 • n / t�} y riItI" ant.-siphon `!E 0 Valve Control Box i5 U- A, V . ..-*, 1 • . V 9 s 0c, emI.'1 1 FP, - ..iorr:`;'''.._ ;.\.\ ..s" O-3 -1-w\M`N����N� 51.4,.t' ...- 00349 `'..r:•` EN���O p PAULA JOY JOHNSON : ����\ ``� � Lrc�rs�b» Sr���l_� �ctiD I-ES 0 9 2023 t