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HomeMy WebLinkAboutSWG2021-00293 - SWG As-Built - 2/22/2023 C.C. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APE t;Ir,URMATION Permit Number SWG 2021-0029 Par I 22017-52-00054 Applicant Name POO Contracting 1 � 9 21 202�ub vision Name/Div/Block/Lot) Applicant Address P. O. Box 4 -Etv City, State, Zip Wuana, WA 9839b '-'� 1n3t8flc•Name Final Vision Inc Site Address 361 E. Budd Dr, Shelton, 98584 Designer Name Acme Design Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑Repair ❑Other System Type Pressure Pretreatment Type NuWater BNR500 >5 ft. from foundation? - - ❑ N/A 111 YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Y >50 ft. from surface water? - - ❑ El ❑ Z < Cleanout between building and tank? - - ❑ El 0 U Tank baffles present? - - ❑ 0 ❑ P 24"access risers over each compartment?- - ❑ • ❑ a. 0 ❑ W Effluent filter installed?- - ❑ Hagerman cn Septic tank size_1000 (trash) gal Manufacturer Ha g o D-box water level and speed levelers used? - - I. N/A ❑ YES ❑ NO J XO Manifold/D-box accessible from surface?- - ❑ mZ Check valves installed? - - ❑ 0 0 OQ 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑■ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A El YES ❑ NO Ca >100 ft. from wells? ❑ X ❑ >100 ft. from surface water? - - ❑ 0 ❑ w LT >10 ft.from potable water lines?- - ❑ X ❑ Q > 5 ft. from property lines and easements?- - ❑ 0 ❑ cc > 30 ft. from downgradient curtain/foundation drains? ❑ © ❑ 0 ❑ Drainfield level and observation ports present ❑ 0 ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over grainfield?- - 0 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ■❑ YES ❑ NO • Pump tank size 17,5() gal Manufacturer Hagerman Z < 24" access riser(s)and accessible from surface? ❑ ® ❑ ~ Alarm or Control Panel Installed? - - ❑ II ❑ n. El © ❑ 2 Control Panel equipped with Timer/ETM/Counter- D a Pump installed in ❑ Bucket or ® On Block or ❑ Other a' Pump Make/Model Liberty 280 ❑D Floats or ❑ Transducer � 6 ft y a Tank draw down 1" in/min Pump capacity 22 gpm Squirt Height_ Pump on time_ 81 sec Pump off time 3hr Daily flow set at 237.6 gpd Updated 8/2'R018 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES t4 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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: Drainfeld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts.ace other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 fo and attached Drawing is accurate. form and attached Record Drawing is accurate. //,10)-,2- SO-iya�ture of Installer Da J% _L/G.S� -yr.)Q.u :Iik • Printed Name of Signee MASON COUNTY PUBLIC HEALTH Z'> The undersigned approves this Installation Report and ,� 'aT';'. Record Drawing on behalf of Mason County Public a LICENSEDDE9 DESIGNER L IFrrir roaromii armarri Health: EXEiRES 12H151 yf.i Val ZJZTA3 Signature of Environm ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8121/2018 M- * * * . M D 0 0 Z D D r m O rr- m D H O OC m m 00 y i�`��hh m m 4,illb Z > C Z 0 0 0 D m m C� m1''14h 0 O x O u� : tt.t, �0 M Z m m m ;1't 1/4 • r��p cn m cn Z z ;;xt F�ii,,� 0 O m O (fin can O'Q N; it,i���� cn >D 73 73 oo Dm D ~ C 0 0 ? 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