HomeMy WebLinkAboutSWG2021-00294 - SWG As-Built - 2/22/2023 CC.
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00294 Parcel # 22017-52-00046
Applicant Name PDQ Contracting Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 4
City, State, Zip Wauna, WA 98395 Installer Name Final Vision Inc:Jason Schauer
Site Address 340 E. Budd Dr. Shelton, WA 9858, Designer Name Rod Left
[,_)u INSTALLATION CHECKLIST
i-"� , ull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
V
r= , i System Type Standard Pressure Pretreatment Type
[-2_ �z
(ems u > ft. from foundation? - - ❑ N/A 0 YES ❑ NO
t~ > ft. from wells? - - ❑ ® ❑
[ Y ft.from surface water? - - ❑ 0 ❑
-- ct:
I anout between building and tank? - ❑ ❑■ ❑
o Tank baffles present? - - ❑ 0 ❑
d24"access risers over each compartment?- - ❑ 0 ❑
W Effluent filter installed?- - ❑ ❑ ❑
Septic tank size 1250 gal Manufacturer Hagerman
O D-box water level and speed levelers used? - - x N/A ❑ YES ❑ NO
J
DO Manifold/D-box accessible from surface?- - ❑ 0 ❑
0?Z Check valves installed? - - ❑ ❑ 0
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A El YES ❑ NO
0 >100 ft. from wells?- - ❑ 0 ❑
w >100 ft. from surface water? - - ❑ ® ❑
LL >10 ft.from potable water lines?- - ❑ 0 ❑
Z > 5 ft. from property lines and easements?- - ❑ 00
ii > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑
o
Drainfield level and observation ports present ❑ NI ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ • ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A ® YES ❑ NO
Y Pump tank size 1250 gal Manufacturer Hagerman
Q 24" access riser(s)and accessible from surface?- - ❑ El ❑
I`
a Alarm or Control Panel Installed? - - ❑ IF
2 Control Panel equipped with Timer/ETM/Counter- - ❑ I ❑
n
n- Pump installed in ❑ Bucket or 0 On Block or • ❑ Other
n'• Pump Make/Model Liberty a`do ® Floats or ❑ Transducer
D. Tank draw down 1"
D. in/min Pump capacity 22 gpm Squirt Height 6'+ ft
Pump on time 81sec Pump off time 3hr Daily flow set at 237.6 gpd
Updated 8/21/22018
Mason County OSS Installation Report pg. 2 Parcel # a9_61 7 " 51 - OOO4(0
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES IX1 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES /7d ❑ 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: Drainfleld&manifold orientation&layout,Septic/pump tank location,North arrow.reserve drainfield,existing and proposed buildings,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.
1
r
1
t44
E Record Drawing Attached
1
I CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
1 /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
1 further certify that all information contained on this I further certify that all information contained on this
f and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Ai___---._./
74/10 .2-
66te rh��
ignature of Installer a
Printed Name of Signee �^�Qs�'
MASON COUNTY PUBLIC HEALTH �:t...of w,,w, ;, + '
The undersigned approves this Installation Report and . \
Record Drawing on behalf of Mason County Public r{
a
Ire
Health: _ •� AFT
ftST N
(p u7i7i/Z� Exp: '.� l z
-� ' szy
Signature of Environmental ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
* * * * * *
D o o Z D D
Z � O � DDx > czcncn rn �
D r -mn D C C ZC,)
m O m O p � •
CD z m cn H H ." Z
a
0 o Z ° ZO
> m X
°m r7 . 4
cn vm70 —
m 1 Cn M A.m CT � �
mDZm cO
a
73 W Z Z ; nl 7C
73 n mm z np •
m cn 0 m1� 0 • °D CO 0 ' 2.o m o z D � . • G . •
p
cWoo ~ � / a O
. O 'o rn � P
m Dm y F= m o O •
° •
m om z z a
o 0 Z Cf) . . o zDrc �m n III
•
0 Z - Cf) .ZmJCI) w •
C ti�
Z \ /_
4
—I "6) .
o m m
0 � � JGD m / 61 �' 14 •
m mo O z ^y �•> mm o CO ,i "IMI AEI?
r
r
-n m DNMI
�''��/ v
0
m r� "rLF
� n
O ----'
41
m %CI) �
m .a�', :.°1111:. °°P'-‘.
70
v
' S'VTIL11y EASEMENT �
0000
u u u u r--, , 1 p 98.0p'
'0 ( (J, 7 r
1 0 D r u n n m^^
M
D D z )3 oroo uJ
cp 0 m � � wF M
c m C m > A c r Z
m -I 0 A 2 r 0 0
� v T 0 0 0
> -- N N r 0
Z D 3 0
Z g y z
X Nm
U) - Z 0 O
2J X H
n m — m m cn
o I i
> --I 1 o
rn
II-.:
TJ
(1) ,
0-)o p N 0 W
mO 0ONo C/) O
w 0 O 0 ..
C 6 Z C) Fri D
N
0 —1 H r-
0b 5 I r i N m o
x 73 -A -I N TI Cl)Z o
o m m D
M co 13
co ........., _ .v
m coT
N., /V
�ml� O NJ O
Z fV
T m cn rn tiTT
I` 1C) 0 D co I , 1 ro ,
c--) 0) co Dj co Z
m � wP co 00 A -IV : ;
-090 mry CD :1, Z W
4
�
CD CCo
s