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HomeMy WebLinkAboutSWG2022-00183 - SWG As-Built - 2/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00183 Parcel # 42135-50-00014 Applicant Name Richard & Frances Scheel Subdivision (Name/Div/Block/Lot) Applicant Address 20A McConky Ave Clear Lake- Lot 7 City, State, Zip McCleary, WA 98557 Installer Name Homeowner Install Site Address 411 W Clear Lake Dr Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ii Full System Installation ❑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? - ❑ 0 ❑ >50 ft.from surface water? - - El ❑ Z ❑ HCleanout between building and tank? - ❑ ❑ U Tank baffles present? - ❑ 0 ❑ H 24" access risers over each compartment?- - ❑ El ❑ a. W Effluent filter installed? Cl) Septic tank capacity (working) 1,250 gal Manufacturer Sound Placement C1 D-box water level and speed levelers used? - - ❑■ N/A ❑ YES ❑ NO �J ❑ O Manifold/D-box accessible from surface?- - • ❑ u. mZ Check valves installed? - Q"} 'P' A - ❑ 0 ❑ c.1Q 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑CommercialiOther >10 ft.from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - ❑ 0 ❑ J >100 ft. from surface water? - `I ❑ ❑ W -4- - -' J-IE li o ❑ ti. >10 ft. from potable water lines?- �:, ��� Z > 5 ft. from property lines and easements?- - - I I - I1r ❑■ ❑ re > 30 ft. from downgradient curtain/foundation dr- ='� ! -�-I ❑ ® ❑ rn - -- Drainfield level and observation ports present - - — — —— ❑ 0 ❑ Graveless chambers or ® Clean gravel u• ? (of- ) Proper cover installed over drainfield? Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Sound Placement Z El 24" access riser(s) and accessible from surface? ❑ ©El ❑ a. Alarm or Control Panel Installed? - III ❑ E Control Panel equipped with Timer/ ETM /Counter- - ❑ n a- Pump installed in ❑ Bucket or II On Block or ❑ Other a'2 Pump Make/Model Liberty 280 ❑■ Floats or ❑ Transducer a. Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 6 ft a Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8!2 i•2018 Mason County OSS Installation Report pg. 2 Parcel#4Z.]36-66 — GGG ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES isj NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES Ei 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: Drainfield&manifold orientation&layout.Septicipump tank location,North arrow,reserve drairfield,existing and proposed builcings,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. -VG • 4 C.,1tu Q)/ ISM t� Ftd2 ] ?i93 ;► MASON COUNTY ENVIRONMENTAL HEALTH JBW 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 Record Drawing is accurate. form and attached Record Drawing is accurate. /Q "dui( Ifn f\Q¢� 1-3(3^ ?3 Signature of Installer Date 1 c JcAm Q ' * Printed Name of Signee k)s MASON COUNTY PUBLIC HEALTH �"�.[ ► The undersigned approves this Installation Report and ' Record Drawing on behalf of Mason County Public �� 49 PAULAJOY 03 JOtiN50N '� Heafh� <• L'i..osrpl±rxi��;E ' N~Aft 1RE3Z1$r1 s?G �- _ 2 ' 2� 2- 3 -n Signalturek6Thnvironmental Health 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 /6\S \aUlL1. Lod7 E RiC rtar A + FrahYPS Schcc.l Fos c-e 1 12135.50.0 0 01 c 11 W C 1 eta( i.a t rc1 I- , SCaie • i (OO s L, t 1 ,, , ^ 30 (,c 90 /20 • 1 4 L\ s• `" • cDAudio-Visual Alarm 3 3 Cleanout • Aio4 ��JJ sk... 3 12 S o Gaon Septic Tank 2 Coartoent with m Effluent Filter S 3 1250 Gallon Pump Chamber ?o, \ /'` `--- ' Lli h x • / bilkt CC \ / 0.-.C"cp wn a ( \• ` '.2''q' '1 ;,�: ;< p �' PAULA JOY JOHNSON yt P 6 FXPt�;R i.1/I2 \ S�. ��� 0 k 4, 2- 3 -2,3 coon, ?1 Je� MFNTq`yFk Ty