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HomeMy WebLinkAboutSWG2022-00179 - SWG As-Built - 2/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00179 Parcel # 42135-50-00012 Applicant Name Frank Campanile Subdivision (Name/Div/Block/Lot) Applicant Address 3208 Hollywood Dr NE Clear Lake- Lot 6 City, State. Zip Olympia,WA 98516 Installer Name Home owner install Site Address 381 W Clear Lake Dr, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Pressure Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A Q YES ❑ NO >50 ft. from wells? - 1- p - ' I} r� 2- - - ❑ [U ❑ Z >50 ft. from surface water? - L5 LI 1 -a - - ❑■ ❑ ❑ H Cleanout between building and tank? -FE$ -���- - - ❑ ❑■ ❑ V Tank baffles present? - - - - - -- -- - - ❑ ❑■ ❑ a 24" access risers over each compart ext?- - - - ❑ • El W Effluent filter installed?- y - - - ❑ ❑ ❑ N Septic tank capacity (working) 1,250 gal Manufacturer Sound Placement GI D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - CI ❑ ❑ mZ Check valves installed? - - ❑ ❑■ ❑ oQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A [U YES ❑ NO C3 >100 ft. from wells?- - P- P11-aVE .,■ ❑U ❑ W >100 ft. from surface water? - - - - - t] ❑ ❑ u. >10 ft. from potable water lines?- - - - - -- F.Es_2 4_2023. - - ��", ❑■ ❑ Z > 5 ft. from property lines and easerne -SUN-T)<EJIR ❑ 0 ❑ Q �';�9E_NtALl�EAITN > 30 ft. from downgradient curtain/foundation drain - - ❑ ❑ Drainfield level and observation ports present - - ❑ * ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?- - El N/A Q YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Sound Placement < 24" access riser(s) and accessible from surface?- - ❑ © ❑ 1-- Alarm or Control Panel Installed? - 5 ce h-- u -c1'- S, ❑ ❑ 0 a E Control Panel equipped with Timer/ ETM /Counter- - ❑ El ❑ n n- Pump installed in ❑ Bucket or ® On Block or ❑ Other M Pump Make/Model Liberty 280 [' Floats or 0 Transducer d Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 6.5 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd UFdatec 92 i:20':8 Mason County OSS Installation Report pg. 2 Parcel# L42I 5s- Sv- 00O( Z ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 1111 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES El 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,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. • i PPROVE FEB 2 1 2023 MASON COUNTY ENVIRONMENTAL HEALTH Jaw . Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with l 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 acc rate. form and attached Record Drawing is accurate. Si nature of s alter Date � t 1 WA Printed Name of Si nee I °' e �, r g i. h • MASON COUNTY PUBLIC HEALTH ;*• ".t The undersigned approves this Installation Report and ".4 ' stGo349 -•�; 9 PP P PAULr,JOY JOHNSON t Record Drawing on behalf of Mason County Public LIC tS::ti'O giG.Nrk" Heal : � rGT' tli o� Z -1`F - 2-- Sign tur nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a21/2018 I ,, Fran k k Cr l S tL / rot 1#yz135-50 00012 LG+ i 3 R' w Clear L alc4 Rd Tesfoff_ 110 r e Str i Cfi v e 42ti0-91111 COLS f0fill fo of SCa Je: ( `,(p ' 30 6c go I2o0 LITh Ilqic floma 11'. 1. 1112,91ZOIM < ✓ CD Audio-Visual Alarm O © Cleanout 1 ��b © I2 S 4 Gallon Septicf 2 Co Tank El6 Effluent with ,' 38.2 H 3 12 S p Gallon Pump Chamber .,11'‘,\ ,' uSt_ �d Dri'v<W ain NJ itt:***1\?)A ?„,.. 4 4te 4 ioioist aiii,...ti4A %.4' . /5, 4,, N , ,. • ... • -r. A be B iZ�PAULASo JOHNSOh��r�� `�1 (9(iltik_ 1 J?O Okp EXPIRES )1 'L—t -2 3 v\ e� �FNT9yFA `� 4TH