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HomeMy WebLinkAboutSWG2022-00213 - SWG As-Built - 2/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00213 Parcel # 42024-31-00470 Applicant Name Gedora Leasing Company Subdivision (Name/Div/Block/Lot) Applicant Address 101 W Sentry Drive City, State, Zip Shelton, WA 98584 Installer Name Mason County Excavating Site Address 50 W Sentry Drive Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © 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? - - 0 ❑ ❑ Z HCleanout between building and tank? ❑ ❑ U Tank baffles present? ❑ 0 ❑ i- 24" access risers over each compartment?- - ❑ 0 ❑ a - ❑ I ❑ W Effluent filter installed?- u) Hagerman Septic tank capacity (working) 1,200 gal Manufacturer 9 Cli D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO --�O ManifoldlD-box accessible from surface?- - ❑ EN El u. mZ Check valves installed? - a/c--- ‘PA'-'""-*-'tam - ❑ 0 ❑ oQ 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 ❑ 3 IC ' 5 ❑6 0 Commercial/Other c.i.$o � E G� >10 ft.from foundation?- /4 -� -E S iA ❑■ YES ❑ NO >100 ft. from wells?- 11 EL;� ❑ ❑ W >100 ft. from surface water? - Vlf-E.E. -a-9-2�2- U ❑ ❑ u. >10 ft. from potable water lines?- Z > 5 ft. from property lines and easements?- - - B ----‘_) - - - ■ I ❑ Q > 30 ft. from downgradient curtain/foundation drains?- - - -=_ �(■� Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A It YES ❑ NO Y Pump tank capacity (flood) 1,200 qal Manufacturer Hagerman Z Q 24" access riser(s) and accessible from surface?- $� ❑ ~ Alarm or Control Panel Installed? - - -S- - - - 14- - - - ❑ ❑ U a ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ m a Pump installed in ❑ Bucket or • On Block or ❑ Other 1 Pump Make/Model Zoeller N152 Floats or ❑ Transducer Y - Tank draw down 2.5 in/min Pump`C:4, pa Si 450 m Squirt Height 5 ft a t3Pump on time 2 min Pu ' time �' Daily flow set at 480 gpd �, FEB Updated P;2'r20'9 ibiASQW COUNTY ENVIRONMENTAL HEALTH JB Vy Report pg. 2 Parcel# 4 Oa-4 —.3 I 00 41 o Mason County OSS Installation P ABANDONMENT RECORD YES IN NO Were existing septic components abandoned as part of this project? - If yes, please describe: 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0 YES 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,Norbr arrow.reserve drainfield,etdsting and proposed buildings.location of wells,waterlines. wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. o �s�C-S - � '-‘-• — — 14go C I N,� - , Ateaci\QA. @ Ve / .;.:! Frd 2 1 2023 .. „A. In VIRyOONMENTAL H>=nI TM IIRecord Drawing Attached CERTIFICATION OF IRSTALLATION INSTALLER DESIGNER/ENGINEER /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 atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of installer Date �F Printed Name of Signee ." -4 ' i. `i r to _A•,x., MASON COUNTY PUBLIC HEALTH ` ,-,. The undersigned approves this Installation Report and � • • f•. y/ 51003t9 •� `lh Record Drawing on behalf of Mason County Public �'1�� PAULA JOl'JOHNSON' `�� tE'�i ' .i�NFi" +-' "� - fib Sigt,Ltt�re nvironmental Health Specialist Date I (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8121/201S �t WL_ — .AI .. 0 Audio-Visual Alarms :tyJ Clean°ut ?OW(Iif`f _y- 31- y70 'If:. .4-�� 0 W74.°1,71i ' ti 1200 Gallon Septic. Tank Fjp w Seh-Hr Dr 4i M �"% ent with -�•: ; 2-Compartment Pi y/.* sibo349 `�'�{j Effiuent Filter • C• ' u� PAULA JOY JOHNSON . S 0. i Expi 5 rilE 'iGN - n4 l OO G011°n PumP Chamber c 3o Lo 90 �a© r:FsO , i • �J 2-?- 23 i00.3 1 27 .57 4 : ' I, I, 1�. 1 .�. = RaS.rve J i E.-,..,,..,_ -----145. Ej OkLO'P��m�r �- A{iR „0 1 ©8 . . ' 7 j _ _ bvi 1oz 1 -© (-----.—nml\* \ \ 1 Rtttnfi oh 1 1 �O1� OiGf � 6.A �� _ _ J 4, 1, .. _ ...... , ..., ;".1 .,,, .1 N j c > . .., - .-'. c 7 *v i-tCii ev. I -EO+GfiCf L. M "FO 101 Si-Ctv?d I - �{ :. --- ---Y ‘c;,3 ,, seSk {nti�e!y ;-torn --a -..� ....:1--__'k 1410,40*t;‘\.,, W SOV;'1_fC1-- a yo' 55.08' 57.5q. ZIS.151 Y5,,e.i• 63. 5 ,/ pO? CP / '&6, k; V ,, 1 J a F EB 21 2023 I MASON COUNTY ENVIRONMENTAL HEALTH j, W