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HomeMy WebLinkAboutSWG2021-00613 - SWG As-Built - 3/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00613 Parcel # 32021-59-01002 Applicant Name Accurate Development Inc Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 76 SHORECREST BEACH ESTATES#2 BLK: 1 LOT: 2 City, State, Zip Allyn, WA 98524 Installer Name South Shore Construction Site Address 401 E Parkway Blvd, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - _ ❑■ ❑ ❑ z >50 ft.from surface water? - �} -1 { { 1-i--- 10 ❑ H Cleanout between building and tank? - - - U - ❑ CI ❑ n o Tank baffles present? - - _MAR-0- -2(12-3- J ❑ 0 ❑ II~. 24"access risers over each compartment?- - ❑ 00 W Effluent filter installed?- - ❑ ❑■ ❑ to Septic tank capacity (working) 1,250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ 0 ❑ u. cot Check valves installed? - - ❑ 0 ❑ OQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - 0 ❑ ❑ 111 >100 ft. from surface water? - - ❑■ ❑ ❑ ti >10 ft. from potable water lines?- - ❑ ❑■ ❑ � > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q X > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑ fn Drainfield level and observation ports present - - ❑ 0 ❑ O Graveless chambers or ❑ Clean gravel used? (check one) 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 Hagerman <• 24" access riser(s) and accessible from surface?- - ❑ Q ❑ a. Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ I ❑ D a. Pump installed in ❑ Bucket or ® On Block or ❑ Other a• Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a Tank draw down 2" in/min Pump capacity 44 gpm Squirt Height 5 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd Jcdatec 8,21:2018 Mason County OSS Installation Report pg. 2 Parcel# -5 Z.° S 0 1 002- - . ABANDONMENT RECORD Were existing septic comp;onen ,abandoned as part of this project? - - 0 YES IX NO If yes, please describe: Were all ccmponents pumped out and property 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 deveiopment. Typical Record Drawings contain: Orninteld&tnanifoid orientation&layout,Septic/pump tank tocation.Nordz arrow.reserve drainer:kJ.existing and proposed Ourldrith3s.location of We4L waterfries• webs.observation porm.,ciesnocts,and otter maintenance accass points. Incomplete Recast Drawings may ornate additional delays In final Installation approval and related Pee**. • • • • • • Record Drawing Attached • • • • CERTIFICATION OF INSTALLATION • . 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 myseff 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 further certify that all information contained on this atta ed R rawing is a rate. form and attached Record Drawing is accurate. t.- t Signature of Installer Date Printed Name Name of Signee MASON COUNTY PUBLIC HEALTH ol The undersigned approves this Installation Report and •. Record Drawing on behaff of Mason County Public 5IOC349 Health: A-7,:t• PAULA JOY JOHNSON • 1:16N8Vi•Dr$1.GNErgi• ‘1. 2('YWIVZ)/-) 17 • Co-Signature of of Environ Health Specialist Date (stamp,signature and date) This FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNT'(WEB SITE Updated 8121/2018 -Cep 4- --R3 � I o " p 3` >c So ei tt 2.,-. 0_4-1 -4-- G-S 1_4" accAs \ oii 0, c_ L)- ( \ \ — — 01 V)-e-i-Lve-er) Kee `IV/0 S1ape 0 Audio-Visual Ala.-m 0 eCleanout O O ` 01 L O GYa).lon Septic Tank _- •© CK 14 2-Compartment withsJ Effluent Filter O125)Gallon Pump Chamber 3 ' , N t S\A - e c' ,v.4rdj1/4. t 1 • t / t �f Z I L..rsk-2- 'J . kg:szX o 3s APP So 40 ROVEDsbu � ,. , A.-,,;,, TAR °92°23 Lc - \jr,.:v\ MASON COUY ENVIRONMENTAL HEALTH � oo z e51b°34PAULAJ0Y:0HNS0N MsrGNna RET y E 'Pa,r-k,,,��- ,mud.,