HomeMy WebLinkAboutSWG2023-00042 - SWG As-Built - 3/6/2023 C.C.
Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00042 Parcel # 22108-52-00076
Applicant Name Carrie Collins Subdivision (Name/Div/Block/Lot)
Applicant Address 130 E Lakeview Dr
Paradise Shore Estates/Lot 75&76
City, State, Zip Grapeview, WA 98546
Installer Name Maples Excavating
Site Address same Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only II Drainfield Only ® Repair ❑Other
System Type Gravity Bed Pretreatment Type
_ _ 4 YES ❑ NO
>5 ft. from foundation? WI WI ❑ ❑
>50 ft. from wells?
_II
Z >50 ft. from surface water? !;,„,,,1 0 ❑
Cleanout between building and tank? - - aTank baffles present?24" access risers over each compartment? IT: Jl
El El ❑
W Effluent filter installed?- �1.
N Manufacturer Existing 2-compartment
Septic tank size 1,000 gal
CI D-box water level and speed levelers used? - - ElN/A ® YES 0
E NO
OO Manifold/D-box accessible from surface? 0 m 0
Z Check valves installed? I ❑
OQ 2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) III 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - - U-C -Y� - ❑ N/A ❑ YES 0 NO
0 >100 ft. from wells? 4 ❑ ❑
W >100 ft. from surface water? ❑ 0
LL >10 ft. from potable water lines?- - - _S ❑ 0 El- > 5 ft. from property lines and easements?- - 0
Q. ❑
Ie > 30 ft. from downgradient curtain/foundation drains? - II El ❑
a Drainfield level and observation ports present - - ❑
(] Graveless chambers or • Clean gravel used? (check one) ❑ CI 0
Proper cover installed over drainfield?-
.•.. tank setbacks consistant with septic tank? - ❑
N/A ❑ YES NO
Pump tank siz- gal Manufacturer ❑
z ❑
< 24" access riser(s) and a -- 'ble from surface?- 0 ❑ ❑
F CL Alarm or Control Panel Installed?
2 Control Panel equipped with Timer/ETM /Coun
a. Pump installed in ❑ Bucket or • : c ock or ❑ O -
a ❑ Floa or ❑ Transducer
5 Pump Make/Model ft
in/min Pump capacity gpm Squirt Height
EL Tank dra Pump off time Daily flow set at
.•d
ump on time Updated E.21;2)'8
,L '7 c o b -5 2- o o-o-t(g,
Mason County OSS Installation Report pg. 2
Parcel#
ABANDONMENT RECORD - II ❑ NO
Were existing septic components abandoned as part of this project? - - - -- -
LK -S1- tty4-z) _ _ . YES NO
If yes, please describe: abandoned per WAC246-272A-0300? - - --"
Were all components pumped out and properly
RECORD DRAWING
need buildings,location nofwTlls, aatReces,
This is a permanent record and must be accurate and descriptive eankgod�o7�NoRh arrow.ocate in of maintenance
existing ard activities
proposed�rc development Typical Recoro
wDrawings contain: pry afield 8 manifold t er maintenance
&ance layout.Sept poi p
create ad.e n Band in final installation approval and related pernes,
wells,observation ports,deanouts,and other maintenance acxss points. Incomplete Record Drawings may
ll Record Drawing Attached
CERTIFICATION OF INSTALLATION
DESIGNER!ENGINEER
INSTALLER
in accor-
I certify that I installed the system in accordance with I certify that the system has been dance with the septic design stamped'APPROVEDn by
the septic design stamped"APPROVED"by Mason
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 shownbeen cleared/approved by County Public Health and meet all
th
and Mason County Public Health and meet all State myself and Mason
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.
/Signature of Installer Date •• ,
'1:/tt.„.tivet.G.42 .
0. wA. ....
Printed Name of Signee , . . 1.
,?,
• 'cry?
MASON COUNTY PUBLIC HEALTH
sto:'sae �Ih
The undersigned approves this Installation Report and AAUCA JOY JOHNSON
'
Record Drawing on behalf of Mason County Public r t-i: Si1
Health: ^n^ 5 I c (Z`"� 3 4 —2 3
Lei 1 ( and date)
Signature of Environmental Health Specialist Date (stamp, signatureUpdated erz,rzota
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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