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HomeMy WebLinkAboutSWG2020-00366 - SWG As-Built - 3/3/2023 CC'. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00366 Parcel # 32003-00-02000 Applicant Name David Berglund Subdivision (Name/Div/Block/Lot) Applicant Address 628 N 6th St Govt Lots 5 EX S 36/25, S 38/83-84 City, State, Zip Shelton, WA 98584 Installer Name Weather Tight Construction Site Address 6 &71 E Sandpiper Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s) Only ❑ Drainfield Only IN Repair ❑Other System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - ❑ 0 ❑ HCleanout between building and tank? - - ❑ U ❑ U Tank baffles present? - - ❑ 0 ❑ d 24" access risers over each com a ❑ I W Effluent filter installed?- - - - - - ❑ ❑■ ❑ U) Septic tank capacity (working) 1,200 gal Manufacturer Existing o D-box water level and speed levelers used? - - • NIA ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ER ❑ u. mZ Check valves installed? - - ❑ ❑■ ❑ ❑Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- �.. - ❑ NIA U] YES ❑ NO r, >100 ft. from wells?- I I y-.;. i- ] ❑ 0 ❑ W >100 ft. from surface water? - 4 11.; ❑ 0 ❑ u. >10 ft. from potable water lines?- MAR (' L 4L43- - -1 ❑ 0 ❑ Z > 5 ft. from property lines and easements - - s r ❑ 0 ❑ Q Q ❑ ❑ CC > 30 ft. from downgradient curtain/founds ion drains? _ - � : ❑ 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? - - ❑ N/A ■❑ YES ❑ No • Pump tank capacity (flood) 1,200 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ © ❑ H a Alarm or Control Panel Installed? - - ❑ 0 ❑ E Control Panel equipped with Timer/ ETM /Counter- - ❑ I ❑ D - Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a• Pump Make/Model Zoeller 161 ■❑ Floats or ❑ Transducer a. 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 Updated 8212018 Parcel# 32 003- 0 0-02 NC Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD YES ID NO Were existing septic components abandoned as part of this project'? - � If yes, please describe: O 'P C - Ors, � C.9a Were all components pumped out and properly abandoned per WAC246-272A-0300? YES ❑ 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.deanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. e ,:?,_ Pri la ( ci cgr Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that l installed the system in accordance with /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 fo and attached Rec rd D wing is curate. form and attached Record Drawing is accurate. ' W1_f l3 zl Signature of Install Date Sco-H- .. tb Printed Name of Signee �"f 2'`l� MASON COUNTY PUBLIC HEALTH ..rT,.1% The undersigned approves this Installation Report and ""' rf 5100349 '.(�,. Record Drawing on behalf of Mason County Public Health: ' PAULA Joy JOHNSON '�'' t L'1(31t S� �'S5i•GiVVR ';I EXPIRES 3/1S�� Signature of Enviro mental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8421/2018 e. 0 0 • Vcy\......, s-\ ss, Sh{d - >- \ ISM \J� r 014. ..c.u. 1 hil0-n'L--„L 0 Audio-Visual Alarm' 3 Cleanout ev5t;n5 ShO19 01200 Gallon Septic Tank 2-Compartment with Effluent Filter 0r1tuJ 0 0 Gallon Pump Chamber �F Ntrl old 3OO5q fL;,., sqlk CNawi UV- d2Comis5ovUd riaer `ham Vi$1 for Park;n9 1,` '1/4 5 0(2 I. (+- 0 (4‘). [,..,, Davy 51r9 1 v nd a �rui #32 oo3- 00-02000 _ cs 6i rt)I E Spndpi jaff.r LA c811 Lo+ �ti L0+ 7 $�a �{: t" 30 s� ;' APPROVE 3o ys vo e : r'' aq. �' MAR 0 3 2023 Q� MASON COUNTYENy�RONMENTAI HEAT Q- 0 -1 �� RET "A 1 A s‘I 't • A& .. ...:4)14:.1 N :...-Q I \klitq CO% >104\ aPPc`c:if 7'..k)\ X i A 3 •`.s S;LJL vy� `; \O ,,--icy- ' 5100349 1 PAULA J C Y JCHNSCN . k e����c set ,�..� 'g. L Cr.._�g��L-�L7�iGnWitl_. :I I 1 , 0 air.La.. 9_ tA,T ..•••-•"-