HomeMy WebLinkAboutSWG2022-00507 - 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 2022-00507 Parcel # 32029-31-00100
Applicant Name Brain & Becky Nielsen Subdivision (Name/Div/Block/Lot)
Applicant Address 511 SE Mill Creek Rd
City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating
Site Address 491 SE Mill Creek Rd Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s) Only ❑ Drainfield Only ■ Repair El Other
System Type Shallow Pressure Pretreatment Type
>5 ft. from foundation? f f- fl-7 r in N/A 0 YES ❑ NO
>50 ft. from wells? ❑ El CI
z >50 ft. from surface water? - - - - - -F-EB-2 2023- I - - - It ❑ CI
N Cleanout between building and tank. - - - - ❑ ❑� Cl
O Tank baffles present? - By- - ❑ ❑� ❑
a24" access risers over each compartment'.?- - - - ❑ ❑■ CI
`W Effluent filter installed?- - ❑ CI CI
o
Septic tank capacity (working) 1200 gal Manufacturer existing
0 D-box water level and speed levelers used? - - 0 N/A El YES El NO
00 Manifold/D-box accessible from surface?- - ❑ I CI
m— Check valves installed? CI Cl CIcaQ
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 El 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A Q YES El NO
O >100 ft. from wells?- - ❑ ❑■ ❑
W >100 ft. from surface water? - - CI ❑ CI
LL >10 ft. from potable water lines?- - ❑ 0 ❑
� > 5 ft. from property lines and easements?- - ❑ ❑■ ❑
Q
lX > 30 ft. from downgradient curtain/foundation drains? - - IN ❑ ❑
0 Drainfield level and observation ports present - - ❑ 0 ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ CI ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO
Y Pump tank capacity (flood) 1287 gal Manufacturer Infiltrator
< 24" access riser(s) and accessible from surface?- - ❑ I. ❑
~
a Alarm or Control Panel Installed? - - CIEl CI
j Control Panel equipped with Timer/ETM /Counter- - ❑ El ❑
d Pump installed in ❑ Bucket or El On Block or El Other
2 Pump Make/Model Zoeller N152 ❑■ Floats or ❑ Transducer
d Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 6 ft
Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd
UpCated 8/2112018
Mason County OSS Installation Report pg. 2 Parcel# -5 2-C 2 61—3 0 d 1 00
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES LI NO
If yes, please describe:CIA D•F• 4�a _"€
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 crainfield,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.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate.
� -�� - 2-I1-1 -2-023
Signature of Installer Date Aril?
Printed Name of Signee * '
MASON COUNTY PUBLIC HEALTH 'I I 2�.�,`,N
�•:�
The undersigned approves this Installation Report and 4. 5
Record Drawing on behalf of Mason County Public ' p� PAUI_A,l .} rtusou
Health: 1N ` ;} I .;'C.►jP4_
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Signatureof EnviroHealth Specialist Date (stamp, signature
and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 6212018
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