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HomeMy WebLinkAboutSWG2022-00584 - SWG As-Built - 3/6/2023 Q•C. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH ,, APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00584 Parcel# 51901-50-02019 Applicant Name Steve Bunker Subdivision (Name/Div/Block/Lot) Applicant Address 12312 SE 179th Place Lost Lake Block:2 Lot:19 City, State, Zip Shelton, WA 98584 Installer Name Joe Fassio Excavating Site Address 10XX W Lakeside Drive, Shelton Designer Name Arrow Septic Designs, Inc >g `F":. 1,NSTALLATION.CHECKLIST - 0 Full System Installation ❑Tank(s)Only El Drainfield Only El Repair ❑Other System Type ^9 Shallow Pressure Pretreatment Type >5 ft. from foundation? --N-Q - ' - Q N/A ❑ YES ❑ NO >50 ft.from wells? - - 0 ❑ ❑ r w. >50 ft.from surface water? - - El ❑ ❑ ;-' ' Cleanout between building and tank? - - ❑ El CI V Tank baffles present? - ❑ I= ❑ 24"access risers over each compartment?- - ❑ U] ❑ 7. Effluent filter installed?- - ❑ CI ❑ i• - Septic tank capacity(working) 1,200 gal Manufacturer Hagerman :NI:1 D-box water level and speed levelers used? - - ❑■ N/A ❑ YES ❑ NO J:. off Manifold/D-box accessible from surface?- - ❑ 0 ❑ ' ;, Check valves installed? - - ❑ 0 ❑ xg Transport Line Size 2" Schedule/Class 40 y 5;•. Bedrooms installed (check one) ❑ 2 ID ❑4 CI 5 ❑6 ❑Commercial/Other rtr >10 ft.from foundation. - /4 c' tr`-'1/4"-SQ- - - iii N/A 0 YES 0 NO >100 ft.from wells?- n-t~;i 41 Cl ❑ ='-j- >100 ft.from surface water? - ,4) -, i0i ❑ ❑ E`:: >10 ft.from potable water lines?- • .�,Y-k_C' 20 !Eji 0 CI:$', f j Eli • , -:: > 5 ft. from property lines and easements?- - IIM 0 ❑ ._. '• > 30 ft.from downgradient curtain/foundation drams?- - - - - - L El .1''. ._. Drainfield level and observation ports present - ""`-- '-•--. .-_.:it Al CI • ;`` ® Graveless chambers or ❑ Clean gravel used? (check one) . :t... Proper cover installed over drainfield?- ❑ 0 ❑ al ' : Pump tank setbacks consistent with septic tank'? ❑ N/A 0 YES ❑ NO ' Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ © ❑ ~` Alarm or Control Panel Installed? - S�� a. - CI CI .::;2 Control Panel equipped with Timer/ETM/Counter- - ❑ © ❑ 4:*` Pump installed in 0 Bucket or ❑ On Block or ❑ Other "Q`' ' Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer tTank draw down 2 in/min Pump capacity 38 gpm Squirt Height 8 ft , }rj:;;`,..4 Pump on time 2.3 min Pump off time 6 Hours Daily flow set at 360 gpd Updated 8/2112018 Mason County OSS Installation Report pg. 2 Parcel# 5\(t01-50-G 1 Q ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ Yes a NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES El NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Typical Record Drawings contain: Grainfield&manifold orientation&layout.Septicipump tank location,North arrow,reserve drainfield,exsting and proposed buldings,location of wells,waterlines, wells.observ-adon ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. SEE- ATT AC'HE'D e 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 a0 and Mason County Codes. State and Mason County Codes 1 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. Sig re of Installer Date Toe Fctsst o .; Printed Name of Signee MASON COUNTY PUBLIC HEALTH � 4 y /I ��� The undersigned approves this Installation Report and ' ?• 0�1 Record Drawing on behalf of Mason County Public 49 ;LI�z PAULA JOY3JOHNSON Health: ' L'iC S b Si NM:* Signature of Environment th Specialist Date (stam p,p, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES S[TE Updated 8212018 ce..Qz:. k u = so ' `vt- &'es @ q - o wr*� j ��S�Jl,! LT s gQ,S W J t- ;+-1 I3 Q-'1-0""n y-€ i . >zQ5iciD1-50- 07.019 i 9 . U. A- 618581 40. 40' 3b, l r 34' '2 • I . , / - stops J \ ' J ! Er IN o PYofose �, I Fyn 4 0 -; fZ i /PFi py/F�3 0... f 'qly W. f ��jy (111*)i44\ 'CZ1s. .\‘%%%.....‘ 1 / 7 I ÷ I AM 0 Audio-Visual Alarm oh Pori' 1 C3 Cleanout 1 0 1200 Gallon Septic Tank I 2-Compartment with Effluent Filter `� I I I qi j O 1000 Gallon Pump Chamber 11 O Valve Control Box tf OS * Lake_t e" �V. -� r-1,��"�� 2�1. i{ 5100349 • h • PAULA JOY JOHNSON �'��� EXPIRES 9"-AN Z- 21- 23