HomeMy WebLinkAboutSWG2022-00549 - SWG As-Built - 3/16/2023 CL.
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00549 Parcel # 52024-33-90010
Applicant Name Devin Payment Subdivision (Name/Div/Block/Lot)
Applicant Address 7530 W Shelton Matlock Rd iiii LOT B OF SP#2537 AF#2189007 PTN OF S 1/2 SW
City, State, Zip Shelton, WA 98584 Installer Name Hanson Excavation, LLC
Site Address W Highland Hills Rd Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ®Other 50'Attenuation Zone
System Type Gravity Trench Pretreatment Type
>5 ft. from foundation? - - ❑■ N/A ❑ YES ❑ NO
>50 ft. from wells? - - ❑ ❑■ ❑
Z >50 ft. from surface water? - - 0CI0
HCleanout between building and tank? - - - - - ❑ 0 ❑
o Tank baffles present? - rtfaMaTMI- - - - ❑ ❑■ ❑
a24"access risers over each compart - - - - - ❑ 0 ❑
W Effluent filter installed?- » 1 �Q�3 ❑ ■❑ ❑
N
Septic tank capacity(working) 135.0 gal Manufacturer Sound Placement
o D-box water level and speed levelers used? - - ❑ N/A 0YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ NI
m— Check valves installed? - I ❑ ElOQ
E Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 ❑ 5 [1]6 ❑Commercial/Other
>10 ft. from foundation?- - • N/A ❑ YES ❑ NO
CI >100 ft. from wells?- - ❑ 0 ❑
W >100 ft. from surface water? - - 0 ❑ ❑
Z >10 ft. from potable water lines?- - ❑ 0 ❑
> 5 ft. from property lines and easements? ❑ ❑■ ❑
a -
Q > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑
Drainfield level and observation ports present - - ❑ IN ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
•••• tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES i NO
Y Pump tank ca..; flood) gal Manufacturer
< 24" access riser(s) and ac .le from surface?- - — ❑ ❑
dAlarm or Control Panel Installed? - - - - ` ❑ ❑
• Control Panel equipped with Timer/ ETM /Coun - - ❑ ❑ ❑
. Pump installed in ❑ Bucket or •- : ock or ❑ 0 ' -
a• Pump Make/Model ❑ Floa or ❑ Transducer
a Tank draw in/min Pump capacity gpm Squirt Height ft
mp on time Pump off time Daily flow set at -•d
,;rcatec e121.2018
Mason County OSS Installation Report pg. 2 Parcel# 52 b 2 -3 � i cc Q
ABANDONMENT RECORD
tXWere existing septic components abandoned as part of this project? - - YES NO
If yes. please describe:
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.exist rig and proposed buildings,location of wells,waterlines,
wells.observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
e.
MASON CONNTY E
NVIRONMENTA
D. Jew
L HEALTH
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.
7Vd-ze_c9-ii, 3-(o -23
ti
Sig ure of Installer Date a r
Jared Hanson 4„q'),
Printed Name of Signee . pAN .'r>;I.
MASON COUNTY PUBLIC HEALTH i O r t),
The undersigned approves this Installation Report and fi�.`llif Y % .' tr
Record Drawing on behalf of Mason County Public '� PAULA.IOY JOHNSON -1' %jl
Health: L'I gi.3:i.3:0 1._ON �f::
( i ki -q- -3-&-23
Signatur/of Et4 mental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE l:pdated 8i212018
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2-Compartment with Effluent Filter I
1 0 D-Box with speed-levelers
and cover to surface
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CO: PAULA JOY JQHe,� ' '�
MAR 1 b 2023 44 U'C �_ p t�G. 1t.• . �
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MASON COUNTY ENVIRONMENTAL HEALTH _`7 _23
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