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HomeMy WebLinkAboutSWG2022-00386 - SWG As-Built - 3/27/2023 Mason County OSS Installation Report pg. 1 C, . C MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00386 Parcel# 32005-41-00031 Applicant Name Nolberto Chavez-Martinez Subdivision (Name/Div/Block/Lot) Applicant Address 2251 E Johns Prairie Rd. TR 13 NE1/4 SE1/4 City, State, Zip Shelton,WA 98584 Installer Name Mason County Excavating Site Address E Johns Prairie Rd, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation 0 Tank(s)Only ❑ Drainfield Only 0 Repair ® Other Hagerman 500 gallon pre-trash System Type Sand-lined pressure bed with Liberty LPLE51 M >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - -[ -���y� ❑ 0 ❑ Cleanout between building and tank? -- �11 ❑ 0 ❑ U Tank baffles present? - ! NTP 2"2-7117- ❑ • ❑ a24" access risers over each compartment?- ❑ EN W Effluent filter installed?- ❑ ® ❑ Es Septic tank capacity(working) 1 50 y -- Hagerman In D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - IN 0 ❑ QQCheck valves installed? - Ai-- _'-``=V. ' iS - 0 ® ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑■ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Q YES ❑ NO CI >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water?- - El [U ❑ u. >10 ft. from potable water lines?- - ❑ 0 ❑ Z Q > 5 ft. from property lines and easements?- - ❑ NI Q > 30 ft.from downgradient curtain/foundation drains?- - © ❑ ❑ Drainfield level and observation ports present - - ❑ PI ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ IN ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1,500 gal Manufacturer Hagerman Z < 24" access riser(s) and accessible from surface?- - ❑ El a Alarm or Control Panel Installed? - SQ on - ❑ ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ Q 0 a Pump installed in ❑ Bucket or ® On Block or ❑ Other a• Pump Make/Model Zoeller N292F, 115v, 1/2 hp ❑!III Floats or ❑ Transducer d Tank draw down 2.25 in/min Pump capacity 58 gpm Squirt Height 10 ft Pump on time 2.6 minutes Pump off time 6 hours Daily flow set at 600 gpd Updated Br21,2018 Mason County OSS Installation Report pg. 2 Parcel# 32005-4t-00031 ABANDONMENT RECORD Were 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 onentation&layout.Septi:Jpump tank location,North arrow,reserve dralnfield,existing and proposed buildings.location of wells,waterlines, wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may ceate additional delays in final installation approval and related permits. t4 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /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 atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. 03-13 -25 Signature of Installer Date Printed Name of Signee it 'a1 I'aa `fk MASON COUNTY PUBLIC HEALTH 1 � ,'.cS The undersigned approves this Installation Report and ."k' ` r 51OCJ49 Record Drawing on behalf of Mason County Public PAULA JOY JOHNSON.y Health: Etd S>`t tinfaIrR" t /z�IL� 3 -23 Signature of ental Health Specialist Date stain signature and date) (stamp, a I THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212ota ASbvi It Noibeffio C ko.Vt2 200. y �0.fC{ 3200 5-y1-oo0 31 E J"Qkin.s rwri t 14 i, S c, of I(: ►'=`i G 1,<<5t • zQ Yo G� $° oar <r k A L_________:____i Li 4. Jr;` of � h' at. or.::i. *:z.;,..-`10 ••.,.1- . \ :• Str,�343 • ti, 1(1�{,1t ,. PAULA JOY JOHNSO4 C� �Q k L'iC (SrigsfIn" is •Ski N .fi LUG —� J 3'�' i ,� 5o m n to n 4 o V �Gh�'S 'Nm / , M,;ghbor� e �.t{ "''°.'� i / 1 ri, loo ,,,;ti A-o DF %'' $� �— i t 4) fa 0 0-190 S10Pt 0 Audio-Visual Alarm i 0 x75' ?c;mar 1 — I 3 Cleanout r — lo'x16� C<Scfv< _ __I3 15 00 Gallon Septic Tank 2-Compartment with Effluent Filter 04 1500 Gallon Pump Ch n nber 5oI►d5 rum ;r bc6iy\ • - APPROVED MAR 27 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET F. 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