HomeMy WebLinkAboutSWG2022-00338 - SWG As-Built - 4/12/2023 Mason County OSS Installation Report pg. 1 C., . C.. MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00338 Parcel # 32007-14-90042
Applicant Name James& Julia Dale Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 3212
City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating
Site Address 71 E El Fuego Dr., Shelton, WA Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
IN Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other RV Solids Pump
System Type Sand Lined Pressure Bed Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO
>50 ft. from wells? - - ❑ II
Y >50 ft. from surface water? - Vt V E i _ - lli ❑ ❑
Z
HCleanout between building and tank? - - i� - ❑ Cl ❑
U Tank baffles present? - Qp� 2�2 - ❑ ❑■ ❑
a24" access risers over each compartment' y - ❑ 0 CI
W Effluent filter installed?- - ❑ ■❑ El
cn
Septic tank capacity (working) 1,200 gal Manufacturer Hagerman
Cii D-box water level and speed levelers used? - -- - - - -- - . NiA ❑ YES ❑ NO
�O Manifold/D-box accessible from surface?- - 0 El El
mZ Check valves installed? - - ❑ ❑l ❑
0Q
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 20 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO
>100 ft. from wells?- - ❑ ❑■ ❑
W >100 ft. from surface water? - - 0 ❑ El
ti >10 ft. from potable water lines?- - ❑ ❑■ ❑
Z
Q 5> ft. from property lines and easements?- - ❑ [I ❑
Q > 30 ft. from downgradient curtain/foundation drains? - - 0 CI
Drainfield level and observation ports present - - ❑ U ❑
El Graveless chambers or IN 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) 1,000 gal Manufacturer Hagerman
Q 24" access riser(s) and accessible from surface?- - ❑ IN ❑
H
a Alarm or Control Panel Installed? - - CII. CI
2 Control Panel equipped with Timer/ ETM/Counter- -. - ❑ 0 ❑
D
a Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other
a• Pump Make/Model Zoeller N153 ❑� Floats or ❑ Transducer
0_
a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 7 ft
Pump on time 1.9 min Pump off time 6 hr Daily flow set at 360 gpd
Updated f.'2?,20'B
Mason County OSS Installation Report pg. 2
Parcel# 32001^ i4— 9oc42
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - D YES
Ea NO
If yes, please describe: NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? 0 YES
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,locaton of wells,waterlines,
wells,observation pors,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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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.
�G' 14' _ 1\-2I -22
ature of Installer Date .4fri
Printed Name of Signee 1 t ,,9 ;t ),
MASON COUNTY PUBLIC HEALTH ,; ,` (Et '. 1-5'.1).,
The undersigned approves this Installation Report and ,�• 5I u.,'1, {�
Record Drawing on behalf of Mason County Public .`.. PAULA JOY JC"'NSON
Lia.14$17(5.MgiGliai"
Health: � g• U�—
Sighat f Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE JPaama 8212ot8
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