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HomeMy WebLinkAboutSWG2022-00343 - SWG As-Built - 4/12/2023 Mason County OSS Installation Report pg. 1 CC, MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00343 Parcel # 32021-57-01025 Applicant Name Michael Jacobson Subdivision (Name/Div/Block/Lot) Applicant Address 371 E Orchard Ln SHORECREST ADD 2ND REPLAT BLK: 1 LOT: 25 City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 111 Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑■ Repair 111 Other Zoeller N264 Solids Pump System Type Subsurface Drip Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES El NO >50 ft. from wells? - monRvs '1 0 ❑ ❑ Z >50 ft. from surface water? - ❑ 0ElN Cleanout between building and tank? - - - -Pi- ; „4- - ❑ ■❑ ❑ O Tank baffles present? - - ❑ ❑� ❑ a24" access risers over each compartment?-BY; ------ ❑ ❑■ ❑ W Effluent filter installed?- - ❑■ ❑ ❑ cn Septic tank capacity (working) NuWater BNR gal Manufacturer Hagerman(Traffic Rated) 9 D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ El ❑ mZ Check valves installed? - - ❑ El ❑ oQ E Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) ■❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO O >100 ft. from wells?- - El ❑ ❑ W >100 ft. from surface water? '� - ❑ ❑ NI L.T. >10 ft. from potable water lines?- ���' a" - ❑ ❑ ■❑ a Z > 5 ft. from property lines and easements?- - El NI El ce > 30 ft. from downgradient curtain/foundation drains? - - U] ❑ ❑ O Drainfield level - - ❑ IN ❑ ❑ Grav Proper cover installed over drainfield?- - ❑ U ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman (Traffic Rated) < 24" access riser(s) and accessible from surface?- - ❑ NI ❑ H a Alarm or Control Panel Installed? - - El II ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ • ❑ 0 - Pump installed in ❑ Bucket or I On Block or ❑ Other 0'• Pump Make/Model Zoeller 5031-0005 ❑■ Floats or ❑ Transducer a Tank draw down 1"in 10 min in/min Pump capacity 1.9 gpm Squirt Height -- ft Pump on time 10.5 minutes Pump off time 1.8 hours Daily flow set at 240 gpd UFaatea 81212018 Mason County OSS Installation Report pg. 2 Parcel# �Z� � � � I ✓��O _ ABANDONMENT RECORD YES ❑ NO Were existing septic components abandoned as part of this project? If yes, please describe: ID YES El No Were all components pumped out and properly abandoned per WAC246-272A-03002 RECORD DRAWING ve enough to re-locate in the need of maintenance activities and uturrendse'elopme def velopment picaalte�ra This is a permanent record ma must nbe Cation accurate yound descriptive 9 Drawings contain Drainfield&manifold onenation&layout.Septic/pump n5P�nwm�en,North arrow.Record Drawings may create additional delays in final proposed buildings, approval and related permits. wells,observation ports,Geamouts,and other maintenance access Po PPROVE APR 1 2 2023 r MASON COUNTY ENVIRONMENTAL HEALTH JBW tARecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 andnd MasonMon Coount Public Health and meet all and Mason County Codes. odes 1 further certi 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. `k2 /4 0S/O 2/22 Signature of Installer D to / t� r 4• °t -ABHr �144'. Printed Name of Signee . - r4.; tr. MASON COUNTY PUBLIC HEALTH N. • The undersigned approves this Installation Report and P ✓,gt�' s,cRecord Drawing on behalf of Mason County PublicPAULA JOY JOHNSONHelth: c����� ..SD EXPiF:fS 1131 / '..../V L,b4/0-3 _ ,.2., _23 Sign u e f nvironmental Health Specialist Date (stamp, signature and date) .' THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updateo 8rz'2ofa • -c. A-s--6Lu 'F Wa;e y- I st vi e 5f e etFe.G ,-vx.ti w t l d l a'f- aA-L y scfpfl e Parc-(14 -320-7 ) -57-0l025 37WrC110rd Lh • 1 � � ZG . \ Sca � . , ' 1 t 6 Jo 20 3G yo E orcv\avA t..v\ --- lificittr • APPROVER ,a. `s r © ! 1111 APR 1 2 2023 0° y t Rc'fai l i Yl q Wet 1, J �}4initilq yVQtl MASON-COUNTY ENVIRONMENTAL HEALTH . J tt 4 Kg• J Bw + � r — . } 01 Audio-Visual Alarm d ,a ✓e c Dc;p, i \ ZW . 0 Cleanout EX:sfi Y15 (j7fGtiYt'f!d ONuWater BNR-500 Pretreatment Tank ' 2 D n l l�' 04 1,000 Gallon Pump Chamber S OSubsurface Drip System Headworks . 0 aaa Sa`ias 9..4..4 --0 ,eC d c.(eiaKbee . , C'w 00 �"'k.�" s.�.p-F«- (e s 6 O D-c c k 1 ; 1 cr •: __1 . t 27' I A. j =�9 31)1' Had I WA 6 .0.1 rt 9F. F•• ' , i 51_0349 A) ,ePAULA JOY JOHNSON ,.-.LIC fatiUESiGN�fit;' r' HAM NlerS Its itilki