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HomeMy WebLinkAboutSWG2023-00014 - SWG As-Built - 4/28/2023 • ?\ . \CkQ0CC Le Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00014 Parcel # 42210-32-90011 Applicant Name Dove Properties& Contracting LLC Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1933 City, State, Zip Shelton, WA 98584 Installer Name j. S, e oo�-c<-- Site Address N. Lake Cushman Rd. Designer Name Qp,`(Z �, 1� INSTALLATION CHECKLIST ® Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑Repair ❑Other System Type Pressure Trench Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A ®YES 0 NO >50 ft. from wells? - r � ❑ Ill El Y >50 ft.from surface water? - r =I ❑ 11 ❑ Z ;5 Cleanout between building and tank? - --- - -t g-20t3--- , ❑ ® ❑ V Tank baffles present? - . � ---) 0 I 0 d24"access risers over each compartment?- B k14' - El ® ❑ W Effluent filter installed?- y •- ' El ® ❑ Septic tank capacity (working) 1.500 gal Manufacturer Hagerman C3 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - 0 II ❑ mZ Check valves installed? - - I ❑ ❑ CQ 2 Transport Line Size 2 inch Schedule/Class Sch. 40 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 © 5 ❑6 ['Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES 0 NO >100 ft. from wells?- - 0 ® El W >100 ft.from surface water? - - ❑ I ❑ EL-. >10 ft.from potable water lines?- - ❑ NI El Z > 5 ft.from property lines and easements?- - ❑ I El >30 ft.from downgradient curtain/foundation drains? - - ❑ ® ❑ ▪ Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) 41 Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - El N/A 0 YES 0 NO • Pump tank capacity(flood) 1.250 gal Manufacturer Hagerman Z ct 24"access riser(s)and accessible from surface?- - ❑ ® El a. Alarm or Control Panel Installed? - - ElI El 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ M d Pump installed in ❑ Bucket or ® On Block or ❑ Other a'• Pump Make/Model Liberty 290 CI Floats or 0 Transducer a Tank draw down 2 in/min Pump capacity 48 qpm Squirt Height 5.5 ft Pump on time 5.6 min Pump off time 11 hrs 54.4 min Daily flow set at 450 gpd Updated 8/21/2018 , -\.). - C VlC\.\-6")S.: C---' --\C-t-' , \( OVA' C\- \) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00014 Parcel # 42210-32-90011 Applicant Name Dove Properties & Contracting LLC Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1933 City, State, Zip Shelton, WA 98584 Installer Name T. J. Goos Site Address N. Lake Cushman Rd. Designer Name Dale L.Tahja INSTALLATION CHECKLIST 0 Full System Installation ®Tank(s)Only 0 Drainfield Only 0 Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? - - ❑ N/A ❑YES ❑ NO >50 ft. from wells? - -- 0 0 ❑ Z >50 ft.from surface water? - - El El HCleanout between building and tank? - - 0 0 0 V Tank baffles present? - - 0 0 0 d24"access risers over each compartment?- - 0 El W Effluent filter installed?- - 0 0 ❑ N Septic tank capacity(working) gal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A ❑YES 0 NO 00 Manifold/D-box accessible from surface?- - 0 0 0 IVE Check valves installed? - - 0 0 0 CQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation'? - - 0 N/A ❑ YES ❑ NO >100 ft.from wells?- - 0 0 0 W >100 ft. from surface water? - - 0 0 0 LT. >10 ft.from potable water lines?- - 0 0 ❑ Z > 5 ft.from property lines and easements?- - 0 0 0 Q > 30 ft.from downgradient curtain/foundation drains? - - 0 0 0 Drainfield level and observation ports present - - ❑ 0 ❑ 0 Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ❑ 0 Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1.000 gal Manufacturer Hagerman < 24"access riser(s)and accessible from surface?- - 0 III ❑ o_ Alarm or Control Panel Installed? - - 0 gl 0 2 Control Panel equipped with Timer/ETM /Counter- - ® 0 0 n a. Pump installed in ❑ Bucket or 0 On Block or ❑ Other In Basket a' Pump Make/Model Liberty 250 If Floats or El Transducer a. a Tank draw down 2 in/min Pump capacity 30 gpm Squirt Height N/A ft Pump on time on demand Pump off time on demand Daily flow set at 90 gpd Updated 8121/2018 Mason County OSS Installation Report pg.2 Parcel# (31-0\Oc) ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - --__- ❑ YES I No If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? - - 0 YES ❑ NO RECORD DRAWING This Is a permanent record and must be accurate and dwalptlw enough to reaocata In the mad of meintanance activities and future development Viol Record Drawings contain. Drainfeld 6 manifold ale ion&layan,Sepddpump tank lotion,North arrow,reserve dratiIdd,aldsthO and proposed buildings,IocaMm Owens,Widnes, wetie obeentation ports,daanous,and other maintenance access points. Incomplete Record Drawings may credo additional delays in Brat hatallation approval and rotated permits. • PPROVE APR 2 8 2023 MASON COUNTY ENVIRONMENTAL HEALTH JBW ■ 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 Meson 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 rap. form and attached Record Drawing is accurate. Signature of installer . �, t ' ;n Printed Name of Signee \ t I MASON COUNTY PUBLIC HEALTH v �,� �c•# The undersigned approves this Installation Report and , Record Drawing on behalf of Mason County Public O�' DALE L. TAHJA .1' +'o L!C SEO D SIGNER f ! v Sign Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upda d amnion . .. ... ,_ • r I 0 '1:' K 11• - . 1 P 5fr) 0,0 . • ... , .61.1, ‘‘ • '!...‘,..rt. S74.4• • rt. % '''' -' .m 4.J? , eq• .(t41) Wk% • •21/4okl . 0..) :: —I I...% ,-; ' • , • e VI 1 •.001•4i. 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