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HomeMy WebLinkAboutSWG2021-00678 - SWG As-Built - 4/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00678 Parcel # 32016-53-03028 Applicant Name Henley WA 13 LLC Subdivision (Name/Div/Block/Lot) Applicant Address 1537 NW Woodbine Way SHORECREST TERRACE 4TH ADD BLK: 3 LOT: 28 City, State, Zip Seattle, WA 98177 Installer Name DB&R, Inc Site Address 60 E Greenwood Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST It Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? ❑ N/A El YES ❑ NO >50 ft. from wells? - IOCEZRWZR 0 ❑ ❑ z >50 ft.from surface water? - E ❑ ❑ F Cleanout between building and tank? - - - - -Hsi+ 2_1_ r.��' - 4 ❑ 0 ❑ C.) Tank baffles present? - - ❑ © ❑ a24" access risers over each compartment?- -BY:-- —w....=+ ❑ El ❑ W Effluent filter installed?- - ❑ ■❑ ❑ Septic tank capacity(working) 1,250 gal Manufacturer Sound Placement La D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ MI ❑ mz Check valves installed? - - ❑ 0 ❑ (3Q Z Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO 0 >100 ft. from wells?- - El ❑ ❑ W >100 ft. from surface water? - - 0 ❑ ❑ u. >10 ft. from potable water lines?- - - -Ske-QeA ❑ ❑ ❑ Z > 5 ft. from property lines and easements? ❑ 0 ❑ C > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑ ci Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Y Pump tank capacity (flood) 1,250 gal Manufacturer Sound Placement Z < 24" access riser(s) and accessible from surface?- - ❑ © ❑ aAlarm or Control Panel Installed? - - ❑ IF ❑ Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ d Pump installed in ❑ Bucket or IN On Block or ❑ Other d Pump Make/Model Zoeller N152D 0 Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 8 ft Pump on time 2 min Pump off time 6 hours Daily flow set at 352 gpd Updated 8212018 t �',' a x' ';S: .s r' Mason County OSS installation Report pg. 2 Pnrcet# 3 2 o(c- -6- O 5c 28 ABANDONMENT RECORD , Were existing septic components abandoned as part of this project? ❑ YES g UO ., . It yes, ptease describe: _ Were all components pumped out and property abandoned per WAC248-272A-03007 • - .. - - - - • 0 YES 0 t RECORD DRAWING i"tia al a parmaneni tecord and must be amulets and desori4UMo enough to ri•btats in the need of maintenance actuates and tutMN development, typrat;Woe 11 COR as,. Dra+ni'etn E.msn&oid crierMatian S tayoul,Sopactot.mo to1A Location,North arrow,.retterwe**ak&epIFmg and ptoposad budding*,loca::on drvw#s,a ttrianes, usills,Observation pets,dcoseouts.and°thar,naintencnce access points, incerr.peta Record Clrnwings may ornato nddalcnst delays In Mat irst,sdslion approval and rested ovals. t^ l ,.. , of 1 I. 011E9 • .: . g_ APR 2 7 2023 of MASON COUNTY ENVIRONMENTAL HEALTH •. JBW { Record Drawing Attached CERTIFICATION OF INSTALLATION , INSTALLER DESIGNER]ENGINEER I certify that 1 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 cearedlapprovnd by both the designer shown here have been ctearedhapproved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Atisson County Codes. Stale and Mason County Codes A'' I further certify that all information contained cut this I further certify that all information contained on this form "Itached Record Drawing is accurate. form and attached Record Drawing is accurate. ��1 � o4/ie /25 Signature of lnstarkr—.1 Cam . 41 _ , --.-.y.,4,. , printed Name at signs J e1 • • h MASON COUNTY PUBLIC HEALTH • i:.4} The undersigned approves this Installation Report and 5-1 ', Record Drawing on behalf of Mason County Public N • PAyyU.({L�,CAC,,{Jr�{(Yy�JyOHNS,C}+N{r y '.r _� •mr.4 I-tJ Orgiali=tom_•-1 Health: -EX . `I di 0,1-,,,-- L_ fXP1RFS 1 q-27-03 [..F - 2.J0 -23 sign tit. li.'r ,nrcnmental Health Specialist Data , , -, (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAIt.ABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 6p6ete402l2ora ., e PPR.OV ' b s u 1+ AP R R 21 202.3 • 30 --\en1ey \N1{\ 13 L 1_C _ Paw I #f 3 2 4/6- 5 3- 0 3 Q Z MASON COUNTY ENVIRON�,9E,N1ALtlEALTH 8 JBW (00 e Cire{nwocd Lvl . t.qq { Key: 0 Audio-Visual Alarm 4 ... coVOCleanout .... ..e.. 0 op _ GktlI1Q !�____ — ,1#226\)4 � •i 25b Gallon Septic Tank NI \ 3 2-Compartment with Effluent Filter 1 '� B YV�L i250 Gallon_ Pump Chamber 1 t d �J Willi Q„-ti -5rehoVt 27 X 4�8 4-28-- O Valve Control Box i 1.c) . EM fig . N ti^i` 1?-. (Li ) 3' N 50 24 �+ — — a� 0 G . civil r-eS.efve S in ?�t vn j' v r ills IC �i3-'�5" 130' wafcr cifeen wood Lr %4 fP 1 i t . i • , ., vii 'r,o to 20 30 40 „„ ��i ,.�,^„ -1--: ��' 5/00340 .(t, � ;."; PAULA JOY JOHNSON '?V/1 LttMg5.0 QKSIGNM#t . I t ~cam»-spa . ----\.b EXP1Rc5 /1 4—Zo-2.3