Loading...
HomeMy WebLinkAboutSWG2023-00113 - SWG As-Built - 5/10/2023 Mason County OSS Installation Report pg. 1 Cl MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00113 Parcel # 42012-52-00029 Applicant Name Dan & Kay Speigle Subdivision (Name/Div/Block/Lot) Applicant Address 61 E Park Place Parkwood, Lot: 29 City, State, Zip Shelton, WA 98584 Installer Name Bamford Septic Repair Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST II Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ® Repair ❑Other System Type Sand-Lined Pressure Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - r�- I} {��} - • LI ❑ Z >50 ft. from surface water? - U lJ I I ❑■ Ell El III Q Cleanout between building and tank? - U Tank baffles present? - - - - - ❑ El ❑ a24" access risers over each compartmen ?- - -- - ❑ ❑� El W Effluent filter installed?- By - ❑ I ❑ cn Septic tank capacity (working) 1,200 gal Manufacturer Existing- Kurt's Precast 0 D-box water level and speed levelers used? - - • N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surf a,,...... - 9"�� - ❑ ® ❑ OOZ Check valves installed? - ��'w,e ��v\K - ❑ I ❑ OQ 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 ❑■ YES ❑ NO >100 ft. from wells?- - ❑■ ❑ ❑ o J >100 ft. from surface water? - - 0 ❑ ❑ W LL >10 ft. from potable water lines?- -. - - ❑ ❑■ ❑ Z Q > 5 ft. from property lines and easements?- - El IN lc > 30 ft. from downgradient curtain/foundation drains? - - NI ❑ ❑ 0 Drainfield level and observation ports present - - ❑ • ❑ ❑ Graveless chambers or Q 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) 1,200 gal Manufacturer Sound Placement < 24" access riser(s) and accessible from surface?- - ❑ E] ❑ aAlarm or Control Panel Installed? - SQOV - ❑ ❑ ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ © ❑ n d Pump installed in ❑ Bucket or NE On Block or ❑ Other 0. Pump Make/Model Zoeller N161 ■❑ Floats or ❑ Transducer E a Tank draw down 4 in/min Pump capacity 88 gpm Squirt Height 5 ft Pump on time 1.37 min Pump off time 6 hr Daily flow set at 480 gpd Urcatrc 8'7 ir2Ot8 r '.,. Mason County OSS Installation Report pg. 2 Parcel# G�� ��^�� ��� ` ABANDONMENT RECORD Were existing septic components abandoned as part of this pro eci? 1_ , YES ❑ NO If yes, please describe: O 1 a V)_b O x t Cu-,c� <UYet \ti�i I al �1p Q� @ tot'ecd Were all components pumped out and properly abandoned per WAC246-272A-0300? - - RYES ❑ 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 orientation&layout.Septic/pump tank Iccation,North array,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,c eanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. C ,\gam, VRecord 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 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. ci____.___c.....:} Signature of Installe Date Printed Name of Signee �., wa ' ��A MASON COUNTY PUBLIC HEALTH •H 'f The undersigned approves this installation Report and h� '•_jai'. 5100349 Record Drawing on behalf of Mason County Public Yc.: PAULA JOY JOHNSON . Health: , ' ��� Qc \oEXPIREs I sr SIN) 10 i 2- 3 44 4 ,8—Z.3 Signature of EnvironmenIal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updates 8.2t2018 4` . Igo, SCALE i'' .--5o' . • (2,) iox30' SPND-LINED o �� 4� vs b ` PRE5SU2E DF `gEP As- o e DAN`r A`I SPEIGLE `l 0-\°1° sr I' 3� R ?ARC,El-*41.011-52:000/CI 5'° 5 �'' til (91 E PAc2K PLACE tiNA \._11f l I Ott E J i 4 v't OL3) >JgOXTo6E _ Irc"v£� \ / 1>Ec otnt4t55LONEA? 09- R51.4OVE0 0 Os guSNt_S OLD �FT6 , $z ggAwpotvEP 49/.> ®44§b F H \ . / / o :, / ' L=TEST �-lot_f_ ��4-s�' 1 D-\'�' LS, 12-�'�►. 0 \;•GLS I P4.' t2.l2.4"--12;4- VC7LS (1P' t 50' Key: TAudio-Visual Alarm Cleanout _E ��R��\-• * ExlsTtu6 31200 Gallon Septic Tank 2-Compartment with VvA"«� Effluent Filter t 0 5' *NEW O1200 Gallon Pump Chamber APPROVE, MAY 10 2023 r� MASON COUNTYENVIRONMENTAL HEALTh RET �Q. ,,Vfli* J-�' .• 57C J349 ' j"Q� PAU A JOY JOHNSON `y l LtC (S�t3 b�5 iGNEft +—LS"v