Loading...
HomeMy WebLinkAboutSWG2023-00013 - SWG As-Built - 5/10/2023 Mason County OSS Installation Report pg. 1 Ci • MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00013 Parcel # 32127-50-00110 Applicant Name Sharron Koidahl Subdivision (Name/Div/Block/Lot) Applicant Address 450 E Penzance Rd LAKE LIMERICK 1 LOT: 110 , S 50/83 City, State, Zip Shelton, WA 98584 Installer Name Shumaker Construction Site Address 720 E Ballantrae Dr Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Othe- 500 Pre-Trash System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ❑Q YES ❑ NO >50 ft.from wells? - -------����� ® ❑ ❑ Z >50 ft. from surface water? - - --- •-' - -'3-a-U- a - - - © ❑ ❑ H Cleanout between building and tank? J - - - ❑ ❑■ ❑ U Tank baffles present? - d -0-2_Z023 - - - ❑ 0 ❑ d 24`access risers over each compartment?- - - -�{,� - ❑ U El W Effluent filter installed?- Lev ��C�/ - - - 0 ❑ ❑ Septic tank capacity (working) NuWater BNR gal Manufacturer Hagerman 5 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO 0 m O Manifold/D-box accessible from�surfa e k -°� S • E]❑ ®Z Check valves installed? - - lC - ❑ 0 ❑ oQ 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - ❑� ❑ ❑ W >100 ft. from surface water? - - 0 ❑ ❑ Er_ >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- See- )°-'`>'Qf - ❑ El ❑■ aE > 30 ft. from downgradient curtain/foundation drains? - - ❑ Au ❑ o Drainfield level and observation ports present - - ❑ • ❑ ❑ Graveless chambers or Clean grovel used? (check onc) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - ❑ © ❑ ~ Alarm or Control Panel Installed? - - -L- - ti�g----S-cio''-\ ❑ FJ ❑ Q. Control Panel equipped with Timer/ETM /Counter- - ❑ 0 ❑ n- Pump installed in ❑ Bucket or ❑ On Block or .1 Other Flow Inducer Tube a' Pump Make/Model Orenco PF200511-1/2hp, 115v, 20gpm ❑■ Floats or ❑ Transducer E a Tank draw down 1.75" in 10 in/min Pump capacity 3.3 gpm Squirt Height -- ft Pump on time 9 min Pump off time 1.84 hr Daily flow set at 360 gpd Updated 8R 112Gt3 Mason County OSS Installation Report pg. 2 Parcel# 321?- 1 --50 - 000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES 121, NO If yes, please describe: ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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: Draineeld&manifold onentation&layout.Septic/pump tank location,North arrow,reserve drairrfield.ousting and proposed buildings,location of wells,waterlines, wells.observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. [3 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 at/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 att erg Re Drawing is accurate. form and attached Record Drawing is accurate. 0 o ZZ Signature of Installer Date APrinted Name of Signee TT. MASON COUNTY PUBLIC HEALTH A a°i vrAta`' ,v, The undersigned approves this Installation Report and ` ee.; r ii •�� •••s�;� Record Drawing on behalf of Mason County Public to , 51CD349 - •: Health: y* PAULA JOY JOHNSON•fit( NR--)\'-ThiNC2X( 1 S1(6 /L LIC YtJ:'Gt� fi EXPIR Signature of Environmental Health Specialist Date (stamp, s77 9 nat6 e an date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Lcdated€112t'2°'8 kes- , . ,i, f (\ r'...4'..' clkcirtr, c.. 0i8a,k. i \ k, ; i I 1 k rCei -4*-- 32127-5 o- 0011a I •1 k i 1 4f I 720 1---- gcillarii-ra r D( I 1 • 5 t oj f_T=2.0. : l k IliwiTill' C i 0 i a :30 0 VE D • TAL HEALD-, 1 APMPAYERNI0R00N2mE2N , DRt\/ \/\IAY , i I 1 1 ry i RE T ( ! MASON COUNTY i . I ; : , , lityi 2.1-1'x 36' i (Th I _ ..) Audic-Visuai Alarm I ‘10•-st v--se_ S k o p -) ; ! @ Cleanout 0 ' 1\1 0 500 C-aflon Pre-Trash Tank • 0 NuWater BN-R-500 Pretreatment Tank Is' \ A ( 1.'000 Gallon Pump Chamber , Ciosage 7 0 I Subsurface Drip System Headworks .4 1 f Porch ! 1, i I -• . "-- - 81 Proc)oS-ed 3B I •WI -:'.--,- ,-; 4.-i 0 U Sse "V: •...A, I 40 w .• .21:ttiN .-- 0 I tot 14 I - 4\ i/2 rzA g:' N ... t°e•-•cA i ---- • . ,,; -'1' . PAuLA6J10°u"3 ..V. G 3, 1 ; Aes-.3L-MS:piill;X401.:..` CB,: . . , ExPtnttariP---- , -----'-'•—•-•. ,,„,,, 0 5- • 40 ) O •r___ _ _ - - I 1 1,*.S"' I its i /IQ 0 .*Dt.k.s(4,93,7•-0V\ i?IreLXV\ I i 2.8•S \ii x 3 0 x 3 0 ( uz_7\-,AA, '' o' Lbie- i 1 sts3os,..ke-c-,r_e_ [ te,-.-‘:. 9....Q.s.......,... A.R.,. 1 tz..,-,-T -z•ecx...,..1/44-mQ.L. ! : se.A....\,,,,,..c_v_\,..1.,...;,..,......„," - - 2-, ‹.-.e.). .\ -