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HomeMy WebLinkAboutSWG2021-00450 - SWG As-Built - 5/19/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00450 Parcel # 41901-76-00020 Applicant Name Kevin &Akela Burns Subdivision (Name/Div/Block/Lot) Applicant Address 1301 W Delight Park Rd City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION���� CHECKLIST ❑ Full System Installation ❑ Tank(s) Only ❑■ Dralifield Only ❑ Repair II Other Add curtain drain System Type 2 --> 3 BR, Add ADU, Gravity Trench Pretreatment Type >5 ft. from foundation? - - ❑ N/A El YES ❑ NO frzmn-vrtl >50 ft. from wells? - ❑ LI ❑ Z >50 ft.from surface water? - ❑ El ❑ HCleanout between building and tank? - - - - - ��-'- - 2823- - ❑ LI El U Tank baffles present? - - ❑ ❑■ ❑ d24" access risers over each compartment?- -By; - ❑ ❑■ ❑ W Effluent filter installed'?- - ❑ ❑■ ❑ cn Septic tank capacity (working) 1,200 gal Manufacturer Existing Concrete La D-box water level and speed levelers used? - - %)-'eiDx - - ❑ N/A El YES ❑ NO �OJ Manifold/D-box accessible from surface?- - ❑ ❑ ❑ QQCheck valves installed? - - I: El ❑ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - El N/A 0 YES El NO a >100 ft. from wells?- - ❑ El ❑ w >100 ft. from surface water? - - El El ❑ a: >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q Q• > 30 ft. from downgradient curtain/foundation drains? - - © ❑ ❑ Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or J Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ • • tank setbacks consistent with septic tank?- - ❑ N/A ❑ YES i NO • Pump tank c_.: (flood) gal Manufacturer Z < 24" access riser(s) and a : ible from surface?- - IN ❑ ❑ Ha. Alarm or Control Panel Installed? - - j Control Panel equipped with Timer/ ETM/Coun - - ❑ ❑ ❑ n- Pump installed in ❑ Bucket or • S- = ock or ❑ 0 • - d• Pump Make/Model ❑ Floa •r ❑ Transducer a_ a Tank draw .• . in/min Pump capacity gpm Squirt Height ft mp on time Pump off time Daily flow set at _•-• Updated 8212018 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES . NO If yes, please describe: El 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: Drainfieid&manifold orientation&layout.Septic/pump tank locator,North arrow.reserve drainfield,ersting and proposed buildings,location of wells,waterlines, wells,observanon ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Pr40115 df\Q—CL- 111 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 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. �Signature of Installer Date -12ek�� 4't t f t 5 . AP), Printed Name of Signeerffht. o1 '4 MASON COUNTY PUBLIC HEALTH tt``)� The undersigned approves this Installation Report and t+ •'- t'�Record Drawing on behalf of Mason County Public 'r� P.AULA JOY JOFwSO Health: UC `\f.Sr pEStGNi ft•' U l tq EXPfRES I�15/ / Signature of Environment t �al Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated arztrzota r — N Dt�k T P� z-4-- Ro ' / nev�T �S2•a3. a 3°------ ..-f-T- SCALE ; a'' - 4ri0 , 1 z. 1 \ k<V,C`r ` sz-.:-Ee5 AN/c,( '1" k\c\ buy 1Ns. () ..e.1:- r\ .,6.1',.,t, / . cv 43 0 A =�= _ TEST H OL., . - ,Aa- o 4ti^' 0-34/ a-77"&LS, 3y''I1-'- \ FPrcpcst.d t—"b HzV'.s �- 80» -�1�ei SL ,-\'`‘ a,''-0_y2"C7L5 w;fi1r, (JOc,k,ft5 0-F CO Me 0.C7 ,0 1';Z 1l s " -;‘(,e s L , F ln� (ooTS -t\A‘r0 A (5nQU -, EXis+w,c,) ()...) 2'Xlir' pr-,,,,Gar Key: Q{r cn i r,f Z l d t y-c.y\v1�2S, ,�d 0 Ncvj (1) ���,.Pr;�Pry Cleanout -1 re r�H ,+� b��w 4,er� �f.S �rr•ln CC N � 3 1,200 Gallon Septic Tank re sex-vt, above,- • .4t 2-Compartment-A4.Effluent Fi :ty , Q..`Su�s+-L.�D-r -l-o Sk.nCcz� g\L. 1 . ,,; 'a1 ,a ,• ittL D-Box with speed-levelers and l. and cover to surface -�j,ew .�` 510C349 ��� de --+Q� PAULA JOY JOHNSON • r� tICOk18A bEtiGwt ii" �� EXPIRes Ti 6� L-t z .s' > APPROVED MAY 19 2023 • MASON COUNTY ENVIRONMENTAL HEALTH RET