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HomeMy WebLinkAboutSWG202-00598 - SWG As-Built - 5/19/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00598 Parcel # 42107-44-00010 Applicant Name Skokomish Valley Farms Subdivision (Name/Div/Block/Lot) Applicant Address 10 N Sweetgrass Ln I L' City, State, Zip Shelton, WA 98584 l(I.w Arrow Excavating Site Address 500 N Sweetgrass Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ii Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? M M ❑ N/A ❑ YES ❑ NO >50 ft. from wells? - v ❑ El ❑ • >50 ft. from surface water? - 0 ❑ ❑ z -MAY-r 8 2-023 HCleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - $-Y4 - ❑ 0 ❑ E- 24" access risers over each compartment?- - ❑ 0 ❑ a W Effluent filter installed?- - ❑ 0 ❑ co Septic tank capacity (working) 1,000 gal Manufacturer Hagerman CI D-box water level and speed levelers used? - - ❑Q N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - ❑ 0 El n?Z Check valves installed? - - - os.�-V. A°`"-tc - ❑ 0 ❑ aQ 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- o"c- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - ❑ ❑I ❑ J >100 ft. from surface water? - - 0 ❑ ❑ W LL >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ El ❑ Ct > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑ Drainfield level and observation ports present - - ❑ II ❑ ❑ Graveless chambers or IN Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ ~ Alarm or Control Panel Installed? - b oorl - `-' I°"-:s `''$- ❑ ❑ U] a • Control Panel equipped with Timer/ETM /Counter- - ❑ © ❑ d Pump installed in ❑ Bucket or © On Block or ❑ Other a• Pump Make/Model Liberty 253 ❑ Floats or 0 Transducer a Tank draw down 1.75 in/min Pump capacity 33 gpm Squirt Height 2.5 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 240 gpd Updated SJ212018 rt pg. 2Parcel# 42► U`7- 4'_ --D�O Mason County OSS Installation ReABANDONMENT RECORD _ D YES 71% NO Were existing septic components abandoned as part of this project? - • If yes, please describe: - LI YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-C300? - RECORD DRAWING ical Record This is a permanent record and manifoldmust orientation&layout.Septic/pump tank location.North arrow.escriptive enough to re-locate in the drainfield,erdsting and proposed bu need of maintenance activities and ildngsre ,llocation of welpment ls.waterlines, Drawings contain: Drainfield& wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 1:XRecord 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 attached Re-Ord Drawl S accurate. form and attached Record Drawing is accurate. . 05 f 23 a nture of installer Dated i ik •.--4,t,") Printed Name of Signee 61.ci lir �ti��MASON COUNTY PUBLIC HEALTH r �`� The undersigned approves this installation Report and N` .ti .7 Record Drawing on behalf of Mason County Public �� 510 349 , �, '�Q=' PAULA JOY JONN$pra ' Health: LtC S•d biCtGr:' .' A _stif\ufv\ev\ co (2, --- 5 C:-23 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uPdatec 8121nDr8 �. SkoKorrn;sh Vallry Parms- Pgfcel L421v7-9 -0Oo1O 4-- ?crcel4g21o7-1-1 f-0001b .> 500 N SWtt+ raSS Lk,Pgrc{I #L12107- y3- 00010 l Ii,_ Sca f: - (oo 0 30 G0 yo J2o 4=7e5-i H01f 0 °.4 80+h )10I-e5 (D0+ �4° P Sandi Silt loam, hit No {-i 2 d. �� ( ) 3'xo' prr44 — d ra s v1 1 l d t}fo i f 1Ac S .. ve V 9 ' O.C. with reserve ► In tw f f ►1 v APPROVED I ( MAY 19 2023 MASON COUNTY ENVIRONMENTAL HEALTH RE? s. E sa) Parcels y21o7- Lf L1-000 )0 © �� Key: ,s,d1 - O Audio-Visual Alarm Cleanout 0 1000 Gallon Septic Tank 2-Compartment with Effluent Filter 1 O 1000 Gallon Pump Chamber ZO X32 1 5 Valve Control Box PCOCesSih ,4c• 't?�y O }QC1 tI co *'A 7,.% {s1- 510 3a9 ..5 �� QZ PAULA JOY JOHNSON LiC 1S5 jp�Sl_GN Ft'` ExPI ES 0 Tt74 S -r S-z3