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HomeMy WebLinkAboutSWG2020-00387 - SWG As-Built - 5/25/2023 LO- . Mason County OSS Installation Report pg. 1 Cc___, MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00387 Parcel # 31 91 1-42-9001 3 Applicant Name CASEY CERRETANI Subdivision (Name/Div/Block/Lot) Applicant Address 1510 W HURLEY WALDRIP RD City, State, Zip SHELTON, WA. 98584 Installer Name HANSEN EXCAVATING Site Address 161 SE KAMILCHE SHORES RD Designer Name CINDY WAITE INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s)Only ❑ Drainfield Only El Repair 0 Other System Type OSCAR Pretreatment Type BNP,500 >5 ft. from foundation? - - ❑ N/A 0 YES 0 NO >50 ft. from wells? - - ❑ CI ❑ >50 ft. from surface water? - 0 ❑i 0 Z Cleanout between building and tank? - ❑ a 0 U Tank baffles present? - - 0 I ❑ d24" access risers over each compartment?- - . 0 W Effluent filter installed?- - - --/--- ' - -C f cc' - Q E 74�/� ® 0 cn Septic tank size I .2-0} gal Manufacturer -~v (A ;,/CZ ?l�, - , c-21. 0 D-box water level and speed levelers used? - 0 N/A El YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ O 0 m— Check valves installed? - - CI I ❑ 2 Transport Line Size 1 Schedule/Class S*)l\ 9 6 Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 0 5 • • 0 Commercial/Other >10 ft. from foundation?- I El YES NO '�� ■ NIA ❑>100 ft. from wells?- DEUM U II CIW >100 ft. from surface water? II- _M_ - • I AC-T5 /.8.23 iv 0 El EL- >10 ft. from potable water lines?- II © 0 Z > 5 ft. from property lines and easements?- - - __ Q f�- ll' MI 0 Q > 30 ft. from downgradient curtain/foundation drr - _ _ - - ❑ NI ❑Drainfield level and observation ports present - - El © ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 - Pump tank setbacks consistant with septic tank?- - El N/A IN YES ❑ NO Pump tank size iS.00 gal Manufacturer Soo h e 1 IACG Me>i r Z < 24" access riser(s)and accessible from surface?- - 0 ® 0 m. Alarm or Control Panel Installed? 0 ® 0 Control Panel equipped with Timer/ETM/Counter- - ❑ ® ❑ a- Pump installed in ❑ Bucket or ❑ On Block or (t Other 1-lo0 47 d d,CQ 1 CL 2 Pump Make/Model _ ❑ Floats or ❑ Transducer a Tank draw down .S�t- (1 `A� 1.r c(ap tiity gpm Squirt Height ft Pump on time Pump off time Daily flow set at i gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 31911-42-90013 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES Q NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES Ei 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 location.North arrow.reserve drainfield.existing and proposed buildings,local on of wells,waterlines. wells.observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. III 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 contain 8d on this form and attached Record rawing is accurate. form and attached Record Drawing is accurate. �� r--- S/,2s13 Sig re of lnstalle Date Printed Name of Signee Z0, ,cvi MASON COUNTY PUBLIC HEALTH m s 1 The undersigned approves this Installation Report and i 4 C DY WAIT 4' Record Drawing on behalf of Mason County Public ENS ESIGNER Health: u. E..;,,kLs 05no; —R_St,Th—tWY\QC1cVN . /2 '. Signature of Environ rental Health Specialist Date P (stam�, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 \ lr.--•--------.-w.. ® L------ --. • O ' A r 0 r' S'cc , , , fT i o li . \ T. •tt_y! k 1' 1 is‘`./ `J g ..., \t0i\:0 ,r S'�oR� 9 y�1,�1� j ".._ stoma i <rs4i - O ENSE: E WNTE LICENSED OESIGN6R �i -.err�L..•.hL1, di Mt V D TN, I MAY 2 5 2023 W• , 1 MASON COUNn APPROVE kiaR• ON�ENTALHEALIV �, OCT 122022 �`�R MASON COUNTY ENVIRONMENTAL HEALTH 1 RET i I , t — --' CO C O �I Q) cu A CO r u —` CP I ' N O O N O O O N Z Q C (D (D t !(p v r- 5• r- r- co CD 0 p ;U Q O = a o S • S — a, (0 R'(0 C0 '? o0 0 C0 a o 0 t CD 0- (D O N O N C n {c 'O G') O CD r O C = -121- vcr (D .i to �' A mu) C D r? O 7� k CD Lw ; low ca 0\ CI: cn m. WCD Printed Frpm Mason County DMS Pnritettfrom Mason Coiinl0.f ., �,u f r A . . . 0 • . -....‘....... -__ I 7 . I ; i r ---1 ' I ; i I 'k,\ 1 1 I ' 4'‘, t NI! I I i 1 C 4 i d . i ___-_-.. 1 -\.-. . Li•I N 1 1 1 a 's 1 e. I k. 111 I APPROVED 1 OCT 12 2022 MASON COUNTY ENVIRONMENTAL HEALTH it n Re , ? . RET rkN C;I:,....... 1 li. ... rs\ ii AO Ali:49-Ns4,,$111:7-ia% . ts .11 6474::,‘• :1.1 t APPROVED of,, .101 jr0 •:IreCI MAY 25 203 Ar# 5 " 18 (k).)•\ yitv il. E fla'ITE:1‘‘,..., LICE ED D SIGNER -I MASON COUNTY ENVIRONMENTAL "...I.,. liN..1,„,m 4,, / •# IXPIRES 05/10/ "6•••••‘it RET ..._....... .. . . I 11. .. 1 t.-• • 1 I j . I APPROVED OT 12 2022 MASON COUNT 'ENVIRONMENTAL HEALTH RET m 0 m 0 , BASAL WIDTH n 1:.„.....„,...i......• .7. . i 001 .. ' '.: :2 '....:'.::.. 7 :4- ci 00 N. m Ct D _ �!i' O o m .43 If (n 1 V AIIIIIII m% . ` cn v' J_ m h6. 2 n tf Do �c y \J. (-N, 0, APPROVED tom} - MAY 2 5 20;;�t . ar 4��' MASON COU TY Eh''R:' EN .'.3 HEAITis; 7 �� �A. S a '4, of Asy 9A i. b . 001 to AY E 4WAITE r�2i,e� ����N r LICENSED DESIGNER 4 (..., \ \\ `",►