HomeMy WebLinkAboutSWG2022-00537 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 C15:-, MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00537 Parcel # 22019-33-03020
Applicant Name Michael Rule Subdivision (Name/Div/Block/Lot)
Applicant Address 441 E Wildflower Lane
City, State, Zip Shelton,WA 98584 Installer Name Active Underground LLC
Site Address Same as Above Designer Name Jim Henry
4 INSTALLATION CHECKLIST
U Full System Installation ❑Tank(s) Only ❑ Drainfield Only El Repair ❑Other
4
System Type Pressure w/Attenuation Zone Pretreatment Type
>5 ft. from foundation? - - ❑ N/A Q YES ❑ NO
4 >50 ft. from wells? - //� - ❑ NI
Z >50 ft. from surface water? - - u3 -- - ❑ ❑
• Cleanout between building and tank? - - - ��, ' `� � ❑ ❑ ❑
�l
U Tank baffles present? - & Q� - - - ❑ ❑■ ❑
a24" access risers over each compartme ?.= 23 4 - ❑ ■❑ ❑
(W Effluent filter installed?- - - ❑ 0 ❑
Septic tank capacity (working) 1500 gal urer SPS
--.._1D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO
XO Manifold/D-box accessible from surface?- - ❑ ® ❑
cc Check valves installed? - - ❑ El ❑
6Q
2 Transport Line Size 2 Schedule/Class 40
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- ❑ N/A 0 YES ❑ NO
C1 >100 ft. from wells? - - ❑ 0 ❑
W >100 ft. from surface water? - - ❑ 0 ❑
it >10 ft. from potable water lines?- - ❑ 0 ❑
Z
K > 5 ft. from property lines and easements?- - CI 0 CI
> 30 ft. from downgradient curtain/foundation drains? - ❑ ■❑ ❑
o
Drainfield level and observation ports present - - ❑ 0 ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - El N/A 0 YES ❑ NO
• Pump tank capacity (flood) 1275 gal Manufacturer SPS
Z
Q 24" access riser(s)and accessible from surface?- - ❑ 0 ❑
~a Alarm or Control Panel Installed? - - ❑ II CI
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ ® ❑
m
a Pump installed in ❑ Bucket or ❑ On Block or ® Other Pump Silo w/Intake 18" Off Floor
d• Pump Make/Model Liberty 280 0 Floats or ❑ Transducer
EL
Tank draw down 1.5 in/min Pump capacity 34 gpm Squirt Height 42" ft
Pump on time 2 Min. Pump off time 6 Hour Daily flow set at 272 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 22019-33-03020
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ 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,Septicipump tank location,North arrow,reserve drainfield,existing and proposed buildings,location 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.
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JUN 0 9 2023 tiLr
MASON COUNTY ENVIRONMENTAL HEALTH ❑ Record Drawing Attached
REV
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 t II inform pn contained on this /further certify that all information contained on this
form an e o cawing is accurate. form and attached Record Drawing is accurate.
�� 06/01/2023 14,Apr ,
ignature of Installer Date /s. , �, .
"I.
James Medcalf I Ao.pts •I
'' )
Printed Name of Signee 11 .
MASON COUNTY PUBLIC HEALTH .• -• r-
The undersigned approves this Installation Report and .
Record Drawing on behalf of Mason County Public r .f"•.�'-"1-NEP
�M v►�.-' �w�AMA\ V.
Health: , , uZ;
k_,N2Aftve LIM (0 (q I 3
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 Updated 8r21/2018