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HomeMy WebLinkAboutSWG2023-00165 - SWG As-Built - 6/22/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-0165 Parcel # 42024-13-00320 Applicant Name Javier& Jessica Moreno Subdivision (Name/Div/Block/Lot) Applicant Address 2138 W Railroad Ave City. State, Zip Shelton, WA 98584 Installer Name Workman Contracting LLC. Site Address Same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST il Full System Installation ❑ Tank(s)Only ❑ Drainfield Only • Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - ❑ N/A • YES ❑ NO >50 ft. from wells? ❑ El ❑ z >50 ft. from surface water? - - - ❑ El ❑ 1-- Cleanout between building and tank? - - ❑ ElEl o Tank baffles present? . - ❑ • ❑ n~. 24" access risers over each compartment?- El 00 W Effluent filter installed?- -- - - - ❑ El ❑ co Septic tank capacity (working) 1,050 gal Manufacturer Sound Placement 9 D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ El ❑ co, 2 Check valves installed? ❑ 0 ❑ ❑a Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Q YES ❑ NO >100 ft. from wells?- - - - - -- - - - ❑ 00 w >100 ft. from surface water? - - ❑ ❑■ ❑ LL >10 ft. from potable water lines?- ❑ ❑■ ❑ z 5 ft. from property lines and easements?- •- - ❑ © ❑ Q u > 30 ft. from downgradient curtain/foundation drains? 1 ❑ LI • Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Y Pump tank capacity (flood) 1,250 gal Manufacturer Sound Placement < 24" access riser(s) and accessible from surface",- - ❑ [] ❑ ~ ❑ 1 Ela Alarm or Control Panel Installed? E Control Panel equipped with Timer/ETM/Counter- - ❑ ® ❑ 0 °- Pump installed in ❑ Bucket or U] On Block or ❑ Other d• Pump Make/Model Liberty 280 Q Floats or ❑ Transducer eL a Tank draw down 1.9 in/min Pump capacity 40 gpm Squirt Height 6 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 240 gpd Uptlaattl 9721/20I8 I ' ort pg. 2 Parcel# Z° Z`k- ( - O D 3Zo Mason County OSS Installation ReApBANDONMENT RECORD ® YES El NO Were existing septic components abandoned as part of this project? ��� If yes• please describe: "' \NN� El YES I:: No Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING cord This Isin s permanent record a must rie accurate yu escriptive enough to Septi'P mp ar.K location.,North arrow.-locate in eese a dra need of minrield,existing and proposed intenance activities and tuture development euildings.location of wells,1cal wateliines, Drawings s ervatcorain: Grainfield 8 manifoldd oher main 8 layout. P in final installation approval and related permits. wells.observaCon ports,Geanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays S—Q34 4-Ck--Q -. II Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER /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 andnd Mason aso County ty y Public Health and meet all and Mason County Codes. des 1 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. ,-_. `t (0-(3-Z\lvt,'/Ki kA.1.0------- , S gnature of Installer Date ,)C.\.WC.k 12_ W 04-1tc—N•ikv\ •.-._Att Printed Name of Signee , ►01 A`�).. vii y • �. MASON COUNTY PUBLIC HEALTH C. i .. r The undersigned approves this Installation Report and s,o',<a ' � ''"�' PAULA JOY JOHNSJN •. Record Drawing on behalf of Mason County Public �' �,LA J JO iNSON ; f Health: EX � fl.57 11. �� ct.rn 6 (ZZ/2 (0-Z2.Z 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 up°arec am,2o18