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HomeMy WebLinkAboutSWG2023-00117 - SWG As-Built - 7/6/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00117 Parcel # 32134-50-00029 Applicant Name Kirk& Patti Campbell Subdivision (Name/Div/Block/Lot) Applicant Address 211 E Evergreen Dr Rainbow Lake/Lot 29 City. State. Zip Shelton, WA 98584 Installer Name South Shore Construction Site Address Same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑Other System Type Sand-Lined Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A El YES ❑ NO >50 ft. from: ewater • >50 ft from ? - ��j� pi. ❑ ❑ Z �' --JJ ❑ ❑■ ❑ Cleanout between building and tank? - - ��fd-;�9 70z3 11 o Tank baffles present? - ❑ ❑■ ❑ P 24" access risers over each compartment By--j ❑ 4 ❑ a. W Effluent filter installed? N Hagerman Septic tank capacity (working) 1,250 gal Manufacturer 9 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ 4 u. mz Check valves installed? - O.* —C K - ❑ i ❑ a 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO a >100 ft. from wells?- - 0 ❑ ❑ W >100 ft. from surface water? - - ❑■ ❑ ❑ LT >10 ft. from potable water lines?- - ❑ El ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q ce > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑ o Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or ir Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES ❑ NO • Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator < 24" access riser(s) and accessible from surface?- - ❑ • ❑ ~ Alarm or Control Panel Installed? - - ❑ 0 El a 2 Control Panel equipped with Timer/ ETM/Counter- - El III CIm Cl- Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 38 gpm Squirt Height 5 ft Pump on time 2.3 Minutes Pump off time 6 Hours Daily flow set at 360 gpd Updated 812 1 120 1 8 1 4._ _ 0fl02ci Mason County OSS Installation Report pg. 2 Parcel# 3I—` ABANDONMENT RECORD Were existing septic components.abandoned as part of this project? IIII O YES ❑ NO If yes, Please describe: _ YES CI No Were all components pumped out and property abandoned per WAC246-272A-0300? RECORD DRAWING - 7ha is a permanent record and must by accurate and descriptive enough to re-locate In the need of maintenance activities and future development location it dwelt. . Sys coru�': or:mn�a matted anenaoon a layout,Septdpump tank iocation.Node arrow.reserve dramrreld.eking andproposedt uulicinon and related pem ats. wails,cpsensteon pops,clematis,and other maintenance access points. Incomplete Record Drawings may create additional delays In Record Drawing Attached CATION OF INSTALLATION -: x INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 wn shown here have been cleared/appson County Public Health and at any roved by bothers , here have been cleared/approved by both the designer and Mason County Public Health and meet all State Statemyseff and and Mason Countyon uty Public ubi Health and meet all and Mason County Codes. 1 further certify that all information contained on this I further certify that all information contained on this fo n atta ed R yawing is a rate. form and attached Record Drawing is accurate. 6=11-23 rr Signature of Installer Date O R.,: i �.407 WAar1 �� Printed Name of Signee ?a4 MASON COUNTY PUBLIC HEALTH `' # •. kb The undersigned approves this Installation Report and _��,+" s l 0 349 ;��) j' PAULA JOY JOHNtSCN ••. Record Drawing on behalf of Mason County Public g 4"•Ltti,Mti 1)cSi'01.4(" Health: ''' �cx(Pts lI5>'2- ` 6/1 7 6)23 G- 23- 7-3 Signature of Environ Health Spec►alist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upload 8212718 em-s ��rr �Ol 0 Audio-Visual Alarm G 1, 0 - `+� 0 to c3Cleanout A S I__3. tr 01200 Gallon Septic Tank }i env y�e'(`{E GAMP$ J.1y �' ent with 2-compartm 3�•t34'`J�'oa ZQ Effluent Filter �aiZC ►.� 4 1000 Gallon Pump Chamber � �k, 'EVeC2-agi ---� O 1 CI \I cave. coef A Taox er 0 , e- 4re tit` tit` APPROVED JUL 0 6 2023 MFN ill' ` MRONMENTAL HEALTH o B rif_ T (' — � way I ,f,a; , — 6 ��s . 1 �- r r r _ i • N f ( • g d df 1 S :, ; .r' I i oo , o kk‘r: V La I .A O 1 d -+-a n it may 1 01 bocIone, A ..i.* .. ,....,,,,, .40,7A. ,„ `-) 1 � Q.. PAULASJOY3JOHNSON.'5"� g irO.M.StbresiaN a` c- z8-Z -S