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HomeMy WebLinkAboutSWG2023-00212 - SWG As-Built - 6/28/2023MIN Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2023-00212 Parcel# 31901-13-90220 Applicant Name Chris& Pamela Murphy Subdivision (Name/Div/Block/Lot) Applicant Address 128 SE Driftwood Ln City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address same Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s) Only • Drainfield Only % Repair ❑ Other System Type Gravity Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - - - -- ❑ . 0 Z >50 ft. from surface water? - -I� - ❑■ ❑ ❑ • Cleanout between building and tank? - - - - 4-L- -4-(� bl i ❑ ✓ Tank baffles present? - I t- �1 ❑■ ❑ a24" access risers over each compartment?- ,-JL _1- 3 2-82-- lyl ® 0 W Effluent filter installed?- • --- - 11 ® ❑ N Septic tank capacity(working) 1,200 By:- ufacturer Existin. D-box water level and speed levelers used? - - ❑ NIA 0: YES ❑ NO D�OJ Manifold/D-box accessible from surface?- - 0 UI 0 mZ Check valves installed? - - © ❑ ❑ CiQ 2 Transport Line Size 4 inch Schedule/Class 3034 ~ Bedrooms installed (check one) j 2 ❑ 3 ❑4 ❑ 5 ❑ 6 ['Commercial/Other >10 ft. from foundation?- re.f4 i►' - ❑ N/A ❑ YES ❑� NO CI >100 ft. from wells?- ❑ © 0 w >100 ft. from surface water? - - 0 0 0 L.T. >10 ft. from potable water lines?- - ❑ LU ❑ Z > 5 ft. from property lines and easements?- - ❑ ® 0 Q ce > 30 ft.from downgradient curtain/foundation drains?- - X ❑ ❑ Drainfield level and observation ports present - - ❑ UJ 0 0 Graveless chambers or 1.1Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ LU ❑ tank setbacks consistent with septic tank? ❑ N/A ❑ YES o • Pump tank c I (flood) gal Manufacturer Q 24" access riser(s) and a ible from surface? ❑ ❑ ❑ CL Alarm or Control Panel Installed? - - ❑ ❑ a E Control Panel equipped with Timer! ETM /Cou - - - - 0 0 0 D d Pump installed in 0 Bucket or ❑ ock or ❑ n'• Pump Make/Model 0 Flo or ❑ Transducer EL a Tank draw in/min Pump capacity gpm Squirt Height ft mp on time Pump off time Daily flow set at d .:xaea .21'2T8 Mason County OSS Installation Report pg. 2 Parcel# -5,AOI — I�j^9'022 ABANDONMENT RECORD - E5(YES El NO Were existing septic components abandoned as part of this project? If yes, please describe: 1 a• 1) • - of) ❑ YES El No Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING tank lomdon,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, 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 Recoro Drawings contain: Drainfieid&manifold orenta'�or.&layout.Septic/pump and related permits. wells,observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may create additionai delays in final installation approval 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 contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. �� `Z ' `- 0��tZ -23 Y Signature of Installer Date •4 OS.. ...Ak....:. f Printed Name of Signee MASON COUNTY PUBLIC HEALTH ii !Z;`/1 •`} The undersigned approves this Installation Report and -- PAULA:JOY JOHNSON � Record Drawing on behalf of Mason County Public .1:1C048r.116.d�S►G?JE'fz Health: EXP—jRri�/ 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 updateo arztnote I 5 a 'DY; -k-u.)oad 1-►� _--- Z—r Sq ' .o ` Ea.S — 2.,o cas, .L -_ \•15e'\' C\\% , 1 Mom' „a M 1 „,.,„.._ ., ______ otzSI- b4.9":„.,4_,,,,-4-. i w ti— - N TO 2 8 ? �jCa- v ,� o zs so �s r� so.' ASO u; 1+_ 47__v--c.ci 4 t9_01-1 G022o I Z.S 5_E D Y 1-c+ 40c/ bib `,n.e.1.-C h} L F 4 5i31. D ` x 3 D 1 FY- ,,-v-,a..,,. D. F. sect APPROVED o• .. JUN 28 2023 ;, •: 'it '..1-f MASON COUNTY ENVIRONMENTAL HEALTH., - nu.n JOY JOHNSON .;� Kev: LrC S '-Ns. RET OCleanou ` EXPIRES 1\/ 0 1,200 Gallon Septic Tank -� 2 2-Compartmencca t- d Effluent Filter OD_Box with speed-levelers and cover to surface n T CG me ar ;fCPair - k AA d d not ..e,+' I - ► -w c-1174.c tt3 -to