Loading...
HomeMy WebLinkAboutSWG2023-00173 - SWG As-Built - 6/28/2023 "` Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00173 Parcel # 32127-50-00120 Applicant Name Keith Fuller Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 714 LAKE LIMERICK 1 LOT: 120 City, State. Zip Shelton, WA 98584 Installer Name Mikkelsen Septic, LLC Site Address 561 E Aycliffe Dr, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ® Repair ❑ Other System Type Shallow Pressure Pretreatment Type i >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? El ❑ ❑ • >50 ft. from surface water? - r'- - 0 CI Q Cleanout between building and tank? - ❑ 0 ❑ F- _ ❑/ ❑ U Tank baffles present? - d --24" access risers over each compartment?- By �_.T- -- ❑ 0 ❑ W Effluent filter installed?- r - ❑ 0 ❑ cn Infiltrator Septic tank capacity (working) 1,060 gal Manufacturer CI D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO J 0O Manifold/D-box accessible from surface?- - El0 mZ Check valves installed? - - ❑ 4 ❑ aa 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 El 3 ❑4 ❑ 5 ❑6 ❑Commercial!Other >10 ft. from foundation?- - ❑ N/A [4 YES ❑ NO CI >100 ft. from wells?- - 0 ❑ ❑ W >100 ft from surface water? - - ❑� El❑ u. >10 ft. from potable water lines?- - El 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ cc > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑ CI Drainfield level and observation ports present - - El [4 ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Z < 24" access riser(s) and accessible from surface? El a El I— a. Alarm or Control Panel Installed? - - El II ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 n n- Pump installed in 0 Bucket or ❑ On Block or ❑ Other 2 Pump Make/Model Liberty 280 0 Floats or ❑ Transducer D. a Tank draw down 1.5 in/min Pump capacity 38 gpm Squirt Height 5 ft Pump on time 1.5 Minute Pump off time 6 hours Daily flow set at 240 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcels �2.1 Z--1" ���baiZO ABANDONMENT RECORD - YES 0 NO Were existing septic components abandoned as part of this project? Q 1 D. . 0.100,nct cl . Old -tat.l'l Y-42 vaw v ed' NO If yes, please describe: YES Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record This is a Pe approval existing,and and wells, waterlines, elated permits. Drawings contain: Dra�nfeld&mandold orienation&layout,Septic/Pump 4� Itank mete Record Drawings may create additional delays in proposeda installation Goa of wells waterlines, wells,observation ports,cleanouts,and other maintenance access points. n. Record Drawing Attached i?A' CERTIFICATION OF INSTALLATION INSTALLER DESIGNER] ENGINEER /certify that 1 installed the system in accordance with 1 certify that the system has been installed in accor- 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 MasonMaasn Countyouty Public ub i Health and meet all and Mason County Codes. Is further certi that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. and attached Record Drawing is accurate. k '-74/..//r/a i/1, 051231Z3 IN ure of In eller Date may;. •�\1 i e ) Son tc �� .,, �� � Printed Name o Signee `.".17. y J, '.V:. MASON COUNTY PUBLIC HEALTH . ... +!. 511i0349 f The undersigned approves this Installation Report andu�a norJOHNSON 'Record Drawing on behalf of Mason County Public ,iG�`SVSs ��SIGyN�f'_� EXPIRE.,6V/ 6-/ cL Health: '�T (Of) c (*Z9 t2 3 (0 -$ -2-- Signature of Environ ental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 81212018 p 1 0 ,G • 0 t0 Pici-L 3221-50-001)..0 3°/C -ts' 501 E ._ _I��E pR. S Lo PE , 4tc' NI.0 V (Mt • it ..\/)% �.✓ i��" 51-0i3t9 . tit i'. PAULA JOY JOHNSON .y 1(� e R .. ••L WSJ UE fair.0`SS:,• 2a --`©usE . -4'. 1\ 0oP014.-7- 6 - -Z 3 0 O O d APPROVED C3) �' x45' PM�2�) E JUN 28 2023 Dv_pcINEc-, `C•? NCi� MASON COUNTY ENVIRONMENTAL HEAL H ' t�' G �� RFT j2t.S E9-v P\s60\1 , i i xv: i0 Audio-Visual Alarm ct. c3 Cleanout O3 1.000 Gallon Septic Tank 2-Compartment with t Effluent Filter 3 t\- \ 0 1000 Gallon Pump Chamber \)) \ O Valve Control Box mil_ �01 _ i\.jo.-Lr r� ��